Implants

Prothetic implants can be used to reconstruct the breast after mastectomy for breast cancer. They may be placed in a subcutaneous or subpectoral position. Generally, the latter is preferred as there is a tendency to complications such as extrusion and skin necrosis with subcutaneous positioning. It is now possible to create a pocket for the implant using endoscopic techniques from an axillary incision.

Problems related to implants include:

• capsule formation of fibrous tissue around the implant:
  • may cause pain and distortion of the breast
  • may necessitate removal of implant and excision of capsule with or without insertion of new implants
• leakage of gel filling from implant:
  • leak of silicone has been suggested as a cause of connective tissue disease; the evidence is poor
  • necessitates removal of implant
• implant 'riding up' into the superior half of the breast: usually because a pocket of suitable size has not been created
• patient feels that the breast does not have the normal consistency of original breast tissue