Breast Reconstruction Choices

Breast implants are made of a silicone outer cover and can be filled with saline (salt water) or, more usually, silicone gel. They come in teardrop or round shapes as well as different sizes. They may also be smooth or a textured surface. The implant choice that is right for you will depend on your desired outcome, personal preferences and physical factors.

Understanding how these different products perform may assist you to choose the right implant for your particular circumstances.

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Implant Options

Silicone vs Saline

Both silicone and saline implants have an outer silicone shell but are filled with either a silicone gel or a saline (saltwater) solution. The main differences are:

Saline Implants:

  • Filled with a saltwater solution similar to the fluid that makes up most of the human body
  • Slightly firmer feel than silicone implants
  • Shorter incisions as the implant is deflated when inserted
  • Flexible fill volume, allowing the surgeon to adjust the volume throughout the procedure.
  • Less expensive

Silicone Implants:

  • Softer, more like natural breast tissue
  • The implant volume is full when inserted giving a predictable result
  • The gel in the implants come in varying degrees of firmness, allowing increased choice
  • Incisions are longer as the implant is full when placed (not deflated)

Both types of implants have a slight risk of rupturing but each type acts differently if this occurs:

  • If a saline implant ruptures, the saline leaks out quickly and the breast appears somewhat deflated, so you know immediately that it's ruptured. The salt water is absorbed by the body.
  • If a silicone implant ruptures, the gel leaks out more slowly because it's thicker. It may take you longer to realize that the implant has ruptured, or you may not realize it at all since the leaked material can remain around the implant. Silicone gel is not absorbed into the body; the gel can sometimes leak into the pocket surrounding the implant and stay there, or it may spread further. Some surgeons may suggest periodic MRI screening to detect any rupture.

In either case, if rupture occurs, surgery would be required to remove and replace the implant.

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Round vs Teardrop/Anatomical

Implants come in round or teardrop shapes. Depending on the breast shape you hope to achieve, you and your doctor may choose either a round or a contoured implant with a teardrop shape. A contoured implant can provide a more natural-looking result as the implant is tapered at the top and gently slopes to a fuller projection point near the base, mimicking the silhouette of a natural breast. However, a slightly larger incision to place the implant may be required with a teardrop implant.

Smooth vs Textured

Implants come with either a smooth or textured surface. Smooth-surfaced implants have a slightly softer shell and are less likely to be felt through the skin. Textured implants have a gentle imprinted surface which is designed to help keep your implants in place and lower the risk of scar tissue tightening around the implant (called capsular contracture), which may require removal of the implant.

Talk to your surgeon about the implant type that would best suit you given your individual situation and preferences.

Size

Deciding on the size of your implant can sometimes be one of the most difficult choices for women having a breast reconstruction. Breast implants do not come in traditional bra cup sizes, but are measured in cubic centimetres, referred to as cc’s.

It is important to remember that silicone implants are already filled when placed whereas saline implants are filled by your doctor during your procedure, allowing some flexibility in sizing. Some saline-filled implants used during immediate, one-step reconstructions, offer the opportunity to adjust the size of your implant for up to 6 months after your procedure.

Your surgeon is the best person to discuss this issue with as implant sizing as part of a breast reconstruction will be dependent upon a number of factors including; matching the implant to your remaining breast (if applicable), the type of mastectomy you have had and the condition of your skin following treatment, the shape of your chest wall and your preferences in relation to the type of implant you want and your desired size.

Tissue Expanders

Tissue Expanders are commonly used in both immediate and delayed breast reconstructions to expand the skin and make room for the final implant.

Tissue expanders are inflatable breast implants, much like a balloon, that are inserted between the skin and chest muscle after your breast tissue has been removed. The expander has a valve that allows the surgeon to inject increasing amounts of saline over time (usually 2-6 months) until the skin gradually is stretched enough to accommodate the implant. The tissue expander is removed once the skin has been stretched to the right size for the implant chosen.

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Tissue expansion is usually carried out in the surgeon’s rooms. After each injection, you might feel some pain or pressure for a few hours. This usually goes away by the next day and any pain is usually managed with paracetamol.

Acellular Dermal Matrix (ADM)

Acellular Dermal Matrix (ADM) is a specialised surgical mesh that provides a strong tissue substitute and is sometimes used (particularly in Immediate One-Step Implant Reconstructions), to provide a pocket that supports the lower portion of the implant, holding it in position. The mesh is attached to the pectoralis muscle in the chest making a “sling” in which the implant can be placed, helping to create a natural droop, shape and contour.

Accelular Dermal Matrix or ADM is either an Allograft or a Xenograft. An allograft is made from human tissue and a Xenograft is made from porcine or bovine skin that has been specially treated and has been approved for use in this type of procedure in Australia. As the surgeon can manipulate the implant position within the sling the result is a more natural looking breast.

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Implants and Other Treatments

If you are likely to have other treatments and would like to have implant breast reconstruction it is important to discuss with your surgeon how these treatments may affect the outcome of your surgery and what can be done to minimise the risk of complications.

Certain Treatments can increase the risk of complications such as delayed wound healing and capsular contracture (tightening of the scar tissue around the implant causing pain, hardness and breast shape distortion, which may require removal of the implant).

With proper planning, the timing, products used and approach to your reconstruction can be co-ordinated to reduce the risk of complications and provide the best possible aesthetic result.

What to Consider - Reconstruction Costs

Public Hospital

  • Reconstruction after a mastectomy is a medical procedure, not a cosmetic one, so the costs are covered through Medicare for a public patient in a public hospital.
  • There may be some extra charges if an implant is used.
  • There may be some charges for private patients in a public hospital.
  • If you choose to have a delayed reconstruction, you will be put on the hospital’s elective surgery waiting list. You may need to wait many months for the operation. Ask your surgeon about the likely waiting period.
  • You can put your name on a waiting list even if you’re not sure that you want a reconstruction.

Private Hospital

  • Private patients must have private health cover or pay the extra costs.
  • In a private hospital, Medicare will cover some of the surgeon’s and anaesthetist’s fees. Your health fund will cover some or all of the remaining costs, but you may need to pay a gap fee or a hospital admission fee.
  • Part or the entire cost of an inflatable tissue expander and any permanent implant may also be covered by your insurance provider.
  • If you decide to join a health fund before your operation, you will have to wait the qualifying period before you can make a claim. This may be up to 12 months. Check with the different health funds.

Which MENTOR® Product
is right for you?

Doctor/healthcare professional advice is required. Your doctor/healthcare professional will advise you whether this product is suitable for you/your condition. Always read product label/Instructions For Use before purchase. Follow the Instructions For Use.

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Additional Support

The emotional stresses of this disease affect not only those diagnosed with the disease, but also their friends and family. Discuss with your surgeon or health care professionals support services that may be available to you.