Breast Implant Options for Reconstruction After Mastectomy

Saline, silicone, and investigational types can be considered

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Breast reconstruction after mastectomy includes several options, and implants are a common choice.

The U.S. Food and Drug Administration (FDA) has approved saline, silicone, and highly cohesive silicone gel ("gummy bear") breast implants for this use. While these implants have similarities, it’s important to understand the differences to decide which is right for you.

This article reviews common features of each type of implant, including size, shape, and texture, as well as possible risks or complications. 

Breast implant placement
 Verywell / Emily Roberts

Common Features

Breast implants are silicone sacs that are filled with either sterile salt water (saline) or silicone gel. They are surgically placed under or over the 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 do so.

A flap technique uses a woman's own donor material (fat, tissue, skin) from other areas of the body for reconstruction. Examples include the TRAM, DIEP, and latissimus dorsi. Some women opt for a combination of both a flap and implants (hybrid reconstruction). 

How Long Implants Last

No breast implant is guaranteed to last a lifetime, The typical lifespan of breast implants ranges from 10-20 years. There is also the possibility of rupture. 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.

All reconstruction surgeries involve similar risks, regardless of implant type.

These include:

  • Problems with wound healing
  • Scar tissue
  • Numbness
  • Pain
  • Infection
  • Adverse reaction to anesthesia

Modern anesthesia is considered very safe, and extreme reactions are rare.

These reactions may include:

  • Temporary confusion
  • Heart attack
  • Pneumonia
  • Stroke

These risks are more common with lengthy surgeries or with severe underlying health problems. Your anesthesiologist can address your questions and concerns about the risks.

Different Shapes and Sizes

Breast implants, like natural breasts, have 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 your desired figure. Most plastic surgeons can show you "before and after" photos of people who have had implant reconstruction so you will know what to expect.

Breast implants are available in both saline and silicone. All implants have a silicone outer shell. Saline or silicone implants differ based on the fluid inside the shell.

Types of Breast Implants
Consideration   Saline   Silicone Gummy Bear
Natural Appearance Least More Most
Natural Feel Least More Most
Expense Least More Most
Risks Least Most Moderate
Rupture Detection Visually Evident May be evident or silent; requires routine MRI Not visually evident; requires routine MRI
Rupture Correction Easiest Harder Harder
Other Considerations     Larger scar

Saline Implants

Saline implants have a sterile inner fluid made of salt and water. It is similar to the fluid in your body. They may come pre-filled or your surgeon may fill them with saline after placing them in your body.

Size

Your plastic surgeon will consider multiple factors to try to achieve your desired outcome including:

  • Diameter (width): Your surgeon will measure your chest cavity to help determine whether you need a narrow, medium, or wide implant.
  • Projection (silhouette): Implants come in low, medium, or high profiles, and this affects how much the implant projects forward.
  • Volume: The volume is the amount of fluid needed in each implant to help achieve your desired result. You may hear this referred to as milliliters or cc (cubic centiliters). 

Some saline implants have a valve that your surgeon can access with a small needle to adjust size without further surgery.

Shape (Contour)

Saline implants have a symmetrical, round shape, giving the breast a fuller, lifted look. When a saline implant moves or shifts, the implant will still keep its shape.

If the shell breaks, the implant will deflate, losing its shape. 

Texture

Saline implants can have either a textured or smooth silicone outer shell. Many women note that they don’t feel as natural as silicone and that they can have a rippling appearance when they move.

Textured implants are generally not used today due to the link with breast implant-associated anaplastic large cell lymphoma.

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 is most commonly used, and it has a valve that allows more saline to be added after surgery.
  • A pre-filled single sac containing saline: This kind of implant cannot be expanded after 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.

Silicone Implants

Silicone implants have a silicone gel-based inner fluid. Traditional silicone implants have the risk of an unnoticeable leak that would allow the silicone to seep into the body.

Silicone implants are considered safer because the shell is thicker and the gel is more sticky or cohesive.

Size

Silicone implant sizing is determined based on diameter, projection, and volume.


Silicone implants have a fixed volume, while saline can be under or overfilled.

Shape (Contour)

Traditional silicone implants are typically round-shaped, making the top portion of the breast appear fuller. If leaks, it does not collapse and maintains its shape.

Texture

Silicone comes in either a textured or smooth silicone outer shell. Many women have noted that silicone implants are softer than saline, which helps them to feel and look like more natural breast tissue. 

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: These implants have one inner sac pre-filled with silicone and one outer sac that is filled with saline during surgery. These can't be expanded after surgery.
  • A two-layered sac with a valve: These implants have one inner sac pre-filled with silicone and one outer sac that is filled with saline during surgery. They can be expanded after surgery by adding more saline through a valve.

Silicone implants may move and feel more like your natural breasts. They pose a risk because your body doesn't naturally contain silicone.

Cohesive “Gummy Bear” Gel Silicone Implants

A gummy bear implant is a newer type that contains a highly cohesive silicone gel that's less likely to get wrinkled and dimple. In fact, it will even retain its shape if the outer silicone shell is broken.

Size

Sizing is determined based on diameter, projection, and volume. 

Shape (Contour)

Highly cohesive silicone implants come in round and teardrop-shaped. The teardrop shape has more roundness or fullness at the bottom. They are also sometimes referred to as anatomic or shaped implants.

Texture

Gummy bear implants have a firmer, stickier, more gel-like consistency than traditional silicone.

They come in a textured or smooth outer shell. The textured outer shell helps them stay in place, which is especially helpful for the teardrop shape. If the teardrop-shaped implant rotates, it can cause an unnatural appearance, and your surgeon may need to perform another surgery to correct the rotation.

Gummy bear implants are less likely to rupture or leak than older implant types, and capsular contracture is less common. These implants may require a larger incision than what is needed for saline or standard silicone implants.

Volume With Breast Augmentation vs Reconstruction

Implant volume varies. Breast size and shape is dependent on breast augmentation implants, remaining breast tissue, and hybrid-flap reconstruction tissue.

For women who have a mastectomy without adding their donor flap tissue, the implant creates the majority of the volume. For example, adding 500 cubic centiliters to existing breast tissue yields a different result than a 500 cubic centiliter implant for someone who has no breast tissue. 

Expanders

Expanders are temporary implants used to prepare for some types of breast reconstruction. The surgeon uses them as a placeholder to create a pocket in the breast where the permanent implants will stay. 

The healthcare team periodically accesses the valve in the expander with a small needle to add saline. This may require multiple office visits, with the goal of making enough room to exchange the expanders for permanent implants.

Risks

The most common risks with breast implants are capsular contracture, implant removal, or the need for a reoperation. Other risks include rupture, wrinkling, asymmetry, scarring, pain, and infection.

Capsular Contracture

Scar tissue can form around the implant, creating a capsule. Typically the scar tissue is not noticeable, and it helps to keep the implant in place.

Capsular contracture is the most common complication with implants. It occurs when the capsule hardens and squeezes the implant. Severe contracture may require implant removal because it can change the appearance of the breast and it can be painful.

Silicone implants pose a higher risk for capsular contracture than saline implants.

Rupture and Deflation

When saline implants rupture, they deflate and lose their shape.

Traditional silicone gel can cause a silent, slow leak, detectable only with magnetic resonance imaging (MRI). The silicone that leaks from the implant can cause swelling, irritation, pain, change in breast appearance, hardening, and lumps. Screening is recommended three years after surgery and every two years after that.

While gummy bear implants would not leak with a tear, an MRI can detect ruptures in the outer shell.

Infection

There is a slight risk of infection with all breast implants. Surgical centers and hospitals take precautions to reduce this risk by checking blood and urine for infection before surgery, giving antibiotics, and using sterile procedures.

Good handwashing and wound care also help with preventing an infection. Breast implant infections typically occur a few days after surgery, but are possible at any time.

Breast Implant Illness

Some women report a set of systemic symptoms following silicone leaks or ruptures, such as:

  • Fatigue
  • Memory loss
  • Cognitive difficulties ("brain fog")
  • Joint pain

Some research has suggested that silicone implants are not linked to connective tissue disease, breast cancer, or reproductive problems.

According to the U.S. Food and Drug Administration (FDA), medical science hasn't determined whether these symptoms, often referred to as "breast implant illness," are due to silicone in the body, but studies are ongoing.

Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL)

Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL), cancer that affects the immune system, is a very rare risk. When it occurs after breast implants, it is usually in the scar tissue or fluid around the implant. However, in some cases, it spreads through the body.

It is typically treated by removing the implant and scar tissue, but some people need treatment with radiation and chemotherapy. According to the FDA, textured breast implants carry a higher risk of BIA-ALCL than smooth-textured ones.

Summary

There are three main types of breast implants: saline, silicone, and highly cohesive silicone gel (“gummy bear). Each has unique features. Many women feel that silicone implants look and feel the most natural. However, some women prefer the round fullness that saline implants offer.

The most common risks include capsular contracture, rupture, deflation, and reoperation. More rare complications include infection, breast implant illness, and (BIA-ALCL).

A Word From Verywell

If you don't need to have radiation or chemotherapy after your mastectomy, you may be able to get implants right away. If you need one or both of these treatments, your surgeon will put in a temporary implant called a tissue expander.

An expander stretches the skin and muscle to make room for a permanent implant, which may go in a couple of months later. Sometimes expanders are needed even without chemotherapy or radiation. Speak to your surgeon about your options so you will feel confident about whatever decision you make.

Frequently Asked Questions

  • What is the best implant after mastectomy?

    The type of implant that is best after a mastectomy depends on multiple factors. These include the type of reconstruction, surgical techniques, and personal preference. Some women feel that silicone feels and looks the most natural, while some women prefer the fullness of saline implants.

  • How long do breast implants last?

    The typical lifespan of breast implants ranges from 10-20 years. 

  • Does insurance cover breast implants after mastectomy?

    The Women’s Health and Cancer Rights Act (WHCRA) is a law that was put into place in 1998. It requires most insurance companies to cover reconstructive surgery, including implants, after a mastectomy. However, there could be religious organizations or some government plans that are exempt from this law. Some insurance plans will require a second opinion before moving forward.

  • Does insurance cover implant replacement after mastectomy?

    The Women’s Health and Cancer Rights Act of 1998 (WHCRA) law requires health insurance to pay for breast implant removal after a mastectomy if the surgeon states that it is medically necessary. It’s always best to check with your insurance company. They may have a different definition of what defines the medical necessity for removal or replacement.

Originally written by
Pam Stephan
Pam Stephan is a breast cancer survivor.
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