Breast reconstruction (Tissue expansion)

This information sheet explains the implications of breast reconstruction surgery and should be read in addition to the Breast Cancer Care booklet ‘Breast Reconstruction’.

This information is intended to help you understand the operation and the aftercare that will be necessary to achieve the best possible result.

What is tissue expansion breast reconstruction?

This is one of a number of techniques that may be used to reconstruct a breast shape after mastectomy surgery.

This expandable implant has a silicone shell, which has a chamber into which saline (salty water) can be injected to gradually fill the implant.

The purpose of this is to stretch the skin over a period of time to accommodate the implant at its largest size.

Filling with saline is carried out via a small opening attached to the implant, which is also positioned under the skin.  This is usually carried out several times as an outpatient at intervals of two to three weeks.  It only takes a few minutes to perform this procedure.

Often the implant can be expanded to slightly larger than the final intended size.  It is left that size for a few months to achieve maximum stretching of the skin. 

Depending on the type of tissue expander implant used, it may remain in place permanently or it may be changed for a fixed size silicone implant.  If the expander implant is to remain in place, the filling port is usually removed during another minor operation. 

The operation

The operation is carried out under general anaesthetic, and takes approximately one hour to perform. 

Hospital stay and aftercare

For most patients the length of stay is one to two days after the operation.

An appointment will be made for you to return to the clinic to see your Consultant/Breast Care Nurse to have your wound checked.  You may also need to attend this clinic for further dressings. 

Your wounds should be kept covered by dressings until your Consultant/Breast Care Nurse is happy with your wound. The stitches will be dissolvable. Another appointment will be made for you to see your Consultant/Breast Care Nurse at two to three weekly intervals to start the expansion process.

You will be offered pain relief both in hospital and to take home.

A comfortable bra can be worn after surgery.  You may need to wear a soft prosthesis or padding in a bra until the expansion process is complete.  Underwired bras should be avoided until your wounds are healed.

After three to four weeks, you may start light exercise. It is however important you continue your arm exercises as instructed by the physiotherapist.

Return to work will depend on your occupation.  Light duties can usually start within three to four weeks.

You will need to attend the outpatients department every two to three weeks initially for expansion procedures.

Heavy lifting and strenuous exercise should be avoided for at least six weeks. 

Driving should be avoided until your wounds have healed and you can comfortably wear a safety belt.  This may take several weeks.

Any specific instructions will be explained to you before you leave hospital.

What are the risks of this procedure?

Most patients will experience few, if any, complications but it is important to be aware of any potential problems.

Bleeding may occur after surgery (usually within 12 hours of the operation).  A very small amount of bleeding is not uncommon but anything more than this may mean another short operation to stop the bleeding.

Infection you will be given antibiotics during the operation to reduce the risk of infection.  If the wound becomes infected after surgery, you may require a course of antibiotics.  Any infections that occur in the tissue around the implant can usually be treated with antibiotics.  Sometimes it is necessary to remove the implant until the infection has settled. It would then be replaced with a new implant.

Capsular Contracture

A breast implant is a foreign body and it is normal for your body to try and isolate the implant.  This is done by producing a ‘capsule’ of scar tissue around the implant.  In up to 10% of patients, the capsule will become very tight, feeling abnormally hard and causing pain within the breast. Modern implants have a special ‘textured’ surface, which helps to prevent this happening. Occasionally, this scarring is so uncomfortable that the implant will have to be removed with the scar tissue -usually a new implant is inserted at the same time.

Implant life expectancy

Breast implant surgery is a lifelong commitment.  Breast implants do have a life expectancy of approximately 10-15 years, after which time they may need replacement.  If the implant has not changed in any way it does not need replacing.  However, it is important to realise that the implants will almost certainly need changing at some point during your lifetime.

Asymmetry (unequal size and shape)

In the short term, there will be a marked difference between the breasts until the tissue expansion process is complete.

After breast reconstruction the size and shape of the new breast will adjust with time and weight changes.  It will feel different to natural breast tissue.  It will feel firmer and cooler than normal breast tissue. Implants tend to create a ‘youthful’ looking breast, which may be less natural in appearance with increasing age.  In patients with very thin breast tissue creasing or folds in the implant may be apparent.  There can also be a rippling effect seen through the skin, which is more likely when saline implants are used than those with silicone gel.

Most women will have some degree of asymmetry (unequal size/shape) between breasts and this is more likely after this surgery.

If necessary, further surgery can be carried out to reposition or replace the implant.  Alternatively, adjustment surgery could be carried out to the opposite breast, if your surgeon recommends this.

Scars

You will have a scar on the front of the chest either in the same location as the mastectomy scar or underneath the breast.  All scars are red and raised initially and begin to settle over a 12-month period.

Ruptured/leaking implants

This is when the outer silicone shell of the implant is punctured and the silicone gel contents could potentially be released into body tissue.  Modern cohesive gel implants have a firm consistency (similar to jelly), which is very unlikely to disperse in significant amounts.  Older implants contained a more fluid silicone, which was more likely to drain out.  Leaked silicone can result in benign lumps occurring in the surrounding tissue.  These are known as ‘silicone granulomas’.

Anaplastic large cell lymphoma ALCL

ALCL is a type of lymphoma – a cancer of the cells of the immune system. There is a small risk of developing ALCL due to having breast implants. This is not a breast cancer. The main symptoms of this condition are persistent swelling or pain. This usually happens well after surgery and often years after implants have been inserted. Any concerns regarding this contact your BCN/GP.

Silicone safety

There have been concerns raised by patients and doctors in the past about the safety of implants.  An independent review group report; Silicone Gel Breast Implants (1998) did not find any evidence of adverse effects and information can be found on their web site. www.silicone-review.gov.uk

The Department of Health continues to monitor all new research into the subject.

Breast Cancer and mammography

Breast implants do not increase or decrease the risk of developing a new breast cancer or a recurrence or a previous cancer.

There is no indication, provided all the breast tissue has been removed during mastectomy, to perform mammograms on the reconstructed breast.  Follow up mammography should continue in the remaining breast.

Useful information about all the issues surrounding breast implants can be found on the Department of Health’s website. www.doh.gov.uk/bimplants

If you require any further information or advice, please contact your breast care nurse.

If you have any problems out of hours or weekends then you can telephone 111 (NHS non emergency contact number).

Further information can be obtained from:

Cancer BACUP