Breast Cancer Breast Implants: What You Should Know About Reconstruction Surgery

Many women diagnosed with breast cancer will undergo a mastectomy, or surgery to remove the breast. Other women may choose to undergo a procedure to prevent breast cancer if they are particularly high-risk and have a concerning family history.

After removal, patients have the option to use implants to rebuild the breast. There can be many reasons why a patient might decide to have this procedure done – desire to regain previous breast shape, fitting better in existing clothes, body dysmorphia, to name a few – as well as reasons why they may be hesitant. Not all women will be eager to undergo another surgery after the stressful experience of breast cancer treatment. However, patients having a mastectomy should be informed about their options and how the process works. What should your patients know about breast reconstruction surgery?

After Breast Cancer: Breast Implant Types

After removal of breast cancer, breast implants in breast reconstruction surgery are often done with either saline or silicone; they can also be done with autologous tissue from other parts of the body or a combination of this tissue and saline or silicone.¹

Saline breast implants are filled with sterile water, whereas silicone implants are typically made of a thick, cohesive silicone gel.² Saline implants are designed to provide a natural look and feel to the breast. Silicone implants are often firmer, but also seen as less likely to break.

Autologous tissue is often used for patients with breast cancer who have undergone radiation therapy, as it can help replace tissue in the breast and chest wall that was affected by radiation.¹ This tissue usually contains skin, fat, and blood vessels, and is referred to as a flap. If health care professionals intend to use autologous tissue for an implant, they will need to thoroughly assess the abdomen to make sure there are no hernias or incisions that could potentially affect blood supply to potential flaps.³ Abdominal flap options include a transverse rectus abdominis musculocutaneous (TRAM) flap, a latissimus dorsi flap, and a deep inferior epigastric perforators (DIEP) flap.

If a patient is unable to use abdominal tissue, flaps may instead be taken from the thigh or buttocks. Implants may also be used in tandem with these flaps to provide more volume. These types of flaps are also free flaps – flaps where the tissue is cut off from its blood supply and must be connected to new blood vessels in the breast area via microsurgery. Tissue from the back and abdomen is more likely to be a pedicled flap, in which the blood vessels remain connected to the body during reconstruction surgery.

Nipple Reconstruction

In some instances, a mastectomy may be performed to preserve the nipple and areola, depending on the cancer location and size. However, surgeons may also reconstruct a new nipple for patients out of skin from the reconstructed breast following reconstruction surgery when the chest is more stable. After the nipple, surgeons may recreate the areola with skin grafts or tattoo ink.

How Is Breast Reconstruction Performed?

Breast reconstruction, if performed after a breast cancer diagnosis instead of as a precautionary measure, may begin during the mastectomy or after a waiting period. If patients opt for a delayed reconstruction, they will have to wait months, if not years, to allow for mastectomy incisions to heal and the rest of their breast cancer treatment to finish.

Breast reconstruction surgery is generally performed in multiple operations. The first operation involves putting a tissue expander under the chest skin or muscle. Over the course of several clinician visits, the expander, a sac similar to a balloon, is filled until the patient’s desired size is reached.² In the following operation, the tissue expander is removed and replaced with the implant. If desired, nipple and areola recreation may occur after the patient is further healed from the initial surgeries.

Depending on the circumstances of the patient, such as their age, desired breast size, and whether they are healthy otherwise, they may be able to have the post-breast cancer breast implant put in without a tissue expander during the mastectomy. In these cases, mesh may be used to hold it in place.

There are medical reasons to undergo a delayed reconstruction as opposed to starting it during mastectomy. The patient’s health care professional may determine their body is healthy enough to have the mastectomy. The type of treatment they will receive for the cancer is another potential factor. However, some patients choose to delay so as to not put their body through additional stress, or because they do not feel as though they can handle another procedure while managing the stress of cancer treatment. Patients and their clinicians should discuss these considerations at medical appointments.

Breast Reconstruction Surgery Risks

Breast reconstruction surgery offers several potential benefits – it may boost a patient’s self-esteem, it does not hide cancer recurrence, and it is not associated with breast cancer recurrence. It does, though, carry risks patients should know about before they decide. As with any surgery, patients run the potential risk of an infection, bleeding, pain, anesthesia complications, and difficulties with the wound healing.⁴ Patients can possibly experience necrosis in part of the tissue flap and a moved or ruptured implant later on.

Some health care professionals may also see smoking as an obstacle for breast reconstruction, as tobacco reduces the supply of blood to tissue and is associated with a higher chance of complications.⁴ It is possible that patients will be asked to quit smoking for an extended period prior to surgery.

In rare instances, breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) may develop, a form of non-Hodgkin lymphoma.² This is a very uncommon side effect, and is generally associated with more textured implants. Per the US Food and Drug Administration, as of April 1, 2022 there had been 1130 cases of BIA-ALCL diagnosed worldwide with at least 59 deaths attributed to it.⁵ In March 2023, the European Commission’s Scientific Committee on Health, Environmental, and Emerging Risks concluded there was an established causal relationship between textured breast implants and BIA-ALCL risk.

Post-Breast Reconstruction Care

The most important thing you can encourage your patients to do for themselves after breast reconstruction is to be patient and take the healing process slowly. Soreness is standard for the first week or two, and bruising can linger for even longer. There are a number of strenuous activities that should be avoided for the first month, if not longer, based on a patient’s discussion with their surgeon.

Patients should not just exercise patience with the physical reaction to breast reconstruction, but also with their emotional state. After undergoing the stress of breast cancer treatment, breast reconstruction can cause a significant emotional reaction and it may take time to adjust.

Read more: Breast Cancer Survivor

Health care professionals should discuss post-surgical care with their patients to provide them with the best possible care for their specific surgery. These discussions should involve what a patient should and should not do after surgery, and what side effects constitute an emergency that warrants medical attention. The more the benefits, risks, and specifics are discussed, the more informed a decision your patients can make about whether they think breast reconstruction surgery is right for them.

This article originally appeared on Cancer Therapy Advisor

References

1. Breast reconstruction after mastectomy. National Cancer Institute. https://www.cancer.gov/types/breast/reconstruction-fact-sheet. Updated February 24, 2017. Accessed October 16, 2023.
2. Breast construction using implants. American Cancer Society. https://www.cancer.org/cancer/types/breast-cancer/reconstruction-surgery/breast-reconstruction-options/breast-reconstruction-using-implants.html. Updated September 19, 2022. Accessed October 16, 2023.
3. Regan JP, Casaubon JT. Breast Reconstruction. [Updated 2023 Jul 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470317/
4. What to expect after breast reconstruction surgery. American Cancer Society. https://www.cancer.org/cancer/types/breast-cancer/reconstruction-surgery/what-to-expect-after-breast-reconstruction-surgery.html. Updated September 19, 2022. Accessed October 17, 2023.
5. Swanson E. Textured implant-associated anaplastic large-cell lymphoma: updating the name. Ann Plast Surg. 2023 Sep 1;91(3):321-323. doi: 10.1097/SAP.0000000000003628. PMID: 37566814; PMCID: PMC10430670.