About breast implant surgery

If you choose breast reconstruction, one option is to have an implant reconstruction. Breast implant surgery can be done in 2 main ways.

• 1-stage procedure (also called 'immediate' or 'direct to implant'): the surgeon inserts an implant during the mastectomy surgery
• 2-stage procedure: you have a tissue expander inserted. This is changed to a permanent implant in a later surgery.

We explain the difference and show how the procedures look.

One-stage procedure

This is a single procedure. During mastectomy surgery, the surgeon removes the breast tissue but keeps the skin. They then insert the breast implant under the skin, either:

• behind the pectoral muscle of the chest wall (‘subpectoral implant’)
• in front of the pectoral muscle of the chest wall (‘prepectoral implant’).

It is becoming more common to put the implant in front of the chest muscle. This is because:

• the implant is less likely to move during exercise ('animation')
• you do not lose any strength in your chest muscle.

However, the implant is closer to the skin, so it may be more visible during some movements. You may require some fat grafting (fat injection) later to cover the implant.

Mesh and dermal sling to hold the implant in place

Sometimes the surgeon uses a mesh to help hold the implant in place. This mesh can be:

• synthetic mesh
• biological mesh called an acellular dermal matrix (ADM).

If you have larger breasts, your surgeon may be able to create a ‘dermal sling’. This uses tissue from the lower part of your breast to support the implant. It may make your breast smaller, and you may need surgery to the other breast to make your breasts the same size ('symmetry surgery').

Two-stage procedure

First, during the mastectomy surgery, the surgeon inserts a temporary implant called a tissue expander. Usually, this is placed under the chest muscle.

The second surgery happens about 3 months later, once you recover from the breast surgery and finish other treatments such as chemotherapy and radiotherapy. The surgeon removes the tissue expander and inserts a permanent breast implant.

The second operation is easier and is typically a day procedure or needs 1 night in hospital. The surgeon usually cuts in the same place as the first surgery, to reduce scarring.

About tissue expanders

A tissue expander is like an empty breast implant. Gradually, it is filled with saline (salt water) or air. This stretches the skin and muscle and makes enough space for a permanent implant.

This is a simple procedure that is done in the surgeon’s consulting rooms. Your first appointment will be about 2 weeks after surgery, when the wound from your mastectomy has healed.

To prepare for the tissue expander, you'll have a 'port' placed just under your skin during your mastectomy. Small amounts of saline or air are injected through the port into the expander to inflate it.

You may need several appointments over 3 to 6 months. The tissue expander can stay in place for up to 3 years.

Some people find the expander can be uncomfortable at times.

When a two-stage reconstruction may be recommended

Your surgeon may recommend this approach if you:

• do not have enough skin available for an immediate implant.
• may be at high risk of surgical complications, because of other existing health issues.
• need radiotherapy after a mastectomy. Radiotherapy can sometimes make an implant hard or change its shape. Your surgeon may suggest you have a tissue expander in place until you finish any radiotherapy treatment. 

Potential complications from breast implant surgery

Whether you have a one-stage or two-stage implant reconstruction, you should discuss these risks with your surgeon.

Breasts may not be identical

Over time, your breasts may look different in size. For example, if you lose or gain weight, the breast implant stays the same size but your other breast will change. This is called ‘asymmetry’.

Less feeling in the reconstructed breast

Compared to your natural breast, the reconstructed breast will have less sensation.

The implant may move

The breast implant may move slightly, giving you an unequal or lopsided appearance. This is less likely with subpectoral implants.

A hard capsule may form

A hard, tough ('fibrous') covering may form around the implant. This is known as a capsule or 'capsular contracture'. A capsule may change the shape of the implant, make it feel firmer to touch, and may also cause pain and discomfort.

The implant may leak

Although this is not common, fluid from the implant may leak into the chest area. This can happen if you have a chest injury.

If you have a saline implant, the saline tends to leak out quickly and the breast may look deflated.

If a silicone implant tears or ruptures, the gel leaks more slowly. Any changes to the size or shape of the breast may happen gradually.

Breast tissue may ripple

The skin of the breast – especially in people who are lean – may ripple, or wrinkle. To treat this, you may need to inject fat taken from another part of the body ('lipofilling'). The surgeon who performed the implant surgery can do this.

You may need further surgery

If you are not satisfied with the appearance of your reconstructed breast or breasts, you may need further surgery. For example, to:

• make your breasts more similar in size and shape after a single mastectomy. This could be a breast reduction and breast lift (‘mastopexy’) or breast augmentation using an implant or injection of fat.
• cover any visible rippling of the skin over the implant. This can be done by injecting fat from another part of your body into your breast area ('lipofilling' or fat transfer).

Symptoms of ‘breast implant illness’ may develop

A small number of people may experience symptoms such as fatigue, memory loss, muscle and joint pain. This is referred to as 'breast implant illness' (BII). Doctors and researchers are trying to understand the causes of BII and how to treat it. Read about BII at BreastCancer.org.

Implants may not last forever

An implant may stay in place for many years, especially if you do not have any complications. However, implants may not last forever and many people need theirs replaced.

Depending on the person, this could be 10 years after they were inserted, or longer. Talk to your doctor(s) about any concerns you have.

Risk of rare cancer (BIA-ALCL)

Textured breast implants have been linked to a very rare form of blood cancer (‘lymphoma’). This cancer is called Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).

The overall risk is extremely low.

The risk is higher when the implant is more textured (‘macrotextured’). Textured implants were used in Australia but the Australian Government removed them from use. More information is available from the TGA website, including BIA-ALCL and breast implants that have been ‘recalled’ or are no longer available.

Medical experts do not recommend that people without symptoms have surgery to remove macrotextured implants. This is because the risks associated with surgery are greater than the risk of developing BIA-ALCL.

Contact your GP or the surgeon who did your surgery if:

• you have any concerns about your implant(s)
• you notice any change around your implant, such as a new swelling, lump or pain.