Saline & Silicone Implants for Mastectomy Reconstruction

Plastic Surgery Patient Examines Breast Implant
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What are the differences in the types of breast implants available for mastectomy reconstruction following breast cancer?  Should you choose saline or silicone, and what is the difference?

Breast Implants After Mastectomy

If you chose to have a mastectomy and implant reconstruction after your breast cancer diagnosis instead of tissue flap surgery (TRAM, DIEP, latissimus dorsi) you will need to know what kinds of implants are available.

The FDA has approved two kinds of implants for reconstruction. Some implants are not yet FDA-approved and are considered investigational devices. In the U.S., a patient must enroll in a clinical study in order to receive an investigational breast implant.

What Is a Breast Implant?

Breast implants are silicone sacs that are filled with salt water or silicone gel. These are surgically placed between layers of muscle to create a reconstructed breast mound. Implants are sized to match your remaining breast or to create symmetry if both breasts have been removed. Breast implants may also be used for breast augmentation procedures.

Common Features of Breast Implants

Breast implants are not usually permanent – they won't always last a lifetime. When an implant leaks, shifts position, or doesn't look right, you will have to have it surgically replaced or removed. Both saline and silicone breast implants are available in a smooth or textured silicone outer shell.

Breast implants won't result in the same sensations as your own breast did, and won't usually move (sway) as did your real breasts.

Saline (Sterile Salt Water) Implants

There are 3 kinds of saline breast implants:

  • A single sac that is filled with a predetermined amount of saline during surgery. This kind of implant cannot be expanded after the surgery.
  • A single sac that is filled with saline during surgery. This kind of implant has a valve that allows more saline to be added, for expansion after surgery.
  • A prefilled single sac containing saline. This kind of implant cannot be expanded after the surgery.

Risks of saline breast implants:

  • Rupture and leaking, through which the breast implant will deflate.
  • Hardening of the area around the implant (capsular contracture).
  • Need for removal or replacement requiring additional surgery.

Silicone (Silicone Gel Filled) Implants

There are 3 kinds of silicone breast implants:

  • A prefilled single sac containing silicone which is not expandable after surgery.
  • A two-layered sac - one inner sac prefilled with silicone, and one outer sac that is filled with saline during surgery. These are also unable to be expanded after surgery.
  • A two-layered sac - one inner sac prefilled with silicone, and one outer sac that is filled with saline during surgery. These can be expanded after surgery, by adding more saline through a valve.

    Risks of silicone breast implants:

    • Rupture with leak which allows the silicone gel to spread outside the shell.
    • Silent rupture, or slow leak, detectable only with MRI.
    • Need for removal or replacement requiring additional surgery.

    Investigational Breast Implants

    The FDA is still studying a new type of silicone gel implant, called a "gummy bear" implant. This type of breast implant has a silicone shell just like the presently used saline and silicone models, but the filler is a silicone gel that is more cohesive and less apt to wrinkle and dimple than the approved silicone gel currently being used. These have been approved in Europe, but may not be widely available in the United States for some time.

    Different Shapes and Sizes

    Breast implants, like natural breasts, come in different shapes and sizes. Some implants are round, and some are tear-drop shaped. Implants also come in a variety of profiles, or cup sizes. Your plastic surgeon can help you decide which size, type and style of breast implant will work best for your breast reconstruction and for your desired figure. Most plastic surgeons can show you "before and after" photos of patients who have had implant reconstruction, so you will know what to expect.

    Sources:

    American Society of Plastic Surgeons. Types of Breast Implants. Accessed 01/20/16. http://www.plasticsurgery.org/cosmetic-procedures/breast-augmentation.html?sub=Types+of+breast+implants

    U.S. Food and Drug Administration. Breast Implants. 09/17/13. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/default.htm

    U.S. Library of Medicine. MedlinePlus. Breast reconstruction – implants. Updated 03/13/15. https://www.nlm.nih.gov/medlineplus/ency/article/007403.htm

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