Breast Implants

The amount of scarring depends on the technique the surgeon uses for the mastectomy. Generally, skin sparing mastectomies have less scars.

There are many different materials that are given to patients regarding Breast Reconstruction. Some are form the plastic surgeon's office, some are from the implant company, others are from our society ASPS. Some patients receive all types. There is not a requirement to give out the booklets from the company but it may be helpful.

I have annual breast MRI because I still have one natural breast and one of my original breast tumors was only discovered on MRI. My most recent breast MRI noted that there is residual breast tissue in the implant side. For this very reason I would say that yes, you should have annual breast MRI, both to check the integrity of the implant and to check for further malignancy. Unfortunately it is usually the insurance companies placing restrictions on doing this, not he doctors or the patients. I would pay for it myself to be sure I was cancer free.

I have performed many silicone implant reconstructions over the years, and have never had anyone "reject" an implant. Thus, while I think the chances of this happening are very small, nearly anything is possible in medicine. As mentioned in one of the responses to the above questions, however, there are other issues that can develop over time with implants, such as capsular contracture formation or leaks, but most patients do well with implants.

There are usually a number of options. Perhaps minor adjustments can be made to the implant reconstruction in the surgeon's office or as an outpatient procedure in an operating room. If more significant revisions are needed, this may require replacing the implant with a new implant, or replacing it with a flap. An experienced plastic surgeon can give you more details on what would be appropriate for you after he or she examines you.

The 2 main breast implant manufacturers in the U.S. are Allergan and Mentor, and both have very long records of excellent safety.

Let’s go to the source of that information for the best answer……

This is from the product insert data sheet included with Mentor Corporation Memory Gel Implants……………..

“Rupture of a silicone gel-filled breast implant is most often silent (i.e., there are no symptoms experienced by the patient and no physical sign of changes with the implant) rather than symptomatic. Therefore, you should advise your patient that she will need to have regular MRIs over her lifetime to screen for silent rupture even if she is having no problems. The first MRI should be performed at 3 years postoperatively, then every 2 years, thereafter. The importance of these MRI evaluations should be emphasized. If rupture is noted on MRI, then you should advise your patient to have her implant removed. You should provide her with a list of MRI facilities in her area that have at least a 1.5 Tesla magnet, a dedicated breast coil, and a radiologist experienced with breast implant MRI films for signs of rupture.”

You can read the entire product insert data sheet here: http://www.mentorwwllc.com/Documents/gel-PIDS.pdf

James E. Craigie, M.D.

The registration is necessary should there ever be a recall or problem with the implant then the company can find out which people have the affected implant.

We usually do not perform mammograms on patients who have had bilateral mastectomies with reconstruction. Since mammography requires that we compress the breast tissue there would be nothing to compress, as there is no breast tissue. We do not compress implants, even in patients who have them for cosmetic reasons.

Great question. I also have silicone gel implants. I only had a single mastecomy but also got implant/lift on the other one for better symmetry (and remember, insurance is required to pay for that!)My plastic surgeon told me they felt more natural than saline and let my husband and me hold them.

I decided on implants pretty quickly; I figure less is more when it comes to surgery. The tissue flap surgery sounded pretty complicated, and my plastic surgeon told me the aesthetic results are not as good. He also told me the silicone implants don't really have leaking issues; they're more like a gummy bear. He told me none of his patients have had problems or needed replacements. I'm three-plus years out and haven't had any problems. But one tip I learned that may be helpful was to make sure the facility that does mammograms has experience with implants, and I learned that mine does. (I still get mammograms on the augmented/non-mastectomy breast.)

I'm also part of an ongoing implant study to help other women, and that's kind of interesting. I take a phone or online survey every year and I have occasional follow ups with my plastic surgeon as part of that.

Hello! I am 2 years now with implants following tissue expanders. At first after surgery, I wore a bra all the time (even to sleep) not because I needed the support but because it was more out of habit. I stopped wearing one, though, not long after my implant surgery and have not missed wearing one. Then you get into the discussion (if you have not had nipple conserving surgery) about nipple reconstruction because some people decide they don't want the trouble of dealing with 'headlight's which negates the - I don't have to wear a bra now!' positive aspect of no bra liberty. But we can save that discussion for another QA! Best wishes to you and congrats on being out of those uncomfortable expanders!

I would reinforce some of the points made by 20questions - there are many options and one technique is absolutely not right for everyone. The best results are when reconstruction is done once (although it is not uncommon to need revisions or minor tweaks). Interview more than one plastic surgeon, and also make sure that they are not only experienced with cosmetic surgery, but post-mastectomy reconstruction surgery - a completely different procedure.

If it is possible to undergo the reconstruction at the time of the mastectomy, many patients prefer that option - as Suzanne said, one major surgery instead of two. It is often a big relief for a woman to be able to wake up from anesthesia after a mastectomy with something in place, even if additional procedures might be needed. Also, if immediate reconstruction is performed, the scarring might be less extensive. Of course every situation is different, and the decision to undergo immediate reconstruction needs to be made on a case-by-case basis after consultation with the breast surgeon, plastic surgeon, and radiation oncologist as stated above.

When implants are placed for breast enhancement, mammograms are still performed as drbreastsurgery noted above. However if a mastectomy with implant reconstruction is performed, mammograms generally are not performed. MRI examinations are sometimes done in this situation to make sure there is no recurrence of cancer on the chest wall or muscle, and to check the implants (if they are silicone) to ensure that there is no leakage.