In this type of breast reconstruction you have a skin-sparing mastectomy and an implant is placed underneath the muscles covering the chest at the same time. This type of reconstruction is usually only possible if you are having relatively small breasts reconstructed. You can discuss with your surgeon whether the nipple can be preserved. Otherwise you may consider nipple reconstruction or using false nipples.

The scar from this type of operation is usually from side-to-side or at an angle following the line of the original mastectomy scar.

Putting in the implants at the same time as the mastectomy, as in this method, gives breasts without the normal droop. The implant is under the muscle so it tends not to be obvious and is not easy to feel.  Because of this, the breasts tend to be firmer and the implant can sometimes change shape slightly when you move, as the overlying muscle contracts. It is therefore not always possible to produce a natural breast shape using this method in older women or in women with large breasts. Your surgeon will advise you about this.

Current breast implants usually last about 10–15 years, but may last longer. It is important to report any change in shape as it may be a sign of leakage or rupture.

Breast reconstruction involving tissue expansion can give very good results, and avoids the need for the more extensive surgery used in tissue flaps. However, it takes longer to complete than other methods, which doesn't suit some women.

This method uses the ability of your skin and muscle to stretch. Skin is surprisingly elastic in most people and a natural breast form can usually be achieved in this way.

How it is done

Tissue expanders (like hollow, empty balloons) are put behind the muscles of the chest behind the breast. They are gradually expanded over a few months with regular injections of sterile salt solution (saline). This is done through a valve put just under the skin at the edge of the new breast shape near the armpit. The injections are usually done in the outpatients department. You may feel a sensation of pressure during this procedure, but most women find that it is not too uncomfortable.

Reconstruction using tissue expansion can be done in one or two stages:

In one-stage surgery, tissue expanders that act as implants are used. The tissue expander is part saline (salt water) and part silicone; usually the expander/implant consists of one-third to one-quarter silicone and the rest saline. There is an inflatable inner chamber that can be filled with saline over a period of several weeks to allow the implant to be adjusted for size. This can be done through a valve (port) that is attached to the implant that will self-seal once the desired breast shape and size is achieved. Such an implant then stays in place and the port and tubing connecting it are removed.

In two-stage surgery, the saline expanders are inflated until the size is slightly larger than desired. They are then left for several months to allow the skin and muscle stretching to settle. The tissue expanders are then removed in a second operation and permanent implants, that are slightly smaller in size than the tissue expanders, are put in. The slight over-expansion allows the implant to lie on the chest wall with a more natural appearance.

With this type of breast reconstruction there will be a long scar (but this should not be any different from the original mastectomy scar). There is also the need for several procedures before it is complete; several visits are needed to have the tissue expanders inflated. Also, the breasts will be relatively small until the expander has been inflated a few times. The reconstructed breasts will always be firmer than natural breasts and have little or no droop.

After complete healing from the above stages, a further procedure can be done if necessary, to create a nipple. This involves creating a nipple from skin over the implant. An area can then be tattooed around this to make a more natural looking nipple and areola (the area of darker skin around the nipple).

Alternatively, you could consider using stick-on nipples made of silicone (known as prosthetic nipples). These can be attached to the reconstructed breast using a special glue. There is more about options for nipple reconstruction and tattooing later in this section.