Implants can be used to reconstruct the breast after mastectomy or lumpectomy. Depending upon the type of mastectomy, either a tissue expander or an immediate implant can be placed (skin sparing vs total mastectomy). If a tissue expander is needed it is placed behind the muscle of the pectoralis major and an alloderm sling may be used to help define and shape the pocket. Expansion via an injection of sterile saline is accomplished in the office setting beginning week 3 , to allow for the overlying skin and tissue to be stretched. The skin is stretched slightly greater then the desired size to allow for a smooth contour once the final implant is placed.
Implants are either saline (salt water) or silicone gel based. The latest generation implants are less likely to rupture then previous ones and feel more natural. Gel based implant reconstruction is the most common type performed and can be very naturally in appearance particularly if both sides are reconstructed (bilateral). Anatomic implants (gummy bear) can be offered to produce a more natural appearing breast with a “tear drop shape.”