Other Considerations

If your patient decides to pursue breast reconstruction with an implant, there are many factors to consider, such as:

• Fill type (silicone)
• Shell surface (smooth or textured)
• Shape (round or shaped)
• Profile (projection)
• Volume (size)

Silicone Gel Implants

Due to the fact that cancer treatment often leaves women with very thin tissue on their chest, silicone implants can be particularly attractive to some breast reconstruction patients. In fact, wrinkling and rippling generally occurs with less frequency with silicone implants, as compared to other implants.

Some safety information regarding silicone gel filled implants can be found here³: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm063743.htm

However, since they are filled with gel, not liquid, a ruptured silicone implant may not be noticeable immediately. Therefore, patients who opt for breast reconstruction with silicone are advised to have periodic MRI's to check for "silent rupture."

POTENTIAL ADVANTAGES	POTENTIAL DISADVANTAGES
Most women find that silicone implants provide a more natural contour, look and feel Visible rippling occurs less frequently Thin women and those with less breast tissue may still achieve a natural-looking result Studies suggest that silicone implants have a longer life span than saline implants	if silicone implants rupture, it is possible that it may go unnoticed for some time A larger incision may be required for silicone implants Silicone implants may be more expensive

Recently, there has been concern over the safety of some breast implants, however, experts regularly examine evidence for the safety of silicone gel implants.

It's important to know that, once inserted, implants are very difficult to damage. Patients can continue with all their normal activities, including traveling by plane and taking part in sports.

Breast implants are not lifetime devices, the longer a woman has implants, the more likely that she will need to have additional surgeries to remove or replace them.

Radiation

Radiation therapy following breast reconstruction, though sometimes necessary, can affect breast implants with complications such as:

• Breakdown of the wound at the incision site
• Extrusion: When the skin thins, allowing the implant to break through
• Capsular contracture: When scar tissue causes the breast tissue to contract, making it appear round or hard. It can also be painful.

Radiation and Tissue Expander-to-Implant Reconstruction

Tissue expander reconstruction may help keep the skin on the breast from contracting or shrinking due to radiation treatment. After radiation, the filled expander can be removed and replaced with a permanent implant.

Radiation and Autologous Reconstruction

Radiation treatments can potentially create problems with the tissue used to form the new breast in autologous (flap) breast reconstruction, causing shrinkage or hardening of the tissue.

If it is determined that radiation is necessary post-mastectomy, many surgeons suggest a delayed breast reconstruction (link to glossary of terms).

Chemotherapy

In some cases, chemotherapy treatment that is delivered post-mastectomy can be delayed further until the expansion process of breast reconstruction with implants is finished. If the surgeon prefers not to delay chemotherapy, the expander can be inflated during treatment.

Exchanging the expander for an implant and creating a new nipple requires the immune system to be in full recovery-usually 6 to 12 weeks after the final course of chemotherapy. (As well, autologous breast reconstruction (link to glossary of terms) procedures may be delayed until after the completion of chemotherapy.)