Advantages
- A quick and straightforward breast reconstruction method
- Does not create additional scars
- Particularly well-suited for lean patients who have not undergone radiotherapy
- One or two preoperative lipofilling sessions greatly enhance results, especially in irradiated patients
Techniques and Results of Implant-Based Breast Reconstruction
The goal of this procedure is to restore breast volume and contour using an internal implant placed beneath the pectoral muscle. It can be performed:
- Immediately after mastectomy (immediate reconstruction)
- Or after a delay (secondary reconstruction)
Depending on the case, the implant may be:
- A permanent implant in simpler cases
- Or a tissue expander, used temporarily to prepare the site for final implant placement by stretching the skin and muscle
Implants are composed of a silicone elastomer shell, which may be smooth, textured, or coated in polyurethane foam to reduce the risk of capsular contracture (shell formation). Most implants used in our practice are anatomical polyurethane-coated implants, selected for their natural shape and stability.
Immediate Reconstruction
Performed right after mastectomy, the implant is placed under the pectoral muscle. When the tumor is far from the areola, we often preserve the areola and perform surgery via an incision under the breast, as in cosmetic breast augmentation.
Delayed Reconstruction
When tissues are thin or tight, we first perform 1–2 lipofilling sessions, spaced two months apart. The mastectomy scar is reused, and an abdominal advancement flap may be used to increase skin coverage in the lower pole of the breast. The pectoralis muscle is elevated to conceal the implant’s upper edge.
Procedure Details
- Anesthesia: General anesthesia, with a pre-op consultation required at least 48 hours in advance
- Duration: Approximately 1 hour
- Hospitalization: 2 to 4 days, due to the need for drainage
- Recovery: Return to work is typically possible after 2 weeks
Rehabilitation: Physical therapy is recommended to minimize discomfort and improve breast flexibility
Questions / Answers
Are there contraindications to breast reconstruction with implants?
Yes. This method is not ideal for all patients, particularly those who:
- Smoke heavily
- Are overweight
- Have undergone radiotherapy, which significantly increases the risk of complications such as tissue contracture or implant failure
In such cases, DIEP or latissimus dorsi flap reconstructions are preferred. Lipofilling prior to implant placement may improve tissue quality and reduce risks.
Should I choose silicone or saline implants?
While saline implants offer safety advantages (no silicone leakage), they:
- They are only available in round shapes
- Tend to feel firmer
- May show folds through the skin, especially in reconstruction
We therefore recommend ergonomic silicone implants for most reconstructive cases.
Is reconstruction with implants possible after radiotherapy?
In general, no. Radiotherapy causes skin retraction and a higher risk of failure. If attempted, there’s a high likelihood of:
- Capsular contracture (20–30% rate)
- Implant removal in severe cases
New radiation techniques and fat grafting before implant placement can reduce these risks, but may delay reconstruction by several months.
What are the possible complications?
- Immediate: Hematoma, infection, wound dehiscence (2–3% failure rate)
- Delayed: Capsular contracture, implant malposition, rotation, or rupture
Are the results long-lasting?
Not permanently. The reconstructed breast with an implant remains fixed, while the natural breast ages and may sag. Symmetrization may be needed over time. Also, implant replacement is typically required after 10–12 years.
Is post-operative pain normal?
Yes, especially when implants are placed under the muscle. Discomfort is usually manageable with painkillers and decreases over days or weeks. Persistent or worsening pain should be evaluated.
How much does it cost?
Breast reconstruction using implants is covered by health insurance after consultation with the social security medical advisor. We charge additional fees of €1,500 to €2,000 depending on the case, which may be covered by your insurance company.