There are two types of implants that are available in the UK – silicone gel (semi-liquid or cohesive) and saline. Both implants have a silicone shell (outer layer) which can be smooth or textured. Textured implants can help to reduce the risk of hardening and deformation (capsular contracture).

Silicone gel implants are most commonly used. They are filled with either a firm, jelly-like silicone or a softer, fluid silicone. The firm implants are less likely to leak. The shell of some silicone gel implants is coated with polyurethane foam that breaks down over time. Polyurethane coated implants were reintroduced in the UK in April 2005.
Saline implants are another option but are used less often as they are more prone to leaking and deflation.

Both implants are available in two shapes, either round or anatomical (teardrop shaped). For further information you can visit the Department of Health (DoH) or Medicines & Healthcare products Regulatory Agency (MHRA) websites:

www.dh.gov.uk

www.mhra.gov.uk/Safetyinformation/Generalsafetyinformationandadvice/Product-specificinformationandadvice/Product-specificinformationandadvice-A-F/Breastimplants

BIA-ALCL

A rare type of immune system cell cancer called Breast Implant Related Anaplastic Large Cell Lymphoma (BIA-ALCL) is possibly linked to silicone breast implants. ALCL is a lymphoma and not cancer of the breast tissue. In women with breast implants, ALCL was found adjacent to the implant itself and contained within the fibrous capsule. The condition presents usually with a late onset seroma (fluid collection around the implant). The first case was reported in 1997, yet it is important to note that breast implants have been used since 1962, with current estimations of 5 – 10 million women in the world with breast implants.

Breast implant associated Anaplastic Large Cell Lymphoma (BIA-ALCL) remains a rare condition, believed to be in the order of 1:50,000 – 300,000 people. All of the information to date suggests that women with breast implants have a very low but increased risk of developing ALCL compared to women who do not have breast implants. Most cases of BIA-ALCL are treated by removal of the implant and the capsule surrounding the implant and some cases have been treated by chemotherapy and radiation.

The MHRA currently advises no change to current practice and patients should be advised that ALCL is a very rare condition.

National Breast Implant Registry

All patients having surgery involving an implant or tissue expander will be asked for their permission for information about their surgery to be added to The Breast and Cosmetic Implant Registry. This registry was set up in October 2016 and has been designed to collect information on breast implants and expanders inserted throughout the UK to monitor and improve patient safety. It will make it easier in future for details of patients to be easily found if implants ever need to be recalled or removed.

Important factors to consider when deciding on a reconstruction with a tissue expander/implant:

  • Your implants are unlikely to last a lifetime, and you are likely to need additional operations in the future to replace/exchange the implants.
  • You may experience complications with breast implants such as rupture, pain, capsular contracture (scar tissue around the implant), infection and a poor cosmetic result. This means that implants may change shape overtime and the cosmetic appearance may change.
  • When the chest muscle (pectoralis major) is lifted to cover a tissue expander or implant, you may experience muscle twitching or contracture over the implant.

Reconstruction surgery using an expander/implant with Acellular/Artificial Dermal Matrix (ADM)

Expanders/implants are usually placed under the chest muscle (pectoralis major) and traditionally the muscle from the back is used as a sling or hammock to support the implant. We are now moving away from this as the impact on the donor site can be troublesome to some patients. Instead we are using ADM or dermal slings.

Not all ADM’s are the same and there are several available. Some are derived from foetal bovine (cow) dermis or calf skin (SurgiMend® & Veritas®). Strattice® and Braxon® are derived from porcine (pig) dermis and Alloderm® is derived from human processed donated skin. In all materials, all of the cellular components and DNA are removed leaving a collagen structure only behind. The ADMs remodel and integrate into your own tissue. Also available are synthetic or artificial matrices made from titanised mesh (TiLoop®) or silk (Suri®) these are a fine meshes that fully incorporate and can remain in the body for ever. The choice will be made by your surgeon depending on what is available at your unit, unless you have strong views regarding the decision.

ADMs can act as an internal bra, hammock or sling. They support the expander/implant in a lower position restoring a natural shape to the breast mound. Usually when an ADM is used then the expander/implant is still placed under the chest muscle (pectoralis major). However, Braxon® can be used to completely wrap around an implant and this may then be placed above the chest muscle directly under the breast/chest skin.

Following a skin sparing mastectomy and immediate breast reconstruction using an expander/implant there remaining skin has very little tissue left covering the implant and the ADM provides additional layer to protect the implant and reduce visible implant wrinkles, folds or creases.

There are some important factors for you to think about when deciding on a reconstruction with an expander/implant and an ADM:

  • The use of drains post-surgery may be extended for up to 2-3 weeks and you may go home with up to 2 drains in place, depending on your unit preference.
  • There is a slightly higher risk of infection due to the extended length of time drains are in place.
  • You may be prescribed a post-operative course of antibiotics to prevent infection.
  • Your implants are unlikely to last a lifetime, and you are likely to need additional operations in the future to replace/exchange the implants.
  • You may experience complications with breast implants/ADM such as rupture, pain, capsular contracture (scar tissue around the implant), infection and a poor cosmetic result. This means that implants may change shape overtime and the cosmetic appearance may change.

Reconstruction surgery using an expander/implant and a dermal sling

If an immediate breast reconstruction is planned, then the breast tissue (with or without the nipple and areola) may be removed, preserving the breast skin. The aim of the mastectomy is to remove the breast tissue meticulously and delicately from inside the breast skin envelope and only remove any skin that may be unhealthy. In most cases the breast skin is usually perfectly healthy and can be preserved to keep the shape of the original breast.

In the case of the dermal sling operation the skin envelope is reduced into a smaller, less ptotic (droopy) size and shape. This is planned in a similar way to a standard breast reduction and leaves similar scars (known as the ‘anchor’ or the ‘inverted-T’).

The dermal sling is created from your own skin in the lower part of your breast. The outer layer of the skin is trimmed so that it may be used on the inside. The dermal sling is used to cover the lower part of an expander/implant so that a more natural shape can be given to your breast reconstruction. The implant may be covered by your chest muscle (pectoralis major) at the top.

There are some important factors for you to think about when deciding on a reconstruction with an expander/implant and a dermal sling:

  • The use of drains post-surgery may be extended for up to 2-3 weeks and you may go home with up to 2 drains in place, , depending on your unit preference.
  • There is a slightly higher risk of infection due to the extended length of time drains are in place.
  • You may be prescribed a post-operative course of antibiotics to prevent infection.
  • Your implants are unlikely to last a lifetime, and you are likely to need additional operations in the future to replace/exchange the implants.
  • You may experience complications with breast implants such as rupture, pain, capsular contracture (scar tissue around the implant), infection and a poor cosmetic result. This means that implants may change shape overtime and the cosmetic appearance may change.

Procedure diagram

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