What’s the Best Breast Implant After Mastectomy?

For many women, a mastectomy can be one of the hardest parts of their breast cancer journey.

“Those emotions are every bit as real as the physical healing,” says Dr. Tseng, “and deserve the same attention and support.”

That’s why many women opt for breast reconstruction after a mastectomy. Today, there are more options than ever before — but what works for one woman might not work for another. “I often remind patients that reconstruction is … about finding the option that's right for them,” says Dr. Tseng.

Whether you choose breast reconstruction with your own tissue or opt for implants, or decide you want to “go flat,” the decision should align with your priorities. Here’s a closer look at your options.

Saline vs. Silicone Gel Implants

Most implants that are used for breast reconstruction have either a saline or silicone filling (both have an outer silicone shell). Each type of implant has its potential benefits and drawbacks.

Saline Implants

If a saline implant tears or leaks, another benefit is that “saline is safely absorbed by the body,” says Danielle H. Rochlin, MD, MPH, a plastic and reconstructive surgeon at Memorial Sloan Kettering Cancer Center in New York City. It’s also fairly easy to detect a rupture without imaging, she says, since the breast changes shape when the implant deflates.

The primary disadvantages of saline implants relate to appearance and feel. “Saline implants tend to feel less natural than silicone implants,” says Dr. Rochin. They’re also more likely to produce rippling — that is, wrinkling of the implant’s outer shell can be visible through the skin, particularly in thinner women, she says.

Saline Implants Pros and Cons

Silicone Implants

“Overall, they tend to feel more like natural breast tissue compared to saline implants,” Rochlin says. They also tend to produce less visible rippling.

The main tradeoff is that a rupture may not cause noticeable changes to the breast, and therefore, may go undetected, Tseng says.

Silicone Implants Pros and Cons

The Polyurethane-Coated Silicone Gel Implant

If polyurethane-coated silicone gel implants are available where you live, your reconstructive surgeon can explain whether they offer any advantages in your particular situation, Tseng says.

Which Breast Implant Is the Best Choice?

While many women often want to know which implant is “best,” Tseng tells her patients there is no single answer. “The best implant is the one that best fits your anatomy, cancer treatment plan, lifestyle, and personal preferences,” she says.

Your breast size and shape, aesthetic goals, and willingness to undergo surgery and future imaging are all aspects to consider before making a choice, Rochlin says.

One caveat: If you’re receiving radiation therapy, you may want to hold off on undergoing reconstruction, at least temporarily.

This doesn't mean implants aren't an option, but radiation can influence the timing and type of reconstruction that's recommended, Tseng says. That’s why she advises meeting with a reconstructive plastic surgeon before your mastectomy whenever possible. “Understanding your options early gives you time to ask questions, consider what matters most to you, and make a decision with confidence,” she says.

Don’t Want Breast Implants? You Have Other Options

Implants aren’t your only option post-mastectomy. Here are some other procedures.

• Tissue Flap Reconstruction This surgery involves using tissue from other areas of your body, such as the back, belly, thighs, or buttocks, to rebuild your breasts.

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• Aesthetic Flat Closure This procedure is the gold-standard if you would like to go flat. It involves removing excess skin, fat, and tissue and carefully contouring the chest so that the skin lies as smoothly and evenly as possible after a mastectomy.

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• External Breast Prosthesis You can opt to use an external artificial breast, which can be worn against your skin or fit into a bra cup (called a mastectomy bra) to replace your natural breast.

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“Each is a valid choice,” Tseng says. “The goal isn't for every woman to make the same decision. It's for every woman to understand her options, feel supported by her care team, and choose the approach that's right for her.”