Breast Implant Options: What to Know

Drawbacks of saline breast implants

Saline implants may not look as smooth or feel as soft as silicone. Because they're filled with fluid, you might notice some rippling in the breast. And if the implant ruptures, your breast will gradually flatten out and get smaller. Removing the old implant and replacing it with a new one requires a minor procedure.

Benefits of silicone gel breast implants

Silicone gel has a thicker texture, which makes these implants look and feel more like natural breasts. They're soft enough to move when you touch them, but still firm enough to hold their shape. Silicone gives the breasts a smoother look that's less likely to ripple than saline implants.

Drawbacks of silicone gel breast implants

Between 9% and 24% of silicone implants rupture. When ruptures happen, they're hard to detect. Doctors call them "silent ruptures" because you usually can't see or feel the silicone leaking. 

Silicone that leaks out can irritate tissues around the breast and cause scar tissue to form. The scar tissue could cause problems in your breast, including:

• Lumps
• Pain
• Swelling
• Changes in the size or shape
• Hardened scar tissue, called capsular contracture
• Loss of feeling in the breast

Deciding on Breast Cancer Implants

You'll meet with a plastic surgeon before lumpectomy or mastectomy to discuss your reconstruction options. You may want to talk to a couple of surgeons to find one with the experience and technique you prefer. 

It's important to feel comfortable with your surgeon. The doctor should listen to your concerns, answer your questions, and respect your choices. They should also work closely with your breast surgeon to plan your treatment. 

Ask your plastic surgeon to talk you through the pros and cons of breast implants before making your decision. Also ask to see before-and-after photos of other patients who've had the type of implant you want.

Go into the procedure with realistic expectations. Implants should give your breasts more symmetry, but they won't exactly match the look and feel of your original breasts. As you get older or you gain or lose weight, your breast implants won't droop or grow bigger/smaller like real ones would. You may need another surgery to adjust their size or shape.

What to Expect During Breast Cancer Implant Surgery

Breast reconstruction surgery can be done at the same time as mastectomy (immediate reconstruction) or at a later date (delayed reconstruction). Even with immediate reconstruction you'll need at least two surgeries. Breast implant placement is a two-step process.

Step 1: Breast tissue expansion

In the same surgery as mastectomy or later, the surgeon will place a tissue expander in front of or behind your chest muscle. The expander looks like a deflated balloon. 

You'll visit the doctor's office every week or two to get injections of saline into the balloon through a port in your skin. The saline will slowly stretch your skin to the breast size you want. This process can take a few months. You may feel some pressure or discomfort as your skin stretches. Some doctors use carbon dioxide instead of saline to stretch the skin. Carbon dioxide may be less uncomfortable than saline.

Step 2: Implant placement

The next step is to remove the tissue expander and replace it with the saline or silicone implant. You may need to wait to have the implant placed until you finish chemotherapy or other treatments. Some surgeons attach surgical mesh to the chest muscle to form a pocket that holds the implant in place. The mesh gives the implant a more natural shape.

You may decide to have your plastic surgeon also reconstruct the nipple and areola – the dark circle around the nipple. Some people get a tattoo to recreate the look of a nipple. But you'll have to wait at least four months after implant placement to give your breasts time to heal and settle into their final position.

Direct-to-implant reconstruction

A small number of women can have the implant placed in the same procedure as mastectomy. After the surgeon removes the breast tissue, the plastic surgeon places the implant without using a tissue expander. Direct-to-implant reconstruction works best if you are young, have small breasts, and are healthy overall.

How Long Do Breast Implants Last?

Breast implants aren't designed to last forever. You can expect to keep your implants for 10 to 20 years. The better you care for your implants, the longer they'll last.

Eventually you'll need to have them removed or replaced because:

• The implant ruptures and leaks silicone or saline.
• You develop scar tissue around the implant.
• You notice wrinkles or ripples on the skin of your breast.
• The implant moves out of position.
• You change your mind and no longer want implants.

You can decide to remove the implants and go flat, or get an implant replacement. Your plastic surgeon may also remove scar tissue and do a breast lift during the replacement procedure.

Takeaways

Surgery is often part of the treatment for early-stage breast cancer. Breast reconstruction with breast implants can help restore the size and shape of your breasts after a lumpectomy or mastectomy. You can choose from saline or silicone implants. Each type has its own benefits and risks. Talk to your plastic surgeon about these breast implant options so you can make the best choice for you.