Reconstruction

Implant-based breast reconstruction

Implant-based reconstruction rebuilds the breast after mastectomy using a silicone implant — usually at the same operation. It is a shorter procedure than autologous reconstruction, with no second surgical site, and is the most commonly performed type of reconstruction in the UK. Dr Fiona Tsang-Wright (GMC 4549831), Consultant Oncoplastic and Reconstructive Breast Surgeon, operates privately in London and Buckinghamshire at the Women's Health Centre – Harley Street, Women's Health Centre - King's Road, and The Chiltern Hospital, and as NHS Consultant at Bucks Breast Unit, Buckinghamshire Healthcare NHS Trust.

Decision 1
Am I a candidate?
Decision 2
One-stage or two-stage?
Decision 3
After reconstruction

Quick answers

Is it done at the same time as my mastectomy?

Usually yes. Immediate reconstruction is the preferred approach for most patients at Breastory.

How long does an implant last?

Modern implants have no set lifespan. Many last 10–20 years or more — but most patients will need revision or replacement at some point in their lifetime.

What is pre-pectoral placement?

The implant is placed in front of the chest muscle, not behind it — now the preferred approach as it preserves muscle function and avoids animation deformity.

Does it affect radiotherapy?

Radiotherapy can cause capsule contracture (scar tissue hardening) around an implant. If radiotherapy is likely, a two-stage approach or autologous reconstruction may be preferred. Discussed in detail at consultation.

01
Decision 1 of 3

Am I a candidate?

One operation
Direct-to-implant (one stage)

The definitive implant is placed at the time of mastectomy. One operation, a defined timeline, and a reconstructed breast from the moment you wake. Best when the skin envelope is well preserved and radiotherapy is not planned.

Two operations
Two-stage (expander then implant)

A temporary tissue expander is placed at mastectomy and gradually inflated over several clinic visits. A second operation then exchanges it for the definitive implant. Better for tight skin envelopes or where radiotherapy is expected.

The type chosen depends on the cancer, your anatomy, and your preferences. This is a detailed conversation at consultation, with written information to take home — not a decision made on the day.

03
Decision 3 of 3

After reconstruction

Immediate reconstruction is done at the same operation as the mastectomy — you wake up with a reconstructed breast. Most patients without planned radiotherapy are candidates.

Delayed reconstruction is done months or years later, once adjuvant treatment (particularly radiotherapy) is complete. Radiotherapy can affect reconstruction outcomes — particularly implants — and in some cases a delayed approach gives a better long-term result. This is a case-by-case discussion.

At a glance

The operation

Anaesthetic General
Duration (direct-to-implant) 2–3 hours
Duration (two-stage) Two separate operations
Hospital stay 1–2 nights
Recovery 4–6 weeks
Second surgical site None
After surgery

Recovery

Days 1–2
In hospital

Drains usually removed before discharge. Limited overhead arm movement initially. Pain is well controlled with regular analgesia.

Weeks 1–2
At home

Rest; avoid heavy lifting. Wound check at 1–2 weeks. Two-stage patients begin clinic expansion visits after wound healing.

Weeks 2–6
Gradual return

Increasing activity; avoid lifting over 2–3 kg until 6 weeks. Most desk-based work can resume at 4–6 weeks.

6 weeks+
Return to normal

Full activity including exercise. Two-stage patients: second operation (exchange) scheduled once expansion is complete. Final shape settles over 3–6 months.

Follow-up appointments are at two weeks, six weeks, three months, six months, one year, and then annually.

What implant reconstruction is

Implant-based reconstruction rebuilds the breast shape after a mastectomy using a silicone implant, typically placed at the time of mastectomy (immediate reconstruction) or later as a staged operation. Compared with autologous reconstruction, it is a smaller operation with a shorter recovery and no second surgical site — but it is a device-based reconstruction, and the implant will eventually need revision or replacement.

Modern implant reconstruction at Breastory uses a pre-pectoral approach wherever possible — the implant placed in front of the chest muscle rather than behind it — supported by an acellular dermal matrix (ADM) or synthetic mesh. This avoids the functional and aesthetic problems of putting an implant under the muscle, and is now the preferred approach in most UK specialist units.

One-stage vs. two-stage

There are two main ways to reach the final reconstructed breast:

Direct-to-implant (one-stage)

The definitive implant is placed at the time of the mastectomy, in a single operation. This is the preferred approach for most patients when:
– The skin envelope is well preserved and well vascularised
– The volume required matches what the skin envelope can comfortably hold
– Radiotherapy is not anticipated, or the team and patient have discussed the trade-offs if it is

Advantages: one operation, a defined timeline, and a reconstructed breast from the moment you wake up.

Two-stage (tissue expander, then implant)

A tissue expander is placed at the time of mastectomy. It is a temporary device that is gradually inflated over a number of clinic visits after surgery, stretching the skin envelope to the required size. Once the expansion is complete, a second operation exchanges the expander for the definitive implant.

Two-stage is preferred when:
– The skin envelope is tight or has limited blood supply
– A larger final volume is required than the skin can initially accommodate
– Radiotherapy is likely to be needed (the expander tolerates the treatment period while decisions are made)

Advantages: more predictable skin healing, and the ability to tailor the final volume once the tissues have recovered from the mastectomy.

Pre-pectoral vs. sub-pectoral placement

Pre-pectoral (pre-muscle) placement positions the implant in front of the pectoralis major muscle, supported by an ADM or mesh. This is now the first choice for most patients at Breastory because it:

  • Preserves normal chest muscle function
  • Avoids animation deformity (the implant moving or distorting when the chest muscle contracts) seen with sub-pectoral implants
  • Gives a more natural appearance in many body types
  • Is less painful in recovery

Sub-pectoral (sub-muscle) placement — where the implant sits partly or fully behind the chest muscle — is still used in selected cases, particularly where the overlying skin envelope is thin and needs the additional muscle cover. It is no longer the default approach for most patients.

Acellular dermal matrix (ADM)

An acellular dermal matrix is a sheet of processed human or porcine tissue, used to support the lower half of the implant and hold it in position. Synthetic mesh alternatives are also used. ADMs allow pre-pectoral reconstruction to be done reliably and have been an important step in the evolution of implant reconstruction.

Different ADM products have different properties and costs; the specific product used is chosen at consultation and is typically covered by private medical insurance as part of the reconstruction.

The operation

  • Anaesthetic: general anaesthetic.
  • Length of operation: typically 1–2 hours for direct-to-implant; slightly shorter for a tissue expander at mastectomy. A sentinel lymph node biopsy adds around 30–45 minutes and is usually done at the same operation for invasive cancers.
  • Hospital stay: 1–2 nights typically.
  • Drains: typically 1–2 surgical drains, staying in for a week or so until daily output is low.

Risks and longer-term considerations

Early risks:
– Infection — 1–5% in specialist practice. Early infection can sometimes be salvaged with antibiotics; a persistent or severe infection may require removal of the implant and reconstruction at a later date.
– Skin healing problems — particularly at the edges of a thin skin flap. Usually managed conservatively; occasionally requires a small return to theatre.
– Haematoma or seroma — collection of blood or fluid that may need drainage.

Longer-term:
– Capsular contracture — the normal capsule of scar tissue that forms around every implant occasionally tightens, distorting the implant and causing firmness or pain. Quoted ranges of 5–20% over the life of an implant are common; radiotherapy approximately doubles the risk of significant capsular contracture and is associated with higher implant-loss rates in national audit data (NMBRA).
– Implant rupture — modern silicone implants can rupture silently; rupture is usually managed by exchange. Modern implants typically last 10–15 years or more but do not last forever.
– Implant revision or exchange — expected as part of the long-term arc of implant reconstruction. Not every patient needs a revision, but it should be planned for.
– BIA-ALCL — breast implant-associated anaplastic large cell lymphoma. A rare condition (reported in the UK at around 1 in 12,000–15,000 implants sold (MHRA, 2024 update). It is associated almost exclusively with textured implants — predominantly macrotextured devices such as Allergan Biocell (withdrawn in the UK) — and there are no confirmed cases in implants that were only ever smooth. MHRA requires surgeons to discuss BIA-ALCL at consent.

Breast implant illness (BII) describes patient-reported systemic symptoms some people attribute to implants. BII is not a proven diagnosis; MHRA monitoring continues, but symptoms are discussed at consent.

Implant details are recorded on the NHS Breast and Cosmetic Implant Registry (BCIR).

Who implant reconstruction suits

Implant reconstruction is a good choice for many patients, particularly:

  • Those who want a shorter operation and faster recovery
  • Patients with a slimmer body habitus for whom autologous reconstruction would take excessive donor tissue
  • Patients whose work or caring responsibilities do not permit a longer recovery
  • Patients who do not want the abdominal scar of a DIEP

It is less suited to patients for whom radiotherapy is planned (where autologous reconstruction or delayed reconstruction may give better long-term results), patients with tight or poorly vascularised skin envelopes (where a two-stage approach may still be feasible but autologous may be preferable), and patients who want a reconstruction that changes with their body over time.

Common questions The questions patients ask first

Do I need to replace the implant every ten years?
Not routinely. Modern implants often last considerably longer than ten years. What is true is that implants are devices with a finite life, and some patients will need a revision or exchange over the course of their lifetime. This should be planned for rather than treated as failure.
Will I have sensation in the reconstructed breast?
Sensation in the chest wall and skin is significantly reduced after any mastectomy and reconstruction, regardless of approach. Some patients regain a degree of sensation over months to years; most do not return to pre-operative normal.
What does the implant feel like?
Modern silicone implants have a soft, gel-like feel. A reconstructed breast will feel different from a natural breast — particularly in terms of weight, movement, and temperature — but the specific feel varies considerably by the implant chosen, the skin envelope, and the individual.
Can I have radiotherapy if I have an implant reconstruction?
Yes, it is possible — but radiotherapy increases the risk of implant-related problems including capsular contracture. If radiotherapy is planned, your team will discuss whether a different sequence (delayed reconstruction, or autologous instead) gives a better long-term result for your specific situation.
What is BIA-ALCL and should I be worried?
BIA-ALCL is a rare lymphoma associated predominantly with macrotextured implants (UK MHRA pooled risk roughly 1 in 12,000–15,000 implants sold). Smooth-only implants have no confirmed cases. Patients with implants should report any late new swelling, lump, or fluid around an implant, as these can be early signs — but the risk in absolute terms is very low.
Explore

Related terms