Implant-Based Breast Reconstruction: Complete Post-Mastectomy Guide

Many individuals opt to have breast reconstruction after mastectomy. This is a deeply personal decision, influenced by their medical needs and personal preferences. For most, it is their path to restore a sense of ‘wholeness’ and normalcy following breast cancer surgery.

There are two key types of breast reconstruction techniques being practiced across the country today – implant-based and flap-based (also known as tissue or autologous reconstruction). Implant-based breast reconstruction uses silicone or saline implants, while flap-based techniques use tissue from another part of the body, such as the abdomen or back. Nipple reconstruction may also be performed later if needed, using grafts, local flaps, or 3D tattooing to complete the restoration. Some patients may also opt for combined or delayed reconstruction depending on their medical needs, personal goals, and cancer treatment plan.

BB Clinic is part of a multidisciplinary team involved in breast reconstruction procedures. This team includes specialist breast surgeon Dr. Michael Yunaev and other oncology specialists, among other professionals. We believe that this all-round, personalised approach better serves our patients’ long-term wellbeing.

Implant-Based vs Flap Breast Reconstruction

Implant-based breast reconstruction is a surgical procedure that uses a breast implant to recreate the shape of the breast after a mastectomy. Unlike flap-based reconstruction, which uses tissue from other parts of the body such as the abdomen or back, implant-based reconstruction typically involves a shorter surgical time and less recovery as there is no  donor site surgery required.

As you can see, each approach has its pros and cons. Moreover, implants may be positioned either under the chest muscle (subpectoral implant placement) or above the muscle (prepectoral breast reconstruction). The choice depends on skin quality, body type, and other health factors, all of which will be discussed during your planning consultation.

Dr. Yunaev and his team will help determine a suitable implant type and placement, which is based on your health, treatment history, lifestyle, and aesthetic preferences.

Surgical Options: One-Stage vs Two-Stage Reconstruction

There are two primary approaches in implant-based breast reconstruction: one-stage and two-stage breast reconstruction.

In the one-stage approach, also known as direct-to-implant breast reconstruction, a permanent implant is placed immediately after mastectomy. This option is generally adopted when there is sufficient healthy skin and soft tissue remaining, and is often supported by acellular dermal matrix (ADM) or synthetic mesh – which is a graft/supporting  material that adds coverage and stability for the implant.

In contrast, two-stage breast reconstruction begins with the placement of a tissue expander. This is akin to a temporary implant that is gradually filled with saline over time to stretch the skin and soft tissue, and make room for the implant. Once the area is adequately prepared, the expander is replaced with a permanent implant during a second procedure.

Choosing between the two depends on several factors, including the amount of tissue preserved after mastectomy, the need for radiation, and individual healing capacity. It helps to have an experienced surgical team by your side, in your breast reconstruction journey.

We will guide you through the various breast reconstruction surgery steps, in a way that supports your long-term wellbeing.

Types of Breast Implants

There are two types of implants that can be used in breast reconstruction: saline and silicone. In case you are wondering about saline vs silicone breast implants, here are the key differences:

Saline implants are filled with sterile saltwater and allow for minor size adjustments during placement. They tend to feel firmer and may ripple more. Silicone implants are filled with cohesive silicone gel, and offer a more natural look and feel, especially for women with less natural breast tissue. While both are safe, silicone implants require intermittent monitoring to detect silent ruptures. Saline implants, while easier to detect if they leak, but may not offer the same aesthetic outcome.

Each type has its pros and cons. Dr. Yunaev will recommend the best option based on your anatomy and goals.

What to Expect During Recovery?

The recovery period for every individual who undergoes an implant-based breast reconstruction is different. Most patients require to stay in hospital for one to two nights and return to light activities within two weeks. That being said, the overall recovery period is gradual.

In the initial days after your breast reconstruction surgery, it is common to experience swelling and bruising, tightness, and fatigue as your body begins to heal. To support you during this phase, our team will offer tailored pain management options, including medication and supportive garments.

Complete breast implant reconstruction recovery can take anywhere between 6 to 8 weeks. However, there will be small changes and further healing, which can continue for several months. Dr. Yunaev may also recommend gentle breast reconstruction physical therapy if needed, to help restore shoulder mobility and posture.

We are committed to offer ongoing support, detailed aftercare instructions, and follow-up appointments to ensure that your recovery progresses smoothly.

Long-Term Outcomes and Aesthetic Considerations

While you will be able to see some noticeable results early on, the final breast reconstruction outcomes take time to start showing. This is when the swelling will subside, scars will fade, and your implant will settle into place.

You can expect gradual improvements in breast reconstruction symmetry and aesthetics over time. Some patients may opt for revision procedures or fat grafting down the track to enhance symmetry.

Breast reconstruction scar healing also evolves over the first year, with scars typically softening and fading over time. Your surgeon will guide you on scar care and realistic expectations for your long-term results.

Breast Implant Complications

Like all surgical procedures, breast reconstruction with implants carries some potential risks and complications that you need to be aware of. While there are many patients recover well, being aware of possible complications allows for better preparation and long-term care:

• Capsular contracture: This is a common issue where the scar tissue (capsule) around the implant tightens – resulting in potential discomfort or changes in breast shape.
• Implant displacement: The implant may shift from its original position, leading to asymmetry.
• Breast implant illness (BII): Some women report symptoms like fatigue, joint pain, and brain fog. While research continues, awareness and open discussion with your surgeon are essential.
• BIA-ALCL and other rare cancers: Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare but serious condition linked to certain textured implants.

If you experience any unusual swelling, pain, or changes, it is important to promptly report to your surgical team. This is also why it is a good idea to factor in ongoing check-ups and imaging as a part of your breast implant reconstruction recovery.

Is Implant-Based Reconstruction Right for You?

Breast reconstruction with implants can be a suitable option for many women, especially those seeking a shorter surgery and recovery time. You may be an ideal candidate for this if:

• You have sufficient skin after mastectomy (skin-sparing techniques)
• You are not expected to undergo radiation therapy
• You prefer to avoid the longer recovery of tissue (flap) reconstruction

However, this method may not be suitable for everyone. It may be less ideal if:

• You require radiation therapy, which can increase the risk of complications such as capsular contracture and implant loss
• You have certain autoimmune or connective tissue disorders
• You have lifestyle factors that may affect healing, such as smoking or uncontrolled diabetes

Ultimately, the best choice depends on your individual situation. A personalised consultation with your surgical team will help assess whether breast reconstruction after mastectomy using implants is the right path for you.

Closing Thoughts

Choosing to undergo implant-based breast reconstruction is often an emotional decision – and should be made with clarity, self-compassion, and the guidance of a qualified specialist. Every woman’s body, goals, and health parameters are different, and there is no one-size-fits-all approach.

At Breast & Body Clinic, we are committed to delivering evidence-based, patient-focused care. Whether you’re considering breast reconstruction after mastectomy for medical or personal reasons, we are here to support you at every step of your journey.

If you are looking for a breast surgeon near you or a breast cancer surgeon in Sydney, we invite you to book a consultation with our team.