Saline-Filled Implant Reconstruction Surgery

Introduction:

The breast reconstruction process can be initiated at the time of mastectomy, that is immediate reconstruction, or it can be performed later, that is delayed reconstruction. The breast reconstruction procedure generally involves two or more operations. Breast reconstruction can be done in two ways, depending on the type of implants used. Breast implants commonly used are silicone and saline water for reconstructing or reshaping the breasts. Several appointments might be required over two to three months after the initial surgery to expand the skin on the chest and prepare for the implant. These implants do not guarantee the exact feel or look of the natural breast. However, it makes the breast resemble the natural breasts before mastectomy.

How Is Breast Reconstruction Performed Using Implants?

Sometimes, during mastectomy (removal of the entire breast in case of breast cancer), the skin and nipple can be saved. Therefore, a breast implant can be used to reconstruct the shape of the breast after mastectomy. The procedure generally involves two operations.

• First Surgery: During this surgery, a tissue expander (a flat water balloon) is placed, which is gradually filled or expanded in subsequent visits to the doctor until a desired size is reached.

• Second Surgery: During this surgery, the tissue expander is replaced with a breast implant. Other procedures might also be performed to reconstruct the nipple-areola area or to improve the overall look.

What Is a Saline-Filled Breast Implant?

A saline-filled breast implant is an implant filled with sterile or germ-free salt water. These implants have been used for the longest period. A new evolution in this type of implant is the development of a structured saline implant. The structured saline implant is also filled with sterile saline or salt water; however, it has an inner structure that helps provide the reconstructed breast with a more natural look.

What Types of Implants Are Used for Breast Reconstruction?

Before implant reconstruction surgery, discussing the risks and benefits of implant types with the doctor is extremely important. Various types of breast implants can be used to reconstruct the breast. In the United States, most implants are made of a flexible silicone outer shell. They contain either saline or silicone gel. Other categories of implants that have different shells and are filled with different materials are also being studied. However, implants are only being used for clinical trials.

What Is the Difference Between Saline and Silicone Breast Implants?

Both saline as well as silicone breast implants are used widely for breast reconstruction. However, there are certain areas where these two differ.

• Saline implants have been approved for use in people 18 years and older; silicone implants can only be used in individuals 22 years and above.

• If the saline implant ruptures the implants, it is absorbed by the body as the implant deflates. However, this is not the case with silicone implants, as their rupture is not apparent, and therefore important to monitor these implants with routine Magnetic Resonance Imaging (MRIs) or ultrasounds to detect any problems.

• Silicone implants usually resemble and feel more like a natural breast, and they can be altered depending on the patient's actual breast firmness. Saline implants usually have rippling effects that might compromise the natural feel and look.

• Saline implants need a slightly smaller incision because they are inflated after being placed in the implant pocket. On the contrary, silicone implants are pre-filled. Therefore, they require a slightly longer incision. If these two implants are compared, saline implants cost less than silicone implants.

What Factors Must Be Considered Before Getting Saline-Filled Implants?

Before undergoing a breast augmentation or reconstruction surgery, the patient must be made aware that breast implantation involves multiple steps and is not a single surgery. Breast implants are not lifetime devices and require implant removal with or without replacement throughout life.

The changes made in the breast after implantation are irreversible and cannot be undone. Later on in life, if the patients want the implants to be removed or replaced, they may experience unacceptable puckering, dimpling, wrinkling, or other cosmetic changes in the breast. Breast implants do not prevent the breasts from sagging after pregnancy and can affect the ability to produce milk for breastfeeding.

Routine screening mammography becomes difficult with breast implants, and the patient might be required to have additional views, leading to more time consumption and radiation exposure.

The health insurance premiums might be increased, and future coverage might be denied for patients who have undergone breast implantation either as a reconstructive or cosmetic procedure.

After breast reconstruction surgery with saline-filled implants, the patient might experience some soreness, swelling, and bruising for two to three weeks. The doctor might suggest certain topical medications for application on the suture area or bandages that need to be changed. The patient's plastic surgeon gives showering, bathing, and wound care instructions.

What Would Happen if an Implant Broke?

The treatment approach relies on the kind of implant, whether a saline implant or a silicone implant.

• In case of saline implant rupture, the implant becomes flattened. This will modify the size and structure of the breast. A saline solution will leak from the implant, and it has no health risks. The covering of the saline implant should be removed with the help of surgery, and the new implant may be placed during surgery.

• If the ruptured implant is silicone, it is often unnoticeable. Silicone gets retained in the scar tissue surrounding the implant, called a silent rupture. If the silicone leaks, it will not cause any harm and can spread to other body parts. Sometimes, the ruptured silicone implant may cause breast discomfort and modify the breast contour. In such cases, surgery is performed to remove the ruptured one, and a new implant may be placed.

Conclusion

Usually, women can return to their normal routine within six to eight weeks after surgery. However, strenuous exercise must be avoided for several weeks. Areas of numbness might be present even after the reconstruction surgery. The patient might feel tightness in the breast instead of pain. Scars and the sensation of normal breasts fade over time. The shape of the reconstructed breast improves gradually over time. Regular checkups are required initially. In the case of a temporary expander, it has to be expanded with saline once weekly until the desired size is reached. Self-exams of the breasts every month must be continued, along with an annual mammogram (an X-ray of the breast that helps to detect or indicate the early signs of breast cancer). It must be noted that breast reconstruction and implants do not change the chance of cancer recurrence, and they generally do not interfere with treatment. If the disease does come back, the medical team can continue with surgery, radiation, chemotherapy, and targeted therapy.