The body’s natural healing process plays a crucial role in the acceptance of breast implants. Instead of outright rejecting them, the immune response causes the body to form a capsule of scar tissue that holds the implants in place. While incision healing is a significant part of recovery, this internal healing process takes several weeks to months, providing reassurance about the body’s ability to adapt.
Breast Reconstruction vs. Breast Augmentation
Choosing the right implant shape is a crucial decision in breast augmentation, a popular cosmetic procedure that enhances the size and shape of a woman’s breasts. If you are interested in having breast reconstruction, your plastic surgeon will be there to guide you through the different options and help you make the best decision for your unique situation, providing a sense of support and guidance.
While breast implants are a successful option for cosmetic breast augmentation in women who have not undergone mastectomy, the challenges they present in breast reconstruction make them a less ideal choice for many women. Understanding and acknowledging these challenges is integral to the journey; you are not alone in facing them.
The types of reconstruction that are offered after a mastectomy or breast-conserving surgery include breast, autologous breast reconstruction, and nipple and areola reconstruction.
Why is there such a difference when both procedures use implants? First, women who have implants placed for cosmetic breast enlargement have natural breast tissue that covers the implants and acts as a protective layer, helping to prevent the capsule that invariably forms around an implant from being noticeable. When all the breast tissue has been removed by mastectomy, only a thin layer of skin remains.
The absence of breast tissue after mastectomy can make it more challenging to achieve a natural look and feel using breast implants. Second, since a synthetic implantable prosthesis has a fixed shape and cannot be sculpted, achieving a satisfactory degree of symmetry with the natural breast may be difficult if a woman has only one breast reconstructed with an implant. The struggle to match an implant to the shape of the other breast’s natural tissue is a significant challenge in breast reconstruction.
While complications and unplanned reoperations can occur after cosmetic breast augmentation, they are significantly less common than after implant reconstruction, highlighting the difference in outcomes between the two procedures.
Understanding Breast Implants
Understanding the two main options, teardrop and round implants, is crucial as it empowers you to make an informed decision that aligns with your personal goals and preferences. Each option offers distinct advantages and aesthetic outcomes; knowing these differences can boost your confidence in your decision.
Breast Reconstruction Procedures
Regarding the several types of reconstructive surgery available, it’s important to remember that the process often involves more than one operation. It’s crucial to take your time to make the best decision for you. This reassurance can help you feel patient and confident in your choice.
The two main types of breast reconstruction are implant reconstruction and tissue (flap) reconstruction. Sometimes, the implant and flap procedures are used together to rebuild a breast.
For all types of breast reconstruction, it’s important to remember that there is often an opportunity for future “touch-up” procedures, such as fat grafting and scar revisions. This knowledge can help you feel secure and informed about the long-term process of breast reconstruction.
Factors to Consider When Choosing Breast Implants
Each woman has unique anatomical characteristics, shapes, sizes, and proportions. That’s why breast implants also come in different shapes and sizes. Some women prefer to enlarge their breasts with small implants, others with large ones that stand out. At the same time, some patients want the bust to take a round and pronounced shape after the operation. Others, on the contrary, want their breasts to have a natural appearance so that it is difficult to guess whether they are augmented or not. You can get the desired effect in whatever situation you find yourself in.
Thus, your breast reconstruction can be performed with round or anatomical implants, the choice of shape, size, and projection being made in correlation with the following factors:
Characteristics and dimensions of your body
First and foremost, you should consider your body’s size and proportions. You want to choose an implant that looks proportionate to the rest of your figure. You may wish to select a larger implant if you have broad shoulders or a larger frame. Smaller implants are usually the better choice if you have a petite figure. It is also essential to consider your desired aesthetic outcome. Some women prefer a rounder, more voluptuous look, while others prefer a more natural shape.
Existing Breast Tissue
Another factor to consider when selecting an implant type is the type of breast tissue you have. If you have a lot of natural breast tissue, a larger implant may work better for you, as it can be hidden behind your existing breast tissue to create a more natural look. However, if you have very little natural breast tissue and want to achieve dramatic results with larger implants, then a shaped implant might be the ideal choice.
Lifestyle
Finally, you should consider your lifestyle when selecting an implant shape. If you lead an active lifestyle and plan to participate in many physical activities, round implants may be the best option as they are less likely to move around or shift with movement. On the other hand, if you lead a more sedentary lifestyle, shaped implants may be a better choice as they provide more stability and won’t shift as easily.
Lifestyle and activities
While your lifestyle and activities may influence your decision, the shape of the best implant for you will ultimately depend on your body shape and desired appearance. Your plastic surgeon, a trusted expert in the field, can guide you on which implant shape may best meet your goals and deliver the expected results. Choosing between teardrop and round implants depends on several factors:
Teardrop Implants
Teardrop implants, or anatomical implants, beautifully mimic the breast’s natural contour, providing a more natural and fuller shape. They are fuller at the bottom and taper towards the top, closely resembling the natural slope of the breast.
Advantages of Teardrop Implants
- Natural shape: Teardrop implants offer a more natural breast shape, especially for women with little natural breast tissue.
- Less upper pole fullness: These implants provide a subtler upper breast contour, ideal for a more modest breast augmentation. ‘Upper pole fullness refers to the fullness in the upper part of the breast, and ‘natural breast shape’ refers to the shape that closely resembles the natural slope of the breast. Teardrop implants are suitable for reconstructive surgery and are often used in breast reconstruction to achieve a more natural appearance.
- Mild breast lift: The relatively higher volume in the lower part of the implant helps tighten the lower pole breast tissue, resulting in a slight breast lift.
Disadvantages of Teardrop Implants
- Higher cost: Teardrop implants are generally more expensive than round implants.
- Risk of rotation: If the implant rotates, it can cause an unnatural breast appearance.
More complicated surgical procedure:
Placing teardrop implants requires a more precise technique, making the surgery more complex. This complexity is due to the need for precise implant positioning to ensure a natural-looking result.
Round Implants
Round implants are symmetrical and provide a more pronounced fullness in the upper part of the breast, resulting in a more rounded breast shape. They are often preferred to achieve a fuller, more voluptuous look.
Advantages of Round Implants
- More upper pole fullness: Round implants enhance the upper part of the breast, giving a fuller appearance.
- Less expensive: Generally, round implants are more affordable than teardrop implants.
- No rotation implications: Since round implants are symmetrical, any rotation does not affect the breast’s shape.
Disadvantages of Round Implants
- Less natural shape: Round implants can appear less natural compared to teardrop implants, especially in women with modest breast tissue. ‘Modest breast tissue’ refers to a smaller amount of natural breast tissue, which may result in a less natural appearance with round implants.
- Possible unnatural appearance when lying down: Round implants may look less natural, as the fullness remains in the upper pole.
Considerations When Choosing Implants
- Personal aesthetic goals: Your desired breast shape and size will influence your choice.
- Body type and breast anatomy: The amount of natural breast tissue, the degree of breast droop, and your overall body shape are critical considerations.
- Lifestyle and activity level: Your daily activities and exercise routine can impact the type of implant best suited for you.
Specialty Bras after Breast Cancer Surgery
When choosing a post-mastectomy garment, your comfort and healing are our top priorities. We understand the sensitivity of your chest area after breast cancer surgery, and we are here to help you feel as comfortable as possible.
Breast cancer surgery, and sometimes radiotherapy, may make your chest area feel particularly sensitive. Wearing a bra may make you feel more comfortable, but this isn’t always true. Your surgeon or breast care nurse may advise you on what bra to wear depending on the type of surgery you have had. You don’t need to wear a specific post-surgery or mastectomy bra unless you are advised.
If you are not advised about bras following surgery, check with your surgeon or breast care nurse about what to wear.
In the first few weeks after surgery, most women wear a soft, non-wired bra that isn’t too restrictive. Men who have had breast cancer surgery will be advised by their treatment team on how they can make the area treated by surgery more comfortable.
Bras After Breast Reconstruction
If you have had breast reconstruction, you may be advised to wear a bra initially during the day and night after your surgery. Many women are concerned about finding comfortable and well-fitting bras following breast reconstruction. Your surgeon will advise you on what bra to wear depending on your type of reconstruction.
During the recovery period, which can last up to a year after surgery, your shape and size may change due to weight fluctuations and treatment-related alterations. It’s important to remember that your bra needs may also evolve during this time, and that’s perfectly normal.
- While the area recovers from surgery, the nerves repair, and any skin changes, you may want to choose a bra that has the following:
- Don’t wear an underwired bra while the area is recovering from surgery because the underwires can be uncomfortable. However, underwire bras can be worn when the area has healed.
- It’s common to experience some swelling initially after breast surgery. To accommodate this, it’s advisable to choose a bra that is a chest size larger than your usual size. For instance, if you typically wear a 34B, consider a 36 B for a more comfortable fit.
- Choose bras that have a high cotton content. These will be gentler on your skin while it heals and help you stay cooler if you’re experiencing hot flushes.
- Bra strap cushions can make the straps more comfortable on your shoulder and help the bra stay in place. You can buy these from lingerie shops or online.
Once the skin in the chest area has healed and settled down, which may take up to a year, you can wear any bra. However, if you’re planning to wear a prosthesis (an artificial breast form that replaces the shape or all or part of the breast), your bra must fit well and have enough support for your prosthesis.
Bra Purchases After Breast Cancer Surgery
- Mastectomy bras, whether you opt for breast reconstruction or use a prosthesis, are designed to provide comfort following surgery. They are a supportive choice to help you feel cared for during your recovery.
- Mastectomy bras have soft inner linings, which prevent pain or skin sensitivity when healing incisions or scars. Some also come equipped with pockets to accommodate surgical drains.
- Post-mastectomy bras offer comfort following surgery, whether you choose to have breast reconstruction or use a prosthesis.
- Mastectomy bras have soft inner linings, which prevent pain or skin sensitivity when healing incisions or scars. Some also come equipped with pockets to accommodate surgical drains.
Post-Mastectomy Garments
Various types of mastectomy garments are available, and you and your surgeon should discuss which is best. In general, however, look for bras with soft seams and no underwires made from breathable materials.
- Most women can be fitted for a prosthesis once their incisions are healed and the swelling is gone. A prosthesis, or breast form, is a quick and easy way to fill the space where your breast once was. They come in many sizes, shapes, and materials and vary in price.
- Using a lightweight prosthesis after a mastectomy decreases pressure on the incisions.
Since breast surgery sometimes affects your shoulder rotation, you may have trouble pulling a bra over your head or reaching the hooks on a bra that closes in the back.
Soft cup bras, designed to stretch over surgical dressings and provide light compression on incisions, offer a practical solution. The front-closure option ensures ease when putting the bra on and removing it, a feature that can provide reassurance during recovery. As swelling decreases, you can adjust the fit by tightening the bra, making it a versatile choice.
Your breast surgeon may recommend wearing a compression bra or vest after surgery. Compression garments help prevent swelling and fluid buildup as you heal.
The right compression bra or vest will hold your skin in place and prevent stretching around your stitches. This reduces the chance of damaging the incisions and needing surgical revision.
While the idea of a pressure bra may initially seem uncomfortable, it’s important to remember that its added support can make mobility easier. This emphasis on comfort can help alleviate any anxiety about post-surgery garments, making the recovery process more manageable.
Pocketed Bras
A well-fitting bra with a full cup can often support you if you wear a prosthesis. Many women find this combination creates a natural appearance and offers a secure, comfortable fit, boosting their confidence and comfort. However, some women prefer a bra with a pocket to help the prosthesis sit more securely.
If wearing a mastectomy bra isn’t recommended by your surgeon or doesn’t appeal to you yet, then a camisole may be a good choice.
These soft, roomy tops are designed to be loose and should not interfere with drains or scar tissue. As your incisions heal, you can upgrade to lacey and decorative camisoles, a stylish and empowering choice that better suits your style. Custom T-shirts, nightgowns, and pajama tops are also designed with bra cups and breast pockets.
What to Look For
Here are some features to consider when buying post-mastectomy bras and camisoles:
- Wide bands: Wide bands across the shoulders and beneath the breasts ensure the bra will stay put and won’t dig into your skin.
- Adjustable straps and closures: This helps achieve the closest and most comfortable fit.
- No seams: Wearing a seamless bra means less irritation for sensitive and tender skin.
- Comfortable fabric: Breathable fabrics and natural fibers will help reduce sweating.
- No underwire: This prevents rubbing on incisions and scar tissue.
- Minimal detailing: Comfort is key, so avoid itchy, irritating lace.
- Full cups:
- Cup separation: (the center of the bra between the cups should sit flat on your chest)
In the past, there were concerns about potential health issues from ruptured silicone-filled implants, such as connective tissue disease, breast cancer, or reproductive problems. However, current studies show that silicone implants do not increase the risk of these health problems. While some people with breast implants may experience symptoms like joint pain, memory loss, or fatigue, it is not clear if these are related to the implants. More research is being done, but these concerns should not cause undue anxiety.
Healthcare Information
After breast cancer surgery, you may develop a stiff shoulder or arm. Your breast care nurse or a physiotherapist will ask you to do regular exercises after surgery to help you recover. They should give you a leaflet that explains the exercises.
Simple Arm Exercises:
- Keep your movement full in your arm and shoulder
- Relieve pain and stiffness
- Reduce swelling
- Encourage circulation
Exercise after Reconstruction Surgery
Exercising after reconstructive surgery is intended to help you return to normal activities and a full range of movement. It takes time to recover from surgery, and you will likely feel tired at first. The exercises will help keep you moving and prevent your shoulder and back from getting too stiff or tight.
You start by doing gentle exercises and gradually build the whole movement over several weeks. This allows time for your body to heal. From the day after your surgery, you can usually use your affected arm normally up to shoulder height for light activities. Your doctor will tell you if there is any reason why you should not do this.
Some movements should not be done in the first one to two weeks to avoid stretching your wounds. Listen to your body. If you feel tired and achy, you might need to slow down. Your shoulder, chest, and back may feel tight and uncomfortable, but it shouldn’t be too painful.
Participating in the exercises after surgery can help if you are having radiotherapy. It can help improve your arm and shoulder movement, so you can get into the same position for every session when you have radiotherapy. If you do have pain, stop and contact your specialist, physiotherapist, or breast care nurse.
Restraints the First Two Weeks
You should avoid certain activities during the first one to two weeks after surgery. Your surgeon might suggest slightly different timings, so check if you are unsure.
Avoid:
- Lifting your arm above the height of your shoulder
- Lifting or pushing with your arm on the side where you had surgery
- Lifting anything heavier than a bag of sugar
- Pushing yourself up from bed using the arm on the side where you had surgery
- Pushing doors open
- Pulling anything towards you, for example, pulling washing out of the washing machine
Avoiding these things helps your muscles heal. It means that while it all settles down, you don’t overstretch your wounds or the place where the muscle is now attached.
When you fasten your bra, do it up at the front, swivel it around, and put your arm on the side you had surgery on first. When you put your coat on, put the side you had surgery on first in the armhole.
Promote:
During the first two weeks, maintaining good posture and doing the exercises helps prevent your shoulders, arms, and back from becoming stiff, helping you get back to normal activities. Your shoulder, arm, and back may feel stiff, but the stiffness will ease as you do the exercises and start to heal.
It is good to get moving as soon as possible—gentle walking can help you maintain your fitness, heal, and feel better.
Promote Good Posture:
- Imagine that you have a piece of string pulling you up tall from the ceiling
- Think tall and straight
- Lifting your chest up
You will probably feel that your back is quite tight, not just across the scar, but sometimes down the whole side of your back that you had surgery on. This is normal but uncomfortable and can take a while to settle down.
Return to Normal Activities
- In the first one to two weeks, try to move around normally. You can generally use your arm up to the height of your shoulder, but do not lift higher.
- With the arm on the side where you had surgery, you can brush your hair and pick up light things, like a cup of tea.
- Change position regularly to stop getting stiff.
- You may have sex, but don’t lift your arms above your shoulders.
Major Concerns Include:
- For the first few weeks following your surgery, it’s essential to adhere to the guidelines provided by your surgeon, including wearing the surgical bra. This will help support optimal healing.
- Most patients can comfortably transition to various bra styles after approximately three months. By following these guidelines, you’re demonstrating your commitment to your recovery and overall health. Your active participation in your recovery is crucial. Wearing anything other than the surgical bra provided by your surgeon can have detrimental effects on your healing process. It’s not just a garment; it’s a key part of your recovery plan.
Rare Cancers
You may have concerns about how breast implants could affect your health. In sporadic cases, women with silicone gel or saline breast implants can develop a type of non-Hodgkin lymphoma (NHL) called breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). It starts in the scar tissue (capsule) around the implant.
BIA-ALCL occurs more often when the implants have textured (rough) surfaces rather than smooth surfaces. It can show up as a collection of fluids, a lump, pain, or swelling near the implant or as asymmetric (uneven breasts). If you notice any of these symptoms, discussing them with your doctor is crucial. Your proactive approach can make a difference in your health.
Early-stage BIA-ALCL can often be effectively treated with surgery to remove the implant and capsule. In cases where the lymphoma cannot be eradicated, radiation therapy may be used. Chemotherapy and other treatments may be necessary for more advanced diseases. Understanding these treatment options can provide reassurance and confidence in managing the condition.
There have also been rare reports of other types of cancer forming in the scar tissue around a breast implant, including some types of lymphomas (other than BIA-ALCL) and squamous cell carcinoma. These reports are relatively recent, so little is known about these cancers.
Health agencies around the world are still collecting information about the number of women diagnosed with BIA-ALCL. Research suggests that the risk for BIA-ALCL is only related to textured implants rather than those with smooth surfaces.
Illness Risks of Breast Implants
Different types of surgery can cause various side effects. They can also sometimes cause unexpected medical complications. Side effects and complications of breast implant surgery will depend mainly on the type of surgery and your overall health. If you had radiation therapy to the chest as part of breast cancer treatment, your surgeon may not recommend breast implants because you may have more complications after surgery.
Early reporting is key. Tell your healthcare team if you have side effects or complications that you think are related to your implant surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them. Don’t hesitate to communicate any concerns you may have. Your health is your priority.
Possible Side Effects and Complications:
- Infection
- Buildup of fluid (called seroma in the breast)
- Pain
- Scar tissue around the breast implant (called capsular contracture), which makes the breast feel hard and lose its shape
- Movement of the implant
- Wrinkling of the implant, which makes the skin on the breast wrinkle (called animation)
- Swelling near the implant or asymmetric (uneven breasts).
- Leaking or breaking of the implant
SUMMARY
Women who have had surgery to treat breast cancer can choose from several types of breast reconstruction. When deciding what type is best for you, you and your doctors should discuss factors including your health and your personal preferences. Take the time to learn what options are available to you. Before deciding, consider talking to others who have had the procedure.
A breast implant is not permanent. You can remove it if you don’t want to have it anymore. Breast implants may last 10 to 15 years before they need to be removed or replaced. As the implant ages, the risk of rupture increases. A rupture is when silicone or saline leaks out of a hole in the implant. You may also need an implant removed or replaced if it moves, changes shape, or if too much scar tissue forms around it. After a breast implant is removed, the skin in the area where the implant was may show dimpling, puckering, wrinkling, or other changes.
As your shape and size may change during and after treatment, it’s a good idea to check your bra size before buying new bras. You can purchase post-surgery or mastectomy bras from specialist suppliers, in person or online, that are designed for women who have had their breast(s) removed.
It is crucial to have open and detailed discussions with your surgeon about your concerns and questions. This will help determine the best implant shape for your body and goals, reassuring you and making you feel cared for.
References
American Cancer Society
BreastCancerNow.Org
Canadian Cancer Society
Cancer ResearchUK.org
Dr. Michael Kernohan
The Plastic & Reconstructive Surgery Group
VeryWell Health
