There are two types that are commonly used: saline or silicone. Whatever type is used, the implant is composed of a capsule containing the fluid. There may be problems associated with the capsule or the type of fluid within it.
Silicone has had a lot of bad publicity when used for breast augmentation in America although it is still widely used for reconstructions elsewhere. Most of the links with other diseases such as connective tissue diseases have not been proven. The advantages of silicone are that the breast feels more like breast tissue.
Saline has been used instead of silicon. Although it has not been associated with other disease processes, the saline more commonly leaks out into the surrounding breast.
The capsule may become hard with time. It is more likely that this will happen if the patient has radiotherapy to the breast.
The prosthesis may be inserted as the size it will be or may be injected with fluid to stretch the overlying tissue over time.
For reconstruction after mastectomy, the prosthesis is inserted under the muscle. A pocket of muscle may be formed from the muscles over the back or from the muscle underlying the breast.
Advantages of prosthetic reconstructions:
- The operation is smaller than using the patient’s own tissue.
- The size may be altered according to the size of the opposite breast.
Disadvantages of prosthetic reconstructions:
- This involves the insertion of a ‘foreign body’. Although there is no good evidence to suggest that it causes any problems for the body, many women don’t like the thought of it.
- The capsule may harden with time.
- The capsular contents (silicon or saline) may leak out.
Reconstructions using the patient’s own tissue:
The bulk of the breast may be made from muscle or fat. The muscle used is usually from the back (the latissimus dorsi muscle) and the fat from the patient’s tummy (TRAM flap).
Types of mastectomy