Breast Reconstruction: If You Choose Implants

If you decide to follow your breast cancer surgery with reconstruction involving implants (and if the procedure is appropriate for you), you may be able to wake up with them already in place. If the skin on your chest wall is too tight, however, your surgeon will insert a balloon-like tissue expander to stretch it to gradually accommodate an implant. You'll go in regularly for a few months, typically once a week for six to eight weeks, for injections of a saline solution into the "balloon" to prepare it for the switch-out operation when an implant is placed there.

"It's a less invasive surgery [than autologous reconstruction], and it can be used by almost any patient," says R. Bruce Shack, MD, professor and chairman of the department of plastic surgery at Vanderbilt University Medical Center in Nashville.

Expect some discomfort—and more surgery
You won't be surprised to hear that the saline injections can be uncomfortable. "It will be tight, but most women are doing pretty much normal things [between appointments]. It's unusual that a woman would have a lot of pain," Dr. Shack says.

Also keep in mind that most implants will need to be replaced at some point, whether due to a complication such as scarring, which can cause hardening (called capsular contracture), or just because the implants have been in for a while and don't last forever.

Patients who have had or will still need radiation therapy are not good candidates for reconstruction with implants because radiation increases the risk of capsular contracture.

But your implant won't hamper future screenings
There is a bright spot, though: It's very unlikely that an implant in your reconstructed breast will interfere with diagnosing a recurrence of cancer in that breast, should it happen. "Most surgeons and oncologists don't do mammograms of a reconstructed breast because there's no breast tissue left," Dr. Shack explains. "The implants are right against the chest wall and any recurrence is likely to be on the skin, so it's difficult for an implant to mask a recurrence."