If you are exploring implant-based breast reconstruction, it can be done in two operations with a temporary tissue expander first, or in a single operation with the implant placed directly. Your surgeon can explain which approach may suit you.
It is one of several routes described in the wider guide to breast reconstruction, and this page explains how the implant route works in general terms.
| Topic | What to know |
|---|---|
| Expander filling visits | Visits are often weekly, depending on expander size. |
| Time before the implant | Chest tissue is usually ready 2 to 6 months after expander placement. |
| Direct-to-implant surgery | It can be done in a single surgery. |
| Implant lifespan | Implants may last 10 to 15 years before removal or replacement. |
| Implant type in Canada | Silicone implants are most commonly used. |
These points come from the Canadian Cancer Society and the National Cancer Institute; information can change, so please check the sources for the latest details.
What implant-based reconstruction involves
A breast implant is a round sac made of rubberized silicone, filled with sterile salt water (saline) or silicone gel, according to the Canadian Cancer Society. The same page notes that silicone implants are the type most commonly used in Canada. The implant sits in a pocket under or over the chest muscle.
The National Cancer Institute explains that breasts can be rebuilt using implants or with autologous tissue, meaning tissue taken from elsewhere in the body, and that sometimes both are used together. Implant-based reconstruction can follow a mastectomy or breast-conserving surgery. The two main variations are a staged approach using an expander and a one-stage direct approach.
The Canadian Society of Plastic Surgeons says the choice of implant, its position and the surgical technique are tailored to each patient.
The two-stage approach with a tissue expander
When the skin and tissue of the chest are too tight or flat to hold an implant straight away, the surgeon needs to make more room first. The Canadian Cancer Society describes an expander as an empty bag with a small valve, like a balloon, placed under the skin or muscle of the chest. Sometimes it is placed during the mastectomy, and it can also be placed in a separate operation later.
After surgery, the expander is filled slowly over a number of visits. A very small needle passes through the skin into the valve to inject saline. The Canadian Cancer Society reports that visits are often weekly, although the schedule depends on the size of the expander and on what the patient and surgeon decide together.
Once the skin has stretched enough, a second operation removes the expander and places the permanent implant. The National Cancer Institute states that the chest tissue is usually ready for the implant 2 to 6 months after the tissue expander is placed. Tissue expanders are covered in more detail in their own article on this site.
The direct-to-implant approach
Direct-to-implant reconstruction is also called single-stage reconstruction because it can be done in one surgery. Instead of using an expander first, the surgeon places the breast implant during the mastectomy or breast-conserving surgery, as the Canadian Cancer Society explains. The same source says it is done less often than tissue expansion.
Surgeons commonly use acellular dermal matrix for this approach. This is a graft made from donated human skin tissue from which the cells have been removed. It is stitched to the chest to form a pocket and acts as a supportive scaffold, like a sling, that helps keep the implant in position. Blood vessels from the body grow into the matrix, and over a few months it is naturally incorporated.
The Canadian Cancer Society adds that this approach may not be available everywhere in Canada, which is a question for the plastic surgeon.
Comparing the approaches
| Feature | Two-stage with expander | Direct to implant |
|---|---|---|
| Operations | Expander placed first, then a second operation for the permanent implant | Implant placed in a single surgery |
| Follow-up visits | Repeated visits to fill the expander with saline | No filling visits needed |
| Support structure | Skin and muscle form the pocket | Acellular dermal matrix commonly supports the implant |
| How common | Used more often | Used less often |
The comparison above draws on the Canadian Cancer Society overview and the National Cancer Institute fact sheet.
Risks, complications and how long implants last
Like all surgery, implant reconstruction carries risks. The Canadian Society of Plastic Surgeons lists infection, bleeding, implant rupture, capsular contracture (scar tissue forming around the implant) and the possible need for future revision surgery.
The National Cancer Institute also lists a collection of fluid called a seroma, pooling of blood called a hematoma, blood clots and extrusion, where the implant breaks through the skin. It notes that obesity, diabetes and smoking may increase the rate of complications. It also describes a very small risk of a very rare form of immune system cancer called breast implant associated anaplastic large cell lymphoma, particularly with textured implants.
The National Cancer Institute further observes that enough skin and muscle must remain after mastectomy to cover the implant, and that implant reconstruction may not be an option for people who have previously undergone radiation therapy to the chest. The Canadian Cancer Society similarly says that after radiation therapy to the chest, a surgeon may not recommend breast implants because there may be more complications after surgery.
Timing around radiation is a common discussion point. The National Cancer Institute explains that radiation therapy can sometimes cause wound healing problems or infections in reconstructed breasts, so some people prefer to delay reconstruction until radiation therapy is completed. It adds that, because of improvements in surgical and radiation techniques, immediate reconstruction with an implant is usually still an option for people who will need radiation therapy. Whether that applies in a particular case is something the surgical team assesses individually.
Anyone who notices side effects or complications that may come from implant surgery is encouraged by the Canadian Cancer Society to tell the healthcare team, because the sooner a problem is reported, the sooner the team can suggest ways to deal with it.
An implant is not a permanent device. The Canadian Cancer Society says breast implants may last 10 to 15 years before they need to be removed or replaced, and that the risk of rupture increases as an implant gets older. An implant may also need to be removed or replaced if it moves, changes shape or if too much scar tissue forms around it.
The Canadian Society of Plastic Surgeons likewise says breast implants are not lifetime devices and may require replacement or additional procedures over time. The choice between filling materials is covered in the comparison of silicone vs saline breast implants.
How implants compare with tissue-based options
Implants are only one option. The National Cancer Institute says implant reconstruction involves a shorter surgical procedure than reconstruction with autologous tissue, with little blood loss, and that the recovery period may be shorter. Its fact sheet describes autologous reconstruction as a longer operation that may give a more natural breast shape.
The best-known tissue-based technique uses abdominal tissue, explained in the article on DIEP flap reconstruction. Which approach suits a given person depends on their anatomy, health and treatment plan. Decisions about surgery and recovery belong with the reader’s own surgeon and care team, who can explain the options for each individual.
Frequently asked questions
Is implant-based reconstruction done in one operation?
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It can be. Direct-to-implant reconstruction places the implant during the mastectomy in a single surgery. The expander route needs a second operation to swap the expander for a permanent implant.
What is a tissue expander?
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It is an empty bag with a small valve, like a balloon, placed under the skin or muscle of the chest and slowly filled with saline to stretch the tissue.
Do breast implants last forever?
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No. The Canadian Cancer Society says implants may last 10 to 15 years before they need to be removed or replaced.
Are silicone or saline implants more common in Canada?
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According to the Canadian Cancer Society, silicone implants are the type most commonly used in Canada.
