Saline and Silicone Breast Implants for Mastectomy Reconstruction

If you are considering breast reconstruction after a mastectomy, and prefer implant reconstruction to 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.

Breast implants are silicone sacs that are filled with salt water or silicone gel, and 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 are not permanent – they won't last a lifetime. When an implant leaks, shifts position, or doesn't look right, you will have to get it surgically replaced. Both saline and silicone breast implants are available in a smooth or textured silicone outer shell. Breast implants won't have the same sensations as your real breasts.

Three 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:

• Rupture and leaking, deflation
• Hardening of the area around the implant (capsular contracture)
• Removal or replacement requiring additional surgery

Three kinds of silicone breast implants:

• A prefilled single sac containing silicone. 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. 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. Expandable after surgery, by adding more saline through a valve.

Risks:

• Rupture with leak - silicone gel spreading outside the shell
• Silent rupture, or slow leak, detectable only with MRI
• Removal or replacement requiring additional surgery

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.

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.