How long do breast expanders stay in

Implant surgery means using a silicone gel or salt water filled silicone balloon to recreate a breast shape after removal of a breast. It is the simplest way of making a new breast.

About breast implant surgery

This type of operation has the advantage of causing very little scarring. But the breast won’t feel as natural as it would if made with living tissue. It is likely to be firmer, less mobile, and feel colder. 

Even though silicone is safe, it is foreign to your body. Your body might form hardened tissue (a capsule) around the implant. In some women, over many years this may make the breast feel hard and uncomfortable and change its shape. This is called capsular contracture. So the breasts might gradually look uneven (asymmetrical). You might need surgery to change the implant or to the other breast to even them up.

People may need further surgery more often after implant breast reconstruction, than after living tissue reconstruction.

If you have an implant reconstruction after a mastectomy, you might need to have the skin stretched using a tissue expander implant first. Without stretching the skin, there might not be enough to make the breast shape.

Possible reasons for not having an implant reconstruction

This type of reconstruction is not always recommended if you are having radiotherapy to the area. Radiation increases the risk of the implant becoming hard and might distort the shape of the breast. It can also make the skin less stretchy. 

Your surgeon will talk to you about the options for reconstruction if you need radiotherapy.  

You can't have this type of reconstruction if you have had a radical mastectomy because the chest muscles will have been removed.

Types of breast implant surgery

There are two main ways of doing implant surgery. The surgeon might put a permanent implant under the chest and muscle during the mastectomy operation. Or you might have a tissue expander implant inserted instead. A tissue expander is a type of implant that is gradually expanded using salt water (saline) to stretch the skin. 

A tissue expander can be temporary or permanent. 

You can find out more about tissue expander implants further down the page.

Immediate implant reconstruction

For this operation, your surgeon removes the breast tissue (mastectomy) and replaces it with an implant. The implant creates a new breast shape. Your surgeon will try to match this to your other breast as much as possible but it will not look the same.

Surgical mesh to support the implant 

During the operation, your surgeon may also use a surgical mesh called an acellular dermal matrix (ADM). This helps to keep the implant in place and create a natural droop.

The mesh can be synthetic or made from pig skin or cow skin. Using pig or cow skin might not be acceptable to some women. Talk to your surgeon if this applies to you.

In women with large breasts, the surgeon can reduce the size of the opposite breast and use some of the spare skin to cover and support the implant instead of using ADM.

Tissue expander implant

A tissue expander is an empty implant that is gradually filled with salt water (saline) over time. The outer shell of the implant is made of silicone.

You can have this as an immediate or delayed reconstruction. 

With this type of reconstruction, the expander slowly stretches your skin and chest muscles over a few months. Tissue expansion can be a good method of reconstruction if you have quite small breasts. It gives a good appearance and you don’t need to have a major operation. 

A tissue expander implant can be temporary or permanent.

You might not be able to have an expander implant if you have large breasts or if you had radiotherapy to the area. Radiotherapy makes the skin less stretchy so it may not suitable for this type of surgery.

How you have tissue expansion

For an immediate reconstruction, your surgeon removes the breast tissue and fits a tissue expander implant under the skin and muscles of your chest. If you have this as a delayed procedure the surgeon usually places the expander implant through the mastectomy scar. 

A couple of weeks after surgery when the scars have healed they inflate it a little at a time. They do this by putting sterile saline through a valve attached to the implant.

You go back to the hospital every couple of weeks to have more saline added. It usually takes 8 to 12 weeks to stretch the skin enough. The whole process can take about 3 to 6 months.

There are two ways of doing this:

• stretching the skin enough with fluid in the expander and then replacing it with a permanent implant
• leaving the silicone covered expander in place

The advantage to replacing the expander with a silicone implant is that the silicone gel implant has a more natural feel than the silicone covered fluid in the expander. But keeping the fluid filled expander means that you don't need to have a second operation.

If you are having the expander left in, your surgeon inflates it until it is slightly larger than your natural size. They leave it for 2 to 3 months. Then the surgeon deflates it to the right size by removing some of the saline. This gives your breast a natural droop. Your surgeon removes the valve when the breast has settled. This is usually as a day case. 

If you are having the expander replaced, you have an operation to remove the tissue expander and the surgeon puts a silicone implant in its place. This operation takes about an hour. You might have this as a day case but some people may stay in hospital overnight. 

Possible side effects

Your breast might feel very tight and uncomfortable for 48 hours or so each time you have fluid added.

As time goes on, your new breast is likely to become less of a match for your remaining breast. The reconstructed breast might harden, and doesn't droop naturally with age.

Are there risks with using implants?

Some people worry that implants could cause other illnesses. Surgeons in the UK follow strict safety standards when using implants. 

You can discuss which type of implant might be the best for you or whether you might prefer other types of reconstruction. 

Do talk to your surgeon if you have had breast implants and are worried.

Breast Implant Associated Anaplastic Large Cell  Lymphoma (BIA-ALCL)

A small number of women who have implants can develop a rare type of lymphoma of the breast. You will have regular follow up appointments after surgery and your surgeon will check for any signs of lymphoma. Let your surgeon know if you notice any lump in the breast or if the breast becomes swollen. This type of lymphoma is usually easy to treat with surgical removal of the lymphoma and the implant.

There are studies to find out more about this. In one study doctors want to understand more about how changes to certain genes, proteins, and sugars could affect how BIA-ALCL develops. This may help develop new treatments for this condition in the future.

Connective tissue diseases (breast implant illness)

In the past, there has been concern that implants filled with silicone gel could cause connective tissue diseases or autoimmune diseases. These are illnesses where something triggers the body's immune system to attack its own tissues. They include conditions such as arthritis and skin conditions and might cause muscle and joint pains.

Some women who have had implants filled with silicone gel have developed these illnesses. Some of the women feel strongly that the gel inside their implants leaked out and caused their illnesses.

A great deal of research has been done to check for a link between silicone and these connective tissue diseases. All the studies have shown that there are no more cases of connective tissue disease in women who have had silicone gel breast implants than in the general population. There is no evidence that silicone causes these illnesses.

In the UK, the Government has asked experts to review the evidence on this several times. Each of these reviews has found that there is no evidence of harm caused by silicone implants.

How long do silicone implant last?

The implant can remain in place for many years if there are no problems, but it's possible that you may need a replacement at some time. 

After breast reconstruction using implants

Arm and shoulder exercises

After the surgery, you will need to do some exercises to get your arm and shoulder moving properly again. Your nurse or physiotherapist will show you what to do and explain when to do the exercises.

While doing the exercises, it helps to wear a supportive and comfortable bra that is not under-wired. The types that have a front fastening are easier to get on and off. If you have any swelling, you may need a slightly larger size than usual for a short time. Your bra can often help to support and mould the reconstruction. Your surgeon or breast cancer nurse can advise you about this. 

• Exercises after implant reconstruction

Recovery

It can take about 4 to 6 weeks to recover from implant reconstructive surgery. For some people, it may take longer. This depends on the type of surgery you have and if you have any problems after surgery.

Follow up

This will vary, your nurse will let you know how often you will need follow up appointments. 

You will still have regular mammograms on your other breast. You will not need one for the reconstructed breast unless you have some remaining breast tissue. Do ask your nurse if you are not sure. 

Surgery to the other breast

Your other breast is likely to change as you get older or if you gain or lose weight. You may need surgery to your natural breast to get a better match.

• Find out more about breast reconstruction and possible problems

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References

• Early and locally advanced breast cancer: diagnosis and treatment
  National Institute for Health and Care Excellence (NICE) July 2018

• Early Breast Cancer: ESMO Clinical Practice Guidelines
  F Cardoso and others 
  Annals of oncology, 2019. Volume 30, Pages 1194-1220

• Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL): an overview of presentation and pathogenesis and guidelines for pathological diagnosis and management
  J Jones and others
  Histopathology, 2019. Volume 75, Issue 6, Pages 787-796

• Association of Breast Surgery (ABS), British Association of Plastic, Reconstructive & Aesthetic Surgeons (BAPRAS),  Breast Cancer Now (BCN)

  How long can you keep a breast expander in?

  If you are having the expander left in, your surgeon inflates it until it is slightly larger than your natural size. They leave it for 2 to 3 months.

  When do breast expanders come out?

  Removal of the expander and exchange for a permanent implant are delayed 8-12 weeks following complete expansion to prevent tissue recoil. Some reports describe the use of a single implant expander allowing a single-stage reconstruction.

  Can breast expanders be left in too long?

  Answer: Tissue expanders can stay in a long time It is not likely to cause problems. However, it is not designed to be a permanent prosthesis so it is firmer (to accommodate the port) and may rupture. Even if that happens, release of saline into the pocket is not generally a concern.

  How long do you wear expanders after mastectomy?

  Tissue expander removal Depending on how much stretching is needed, the process of pumping up the expanders may take three to seven months.