Breast Reconstruction (cont.)
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Reconstruction Using Implants
Implants are designed to recreate the original breast shape and contour. A breast implant is a silicone shell filled with either silicone gel or saline. The implant comes in a variety of shapes and sizes. Silicone-filled implants are filled with either solid silicone gel or liquid silicone gel.
A tissue expander (balloon) is inserted beneath the skin and chest muscle either during the mastectomy procedure or at a later operation. The surgeon periodically injects saline into the balloon to gradually fill it over several weeks or months so that the overlying skin can expand. After the skin over the breast area has stretched enough, the tissue expander is removed in a second operation and a permanent breast implant is inserted. Some expanders are left in place as the final implant. Some women do not require tissue expansion before receiving an implant; for these women, the surgeon inserts an implant directly.
Because of concerns about the safety of silicone gel-filled breast implants, the Food and Drug Administration (FDA) has decided that breast implants filled with silicone gel may be used only in an FDA-approved clinical trial. Most plastic surgeons are able to provide a person with information regarding the use of silicone implants. If not, they should be able to provide a referral to a plastic surgeon in the area who participates in these trials.
The silicone gel-filled breast implants are preferred to saline-filled implants because they provide a more natural feel to the reconstructed breast. However, there have been some concerns about safety if silicone leaks from the implant. If a silicone implant ruptures completely, the implant has to be removed surgically.
Saline-filled implants have an advantage-if saline leaks out, one can easily recognize that a problem has developed for the breast mound and contour is lost. Silicone implant leak and rupture can be more difficult to identify. However, saline-filled implants do not have the natural feel of silicone-filled implants; so they have a less realistic appearance. Saline-filled implants are more likely to wrinkle or leak than silicone implants.
Marga Massey, MD
Leigh A Neumayer, MD, MS, FACS
Galen Poole, MD, FACS
Mary L Windle, PharmD
Lee P Shulman, MD
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