This page was reviewed under our medical and editorial policy by
Daniel Liu, MD, Plastic and Reconstructive Surgeon
This page was reviewed on February 8, 2022.
While mastectomies are a life-saving measure for people with breast cancer or those at high risk for developing it, breast removal may be traumatic physically and mentally.
After a mastectomy, you have multiple options:
If you’re considering breast implants, take the time to learn more about the options and procedures.
Breast implants are breast-shaped silicone bags, which may be smooth or rough, that are either filled with sterile saltwater (saline) solution or silicone gel. Smooth implants move around inside the breast more, mimicking natural movement, but rough implants are less likely to shift over time.
Silicone and saline implants have been used since the 1960s, but the U.S. Food and Drug Administration (FDA) put a hold on silicone implants outside of clinical trials in the ’90s due to potential health risks. Recent versions of silicone implants were approved by the FDA in 2006, and no studies have shown definitive links to autoimmune diseases or issues caused by leakage.
Because of the texture of the silicone gel, these implants feel more like natural breast tissue. Saline is a watery fluid that creates a “sloshing” feel to your breast. You’re also more likely to feel the shape of the saline implant under the skin.
As newer silicone implants evolve, they’re being filled with gels of different degrees of stiffness. You can get stiffer, or more cohesive, gel implants that are a bit thicker in texture and more likely to keep their shape over time, or looser gels that mimic the natural breast movement a bit better.
Once you decide to undergo breast reconstruction, you need to choose between getting implants or having your breasts reconstructed using fat and skin from other parts of your body.
Implants mean a quicker surgery and a shorter recovery period, and they don't leave scars on other parts of your body. However, breasts made of your own tissues may be more aesthetically pleasing and feel more natural.
Other issues to consider include:
On average, patients who undergo breast reconstruction report being happy with the outcome. Of those with implants, about 61 percent to 78 percent expressed satisfaction with the results, according to a 2017 review in the Annals of Medicine and Surgery. Satisfaction rates for patients who had breasts reconstructed from their own tissues were 72 percent to 79 percent. Complications may affect satisfaction rates with implants down the line—five years after surgery, satisfaction decreased to 54 percent.
If you choose implants, you’ll need to decide what type of implant to get and think through the size and shape you want for your reconstructed breasts.
Try asking other survivors who got implants about their experience. They may have a good doctor to recommend or suggestions about factors you hadn’t considered.
If you’re undergoing a mastectomy, you may be eligible to have the implants inserted during the same procedure. This type of implant surgery, called direct-to-implant reconstruction, preserves the most breast skin, but it does not eliminate the potential need for more surgeries down the line.
Another common option is to prepare your body for implants over several steps, called a staged breast reconstruction. This surgery usually involves the use of an implant called a tissue expander, which is slowly filled with fluid to stretch out the skin.
Some types of breast cancer may require completing cancer treatment before reconstruction begins. Breast cancer radiation treatment, especially, may delay healing and cause new scarring or lead to infections in the reconstructed breasts, complicating recovery. Delaying reconstruction may also let you focus on getting treatment, improving your health, and quitting smoking if needed.
The biggest risks of getting breast implants are due to the repeated surgeries needed during staged breast reconstruction. These include the risk of undergoing anesthesia multiple times, especially for patients in poor health, with multiple health conditions, or those who are older than 65, obese or have other complicating factors such as high blood pressure or smoking.
You may need additional surgeries to refine the breast tissue, remove scar tissue or balance out breast size or shape. Some patients end up with uneven or asymmetrical breasts in terms of size, shape or level. They may also experience pain or thinning of the skin around the breast. Visible wrinkling of the implant shell or the implant edges may affect thinner women. Aging and weight change will also change the size and shape of the breast, so it's important to remember that implants will not change as the rest of the body changes.
The other risk of breast implants comes from the possibility of infection, and you may need antibiotics or even removal of the implants while your body heals.
A rare type of cancer called anaplastic large cell lymphoma (ALCL) has been reported in patients who have gotten implants, usually textured ones. It tends to crop up about eight to 10 years after the placement of implants. ALCL is a cancer of the white blood cells, not of the breast. Keep an eye out for:
Some patients who have received breast implants have reported a variety of systemic symptoms, including joint pain, fatigue, rash, memory loss and “brain fog” that some patients have called breast implant illness. While the causes of these symptoms are unclear, some patients have reported relief after removal of their implants and surrounding scar tissue capsule, though not all of these patients may experience improvement in their symptoms. Researchers are working to better understand the possible link between breast implants and these symptoms.
Healing from surgery may be more successful and take less time for patients who don’t smoke cigarettes or use other nicotine products. Consider quitting smoking and asking your doctor for help if you’ll be undergoing multiple surgeries. It may have a real impact on your outcome and healing process.
Make sure you have plenty of soft, loose shirts and supportive (but not underwire) bras for the post-surgery period. If using tissue expanders, you may want to look into getting a breast form or padding to help make up the difference, especially if you’ve only had a single breast removed.
If breast implants are inserted during the mastectomy, your surgeon places the implant on top of or under the chest muscle to replace what was removed.
If you’re receiving a staged breast reconstruction, the tissue expanders are slowly filled with saltwater over weeks, until they’re about 110 percent to 120 percent bigger than the size of your eventual implants. These expanders may be implanted directly after the breasts are removed or after additional treatments. About six weeks after the final filling, your doctor swaps out these expanders with new implants in an outpatient procedure.
If you’ve undergone radiation treatment, your surgeon also removes any scar tissue that has formed from those treatments.
Your doctor may prescribe antibiotics after your implant surgery and recommend you use a supportive bra for the first month. Avoid intense physical activity for the first four to six weeks.
During either the original mastectomy or tissue expander placement, you may have drains inserted into the chest area to eliminate fluids that may build up in the surgical site during the healing process. A small empty ball catches the fluid, and the doctor or nurse can teach you how to empty it. This drainage tube is removed at some point after the implant operation, depending on how long healing takes.
It may take up to eight weeks for bruising and swelling to subside after placement of your breast implants. It may take up to two years for scars to fade and the tissues to fully heal.
After your breast implants have healed, you may also need to get your nipple reconstructed. You may have one built from tissue or tattooed. The nipple reconstruction is usually the last step in the staged breast reconstruction.
Still, it’s important to get your silicone implants checked out with a magnetic resonance imaging (MRI) scan every few years to ensure they haven’t ruptured.