IMPLANTS AND EXPANDERS
Implants and tissue expanders are popular choices with reconstructive surgeons. Of course, many patients are familiar with breast implants, both from media coverage and the popularity of implants with well recognized Hollywood celebrities. Although similar to breast implants, implants used in reconstructive surgery have many differences to those used solely for breast enlargement. For instance, they have to be larger since they are used to replace an entire breast, and not just to make a breast bigger. The larger size needed makes them heavier, especially when saline (salt water) is used. Silicone gel filled implants were banned by the FDA until recently but saline implants did remain available during this ban.
Implants used in reconstruction are made of a silicone shell and have either a saline or silicone filling. Expanders are somewhat like implants, they are silicone shell balloons that are inserted into mastectomy pockets and need to be stretched over time. By filling the expander with saline during a several week course after surgery, the expander is inflated, stretching the skin over it to make it look more like a breast. Expanders may need to be removed, depending on the type, or may be left in permanently after they are completely inflated. Patients that have expanders need to undergo weekly (or more often) injection of the expanders with saline to stretch them.
Implants and expanders have the advantages of being widely available in most hospitals, are packaged and don't require meticulous dissection or harvesting of tissues, and most plastic surgeons are trained and comfortable with their use. Because they are widely available and surgeons are so comfortable with them, their use in reconstruction is often encouraged to patients. But, like all forms of reconstruction, they have disadvantages.
All implants develop a form of scar at the interface of the implant that comes in contact with the tissue of the body. This scar is known as a capsule. The capsule tends to contract over time and get hard. Almost all implants develop some form of capsular contracture, with the degree and developmental time course varying among patients. Capsular contracture can result in implants that are hard, distorted and painful. Patients should consider that their implant will develop capsular contracture, and that more likely than not, they will have to have to undergo more surgery on their breasts within about ten years. Other late complications besides contracture can develop as well, including implant leakage and failure, infection and implant exposure. Implant exposure is more common when implant reconstructions are performed in the face of future or previous radiation.
Disadvantages of implants include:
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They are artificial and made of silicone
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They develop capsular contracture and become distorted in appearance over time
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They can become hard over time
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They have significant rates of complication when radiation is expected or required
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They don't feel like breasts
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Replacement surgery may be necessary many years later
Some patients would rather not have a new area of scar and therefore do not wish to undergo microvascular reconstruction, or they are not candidates for microsurgery, or they do not wish to undergo the longer surgical procedure necessary for microsurgery. These patients may be candidates for implants/expanders or latissimus reconstruction. with an implant/expander.
Consulting with a qualified plastic surgeon familiar with these procedures is necessary to fully understand the risks, benefits, complications and alternatives.