Breast Implants Options for Reconstruction After Mastectomy

Saline, silicone, and investigational types can be considered

If you plan to have a mastectomy and pursue reconstruction using breast implants as opposed to tissue flap surgery (TRAM, DIEP, latissimus dorsi), you'll have three main options to choose from. The U.S. Food and Drug Administration (FDA) has approved, saline, silicone, and highly cohesive silicone gel ("gummy bear") breast implants for this use, and while these implants have similarities, you'll need to weigh the differences to decide which is right for you.

Common Features

Breast implants are silicone sacs that are filled with either sterile salt water (saline) or silicone gel. They 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 (and your desired look) if both breasts have been removed.

Some implants have a smooth silicone shell while others have a textured shell. Smooth-shelled implants may rotate over time, while textured shells are less likely to.

No breast implant is guaranteed to last a lifetime. When an implant leaks, shifts, or doesn't look right, you will have to have it surgically replaced or removed.

After getting implants, you won't have the same sensation as you did in your natural breasts, and your breasts will probably move differently.

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.

If you don't need to have radiation or chemotherapy after your mastectomy, you can get implants right away. However, if you do need one or both of these treatments, the doctor will put in a temporary implant called an expander. An expander stretches the skin and muscle to make room for a permanent implant, which may go in a couple of months later.

Saline Implants

The three kinds of saline breast implants are:

  • A single sac that's filled with a pre-determined amount of saline during surgery. This kind of implant cannot be expanded after the surgery.
  • A pre-filled single sac containing saline. Likewise, 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 after surgery.

Risks of saline breast implants include:

  • 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 Implants

The three kinds of silicone breast implants are:

  • A pre-filled single sac containing silicone. This is not expandable after surgery.
  • A two-layered sac (one inner sac pre-filled 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 pre-filled 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 include:

  • Rupture with a 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


Gummy Bear Implants

The newest type of implant is often referred to as a gummy bear implant. It contains a highly cohesive silicone gel that's less likely to get wrinkled and to dimple. In fact, they'll even retain their shape if the outer silicone shell is broken.

All gummy bear implants are teardrop-shaped. If you want large implants without the unnaturally round look some implants give the upper breast, this may be the right type of implant for you.

Also, gummy bear implants are less likely to rupture or leak than older implant types, and capsular contracture is less common. However, the surgeon may need to make a larger incision compared to saline or standard silicone implants.

Risks of gummy bear implants include:

  • Leaks that, while less common, are harder to detect; this requires periodic MRIs to check their integrity
  • An odd appearance if they do rotate, due to their shape

A Word From Verywell

Modern breast implants are considered very safe. Your doctor(s) can help you consider the many features of implants and find the right mix of features for making your breasts look the way you want them to.

Was this page helpful?

Article Sources