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Implant based breast reconstruction and augmentation

Maurice Nahabedian, MD
Section Editor
Charles E Butler, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Modern breast reconstruction began in 1964 with the introduction of the silicone breast implant. Since that time, implants have evolved, although the basic components have remain essentially unchanged. Implants themselves can be filled with either saline or silicone gel.

Breast implants are used either for reconstructive or aesthetic (cosmetic) purposes.

Implants can help restore the breast to normal appearance following a unilateral or bilateral mastectomy for patients with breast cancer, or following risk reduction surgery. Reconstruction can be performed immediately after the mastectomy, or delayed. Implants may also be used for reconstruction of congenital or traumatic defects, and for management of significant asymmetries.

Aesthetic uses for implants improve an otherwise normal breast and include breast augmentation, and less commonly, implants can be used together with a mastopexy.

The prosthetic devices available for reconstruction, choice of procedure, timing, and surgical techniques of implant-based reconstruction will be reviewed here. The use of tissue flaps and grafts for reconstruction is reviewed separately. (See "Overview of breast reconstruction" and "Options for flap based breast reconstruction".)


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Literature review current through: Sep 2016. | This topic last updated: Jun 21, 2016.
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  1. Benediktsson K, Perbeck LG. Fluid retention in Bioplasty Misti Gold II breast prostheses with development of capsular contracture. Scand J Plast Reconstr Surg Hand Surg 2000; 34:65.
  2. Eriksen C, Lindgren EN, Frisell J, Stark B. A prospective randomized study comparing two different expander approaches in implant-based breast reconstruction: one stage versus two stages. Plast Reconstr Surg 2012; 130:254e.
  3. Gahm J, Edsander-Nord A, Jurell G, Wickman M. No differences in aesthetic outcome or patient satisfaction between anatomically shaped and round expandable implants in bilateral breast reconstructions: a randomized study. Plast Reconstr Surg 2010; 126:1419.
  4. Gylbert L, Asplund O, Jurell G. Capsular contracture after breast reconstruction with silicone-gel and saline-filled implants: a 6-year follow-up. Plast Reconstr Surg 1990; 85:373.
  5. Thuesen B, Siim E, Christensen L, Schrøder M. Capsular contracture after breast reconstruction with the tissue expansion technique. A comparison of smooth and textured silicone breast prostheses. Scand J Plast Reconstr Surg Hand Surg 1995; 29:9.
  6. Rocco N, Rispoli C, Moja L, et al. Different types of implants for reconstructive breast surgery. Cochrane Database Syst Rev 2016; :CD010895.
  7. Handel N, Cordray T, Gutierrez J, Jensen JA. A long-term study of outcomes, complications, and patient satisfaction with breast implants. Plast Reconstr Surg 2006; 117:757.
  8. Prado AS, Andrades P, Benitez S. A word of caution on the explantation of polyurethane breast implants. Plast Reconstr Surg 2006; 117:1655.
  9. Gherardini G, Zaccheddu R, Basoccu G. Trilucent breast implants: voluntary removal following the Medical Device Agency recommendation. Report on 115 consecutive patients. Plast Reconstr Surg 2004; 113:1024.
  10. Monstrey S, Christophe A, Delanghe J, et al. What exactly was wrong with the Trilucent breast implants? A unifying hypothesis. Plast Reconstr Surg 2004; 113:847.
  11. Piza-Katzer H, Pülzl P, Balogh B, Wechselberger G. Long-term results of MISTI gold breast implants: a retrospective study. Plast Reconstr Surg 2002; 110:1455.
  12. Spear SL, Parikh PM, Reisin E, Menon NG. Acellular dermis-assisted breast reconstruction. Aesthetic Plast Surg 2008; 32:418.
  13. Salzberg CA. Nonexpansive immediate breast reconstruction using human acellular tissue matrix graft (AlloDerm). Ann Plast Surg 2006; 57:1.
  14. Nahabedian MY. AlloDerm performance in the setting of prosthetic breast surgery, infection, and irradiation. Plast Reconstr Surg 2009; 124:1743.
  15. Salzberg CA, Ashikari AY, Koch RM, Chabner-Thompson E. An 8-year experience of direct-to-implant immediate breast reconstruction using human acellular dermal matrix (AlloDerm). Plast Reconstr Surg 2011; 127:514.
  16. Nanayakkara PW, de Blok CJ. Silicone Gel Breast Implants: What We Know About Safety After All These Years. Ann Intern Med 2016; 164:199.
  17. Breiting VB, Hölmich LR, Brandt B, et al. Long-term health status of Danish women with silicone breast implants. Plast Reconstr Surg 2004; 114:217.
  18. Balk EM, Earley A, Avendano EA, Raman G. Long-Term Health Outcomes in Women With Silicone Gel Breast Implants: A Systematic Review. Ann Intern Med 2016; 164:164.
  19. Burns CJ, Laing TJ, Gillespie BW, et al. The epidemiology of scleroderma among women: assessment of risk from exposure to silicone and silica. J Rheumatol 1996; 23:1904.
  20. Edworthy SM, Martin L, Barr SG, et al. A clinical study of the relationship between silicone breast implants and connective tissue disease. J Rheumatol 1998; 25:254.
  21. Gabriel SE, Woods JE, O'Fallon WM, et al. Complications leading to surgery after breast implantation. N Engl J Med 1997; 336:677.
  22. Hochberg MC, Perlmutter DL, Medsger TA Jr, et al. Lack of association between augmentation mammoplasty and systemic sclerosis (scleroderma). Arthritis Rheum 1996; 39:1125.
  23. Hennekens CH, Lee IM, Cook NR, et al. Self-reported breast implants and connective-tissue diseases in female health professionals. A retrospective cohort study. JAMA 1996; 275:616.
  24. Janowsky EC, Kupper LL, Hulka BS. Meta-analyses of the relation between silicone breast implants and the risk of connective-tissue diseases. N Engl J Med 2000; 342:781.
  25. Hölmich LR, Lipworth L, McLaughlin JK, Friis S. Breast implant rupture and connective tissue disease: a review of the literature. Plast Reconstr Surg 2007; 120:62S.
  26. Hölmich LR, Kjøller K, Fryzek JP, et al. Self-reported diseases and symptoms by rupture status among unselected Danish women with cosmetic silicone breast implants. Plast Reconstr Surg 2003; 111:723.
  27. Brinton LA. The relationship of silicone breast implants and cancer at other sites. Plast Reconstr Surg 2007; 120:94S.
  28. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ (Accessed on March 28, 2016).
  29. Stevens WG, Harrington J, Alizadeh K, et al. Five-year follow-up data from the U.S. clinical trial for Sientra's U.S. Food and Drug Administration-approved Silimed® brand round and shaped implants with high-strength silicone gel. Plast Reconstr Surg 2012; 130:973.
  30. Hammond DC, Migliori MM, Caplin DA, et al. Mentor Contour Profile Gel implants: clinical outcomes at 6 years. Plast Reconstr Surg 2012; 129:1381.
  31. Maxwell GP, Van Natta BW, Murphy DK, et al. Natrelle style 410 form-stable silicone breast implants: core study results at 6 years. Aesthet Surg J 2012; 32:709.
  32. McCarthy CM, Pusic AL, Kerrigan CL. Silicone breast implants and magnetic resonance imaging screening for rupture: do U.S. Food and Drug Administration recommendations reflect an evidence-based practice approach to patient care? Plast Reconstr Surg 2008; 121:1127.
  33. Cher DJ, Conwell JA, Mandel JS. MRI for detecting silicone breast implant rupture: meta-analysis and implications. Ann Plast Surg 2001; 47:367.
  34. Safety of Silicone Breast Implants. Stuart Bondurant, Virginia Ernster, and Roger Herdman, Editors; Committee on the Safety of Silicone Breast Implants, Institute of Medicine 1999. PDF available from the National Academies Press http://www.nap.edu/catalog/9602.html (Accessed on August 16, 2011).
  35. Anaplastic Large Cell Lymphoma (ALCL) in Women with Breast Implants: Preliminary FDA Findings and Analyses. Center for Devices and Radiological Health US Food and Drug Administration 2011. www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239996.htm (Accessed on August 16, 2011).
  36. Kim B, Roth C, Chung KC, et al. Anaplastic large cell lymphoma and breast implants: a systematic review. Plast Reconstr Surg 2011; 127:2141.
  37. Slavin SA, Schnitt SJ, Duda RB, et al. Skin-sparing mastectomy and immediate reconstruction: oncologic risks and aesthetic results in patients with early-stage breast cancer. Plast Reconstr Surg 1998; 102:49.
  38. Kroll SS, Baldwin B. A comparison of outcomes using three different methods of breast reconstruction. Plast Reconstr Surg 1992; 90:455.
  39. Eberlein TJ, Crespo LD, Smith BL, et al. Prospective evaluation of immediate reconstruction after mastectomy. Ann Surg 1993; 218:29.
  40. Kroll SS, Coffey JA Jr, Winn RJ, Schusterman MA. A comparison of factors affecting aesthetic outcomes of TRAM flap breast reconstructions. Plast Reconstr Surg 1995; 96:860.
  41. Hidalgo DA. Aesthetic refinement in breast reconstruction: complete skin-sparing mastectomy with autogenous tissue transfer. Plast Reconstr Surg 1998; 102:63.
  42. Alderman AK, Wilkins EG, Lowery JC, et al. Determinants of patient satisfaction in postmastectomy breast reconstruction. Plast Reconstr Surg 2000; 106:769.
  43. Alderman AK, Kuhn LE, Lowery JC, Wilkins EG. Does patient satisfaction with breast reconstruction change over time? Two-year results of the Michigan Breast Reconstruction Outcomes Study. J Am Coll Surg 2007; 204:7.
  44. Spear SL, Boehmler J. Immediate two-stage breast reconstruction utilizing a tissue expander and implant. In: Surgery of the Breast: Principles and Art, Spear SL (Ed), Lippincott, Williams and Wilkins, Philadelphia 2006. p.463.
  45. Beasley ME. Delayed two-stage expander/implant reconstruction. In: Surgery of the Breast: Principles and Art, Spear SL (Ed), Lippincott, Williams and Wilkins, 489 2006. p.489.
  46. Nahabedian MY. Breast reconstruction: a review and rationale for patient selection. Plast Reconstr Surg 2009; 124:55.
  47. Colwell AS, Damjanovic B, Zahedi B, et al. Retrospective review of 331 consecutive immediate single-stage implant reconstructions with acellular dermal matrix: indications, complications, trends, and costs. Plast Reconstr Surg 2011; 128:1170.
  48. Semple JL. Breast-feeding and silicone implants. Plast Reconstr Surg 2007; 120:123S.
  49. Semple JL, Lugowski SJ, Baines CJ, et al. Breast milk contamination and silicone implants: preliminary results using silicon as a proxy measurement for silicone. Plast Reconstr Surg 1998; 102:528.
  50. Breast augmentation: Cancer concerns and mammography – A literature review. Plast Reconstr Surg 2004; 113:117e.
  51. Handel N, Silverstein MJ. Breast cancer diagnosis and prognosis in augmented women. Plast Reconstr Surg 2006; 118:587.
  52. Handel N. The effect of silicone implants on the diagnosis, prognosis, and treatment of breast cancer. Plast Reconstr Surg 2007; 120:81S.
  53. Roxo AC, Nahas FX, Salin R, et al. Volumetric Evaluation of the Mammary Gland and Pectoralis Major Muscle following Subglandular and Submuscular Breast Augmentation. Plast Reconstr Surg 2016; 137:62.
  54. Clemens MW, Miranda RN, Butler CE. Breast Implant Informed Consent Should Include the Risk of Anaplastic Large Cell Lymphoma. Plast Reconstr Surg 2016; 137:1117.
  55. Phillips BT, Bishawi M, Dagum AB, et al. A systematic review of antibiotic use and infection in breast reconstruction: what is the evidence? Plast Reconstr Surg 2013; 131:1.
  56. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195.
  57. Hardwicke JT, Bechar J, Skillman JM. Are systemic antibiotics indicated in aesthetic breast surgery? A systematic review of the literature. Plast Reconstr Surg 2013; 131:1395.
  58. Antimicrobial prophylaxis for surgery. Treat Guidel Med Lett 2012; 10:73.
  59. Araco A, Gravante G, Araco F, et al. Infections of breast implants in aesthetic breast augmentations: a single-center review of 3,002 patients. Aesthetic Plast Surg 2007; 31:325.
  60. Adams WP Jr, Rios JL, Smith SJ. Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study. Plast Reconstr Surg 2006; 117:30.
  61. Mladick RA. "No-touch" submuscular saline breast augmentation technique. Aesthetic Plast Surg 1993; 17:183.
  62. Keller Funnel website www.kellerfunnel.com/doctors (Accessed on July 28, 2011).
  63. Araco A, Gravante G, Araco F, et al. A retrospective analysis of 3,000 primary aesthetic breast augmentations: postoperative complications and associated factors. Aesthetic Plast Surg 2007; 31:532.
  64. Wiener TC. Relationship of incision choice to capsular contracture. Aesthetic Plast Surg 2008; 32:303.
  65. Henriksen TF, Fryzek JP, Hölmich LR, et al. Surgical intervention and capsular contracture after breast augmentation: a prospective study of risk factors. Ann Plast Surg 2005; 54:343.
  66. Wong CH, Samuel M, Tan BK, Song C. Capsular contracture in subglandular breast augmentation with textured versus smooth breast implants: a systematic review. Plast Reconstr Surg 2006; 118:1224.
  67. Davidge KM, Levine R, Brown MH. Comparative outcomes of smooth versus textured round gel implants in primary breast augmentation. Plast Reconstr Surg 2010; 126:66.
  68. Barnsley GP, Sigurdson LJ, Barnsley SE. Textured surface breast implants in the prevention of capsular contracture among breast augmentation patients: a meta-analysis of randomized controlled trials. Plast Reconstr Surg 2006; 117:2182.
  69. Fagrell D, Berggren A, Tarpila E. Capsular contracture around saline-filled fine textured and smooth mammary implants: a prospective 7.5-year follow-up. Plast Reconstr Surg 2001; 108:2108.
  70. Tarpila E, Ghassemifar R, Fagrell D, Berggren A. Capsular contracture with textured versus smooth saline-filled implants for breast augmentation: a prospective clinical study. Plast Reconstr Surg 1997; 99:1934.
  71. Schaub TA, Ahmad J, Rohrich RJ. Capsular contracture with breast implants in the cosmetic patient: saline versus silicone--a systematic review of the literature. Plast Reconstr Surg 2010; 126:2140.
  72. Hardwicke JT, Prinsloo DJ. An analysis of 277 consecutive latissimus dorsi breast reconstructions: a focus on capsular contracture. Plast Reconstr Surg 2011; 128:63.
  73. Sullivan SR, Fletcher DR, Isom CD, Isik FF. True incidence of all complications following immediate and delayed breast reconstruction. Plast Reconstr Surg 2008; 122:19.
  74. Adams WP Jr, Conner WC, Barton FE Jr, Rohrich RJ. Optimizing breast pocket irrigation: an in vitro study and clinical implications. Plast Reconstr Surg 2000; 105:334.
  75. Adams WP Jr, Conner WC, Barton FE Jr, Rohrich RJ. Optimizing breast-pocket irrigation: the post-betadine era. Plast Reconstr Surg 2001; 107:1596.
  76. Directions for use Natrelle biocell textured and Natrelle smooth saline-filled breast implants. Allergan, 2007. www.allergan.com/assets/pdf/m712-04_saline_dfu.pdf (Accessed on August 16, 2011).
  77. Directions for use Natrelle silicone-filled breast implants smooth & biocell texture. Allergan, 2009. www.allergan.com/assets/pdf/L034-03_Silicone_DFU.pdf (Accessed on August 16, 2011).
  78. Product insert data sheet Mentor MemoryGel silicone gel-filled breast implants. Mentor, 2010. www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/UCM245623.pdf (Accessed on August 16, 2011).
  79. Product insert data sheet saline-filled & Spectrum breast implants. Mentor, 2010. http://www.mentorwwllc.com/Documents/SalineSpectrumPIDS.pdf (Accessed on August 16, 2011).
  80. Wiener TC. The role of betadine irrigation in breast augmentation. Plast Reconstr Surg 2007; 119:12.
  81. Pfeiffer P, Jørgensen S, Kristiansen TB, et al. Protective effect of topical antibiotics in breast augmentation. Plast Reconstr Surg 2009; 124:629.
  82. Mirzabeigi MN, Sbitany H, Jandali S, Serletti JM. The role of postoperative antibiotics in reducing biofilm-related capsular contracture in augmentation mammaplasty. Plast Reconstr Surg 2011; 128:34e.
  83. Pajkos A, Deva AK, Vickery K, et al. Detection of subclinical infection in significant breast implant capsules. Plast Reconstr Surg 2003; 111:1605.
  84. Roberts A, Baxter N, Camacho X, et al. Once is Rarely Enough: A Population-Based Study of Reoperations after Postmastectomy Breast Reconstruction. Ann Surg Oncol 2015; 22:3302.
  85. Spear SL. Redefining reoperations. Plast Reconstr Surg 2008; 122:1279.
  86. Codner MA, Mejia JD, Locke MB, et al. A 15-year experience with primary breast augmentation. Plast Reconstr Surg 2011; 127:1300.
  87. Adams WP, Bengston BP, Glicksman CA, et al. Decision and management algorithms to address patient and food and drug administration concerns regarding breast augmentation and implants. Plast Reconstr Surg 2004; 114:1252.
  88. Tebbetts JB. Achieving a zero percent reoperation rate at 3 years in a 50-consecutive-case augmentation mammaplasty premarket approval study. Plast Reconstr Surg 2006; 118:1453.
  89. Tebbetts JB. A system for breast implant selection based on patient tissue characteristics and implant-soft tissue dynamics. Plast Reconstr Surg 2002; 109:1396.
  90. Tebbetts JB, Adams WP. Five critical decisions in breast augmentation using five measurements in 5 minutes: the high five decision support process. Plast Reconstr Surg 2005; 116:2005.