Filled Tissue Expander   

For most women, the skin that remains after mastectomy must be stretched or expanded to make space for an implant. Performing this procedure, the surgeon put in a balloon-type device called a tissue expander under the chest muscle. This expander has a port (a metal or plastic plug, valve, or coil), which permits the surgeon to add increasing amounts of liquid in the course of time (about six months), without extra surgery.

After a while your skin and soft tissue are stretched to achieve the desired appearance. The tissue is actually stretched a little beyond your desired size, to create natural sag. If the tissue is stretched too far, it can cause discomfort and occasionally flatten part of your rib cage. Ask your doctor how he plans to avoid this occurrence.

Final Steps

As soon as stretching is done and your other treatments (chemotherapy, radiation, or both) are completed, the expander is usually substituted with a permanent implant. Breast implants are filled with either saline or silicone gel.

In some cases a surgeon may use a permanent expander. This device performs two equal functions: acts as an expander and an implant. As stretching is completed and the "expander" is filled to the right amount with saline, the port is removed and you have a breast implant with no extra surgery.

Scar Tissue

Once a breast implant is in place, scar tissue forms all around it, forming what's called a tissue capsule. In most of the cases, these tissue capsules are soft-to-firm and unnoticeable. However, less than 15% of the time, a hard capsule forms that can be painful and deform the breast. In these cases, a surgeon can break up the scar tissue and, if necessary, replace the implant.

If you have radiation therapy to the breast area, the risk of scar tissue and hardening around the breast implant increases to 40–50%.

Massage and exercises may reduce the risk of forming a hard capsule (with or without radiation). You can ask your surgeon to show you how to massage the implant and the area around it, firmly but gently.

Shifting, Leaking

An implant has a small risk of riding up the chest, so you may have to massage it down into place.

Rarely, implants leak fluid. The chance of your breast implant leaking increases over time. For the most part implants that have been in place for 10–15 years have some leakage, but it's usually insignificant.

Leaking saline is harmless. But you should inform your specialist if your implant leaks, because your breast may get smaller. A little leak of a saline implant can't be detected.

Yet a small leak of a silicone implant can be seen on an MRI (magnetic resonance imaging) scan, or sometimes on an ordinary X-ray. Only if it isn't necessarily dangerous, it can lead to complications that you'd rather avoid. In condition you suspect a silicone implant is leaking, have it checked and, if necessary, reinstated.