Breast implantsBreast implants are silicone rubber sacks filled with saline solution. They are used to enlarge a woman's breast through a procedure called breast augmentation. Breast implants are usually quite successful at making the breasts larger and fuller. The results may not look exactly like “natural” larger breasts; however, they tend to be a bit more round and less saggy than natural breasts of the same size. Most women find these differences to be an improvement to their appearance.
Breast implants are made from an outer layer of silicone, generally filled with silicone gel or salt water. The substance silicone is used in many items, including cosmetics and food. Whilst there is no evidence to suggest that silicone implants have negative implications for autoimmune diseases, rheumatoid arthritis or breast cancer, the long term implications are yet to be firmly researched. One confirmed factor to consider though, is that breast implants can interfere with mammography, where the breast is x-ray screened for traces of cancer cells.
A breast implant is a technique used in cosmetic surgery to increase the size of one's breasts or to reconstruct the breast (for example, after a mastectomy). There are three types of breast implants: Saline-filled which have an external silicone shell and are filled with sterile saline liquid. These implants are currently the only ones available in the United States. Silicone gel-filled which have an external silicone shell and are filled with silicone gel. They are not currently available for implant in the United States, but future regulation may change this. In the 60 countries outside the United States where silicone implants remain available, they are used in approximately 90% of implant operations. String implant, a third, much less common type of implant. This implant uses a polypropylene material as an implant. String implants are unique in that they cause the breast to perpetually expand after surgery, and are preferred by those women who choose to have the largest breasts possible. They are not currently available for implant in the United States, but future regulation may change this.
One of the most important factors in a successful breast augmentation is the proper placement of the implant. There are three places implants can be put to increase the size of a woman's breasts: subglandular, subpectoral, and submuscular. Subglandular placement puts the implant directly behind the mammary gland and in front of the muscle. This placement requires the least complicated surgery and yields the quickest recovery. Athletic women may opt for this placement because it prevents flexing chest muscles from interfering with the look or integrity of the implant. The downsides of this placement are increased chance for capsular contracture, greater visibility and vulnerability for the implant. This is because only the flesh and gland separate the implant from the outside world. Depending on the amount of available breast tissue, the implant may be seen "rippling" through the skin.
Subpectoral placement involves lodging the implant under the pectoralis major muscle. Because of the structure of this muscle, the implant is only partially covered. This alternative reduces the risk of capsular contracture and visible implant rippling, but recovery time from this positioning is typically longer and more painful because the doctor has to manipulate the muscle during surgery. Also, because of increased swelling, the implant may take longer to drop into a natural position after surgery. If the augmentation is being performed to lift sagging breasts, this type of placement may not be the right approach. Because the implant is only partially covered by the muscle, the weight of the fluid is not supported. In a woman with sagging breasts, the implant may droop and create two separate bulges in the breast lobe. Submuscular placement puts the implant firmly behind the chest muscle wall. The implant is placed behind the pectoralis major muscle and behind all of the supporting fascia (connective tissue) and non-pectoral muscle groups. Submuscular implants tend to be the best for mammograms, as they put the implant fully behind the area that needs to be examined. This placement has the same drawbacks of subpectoral placement with an even longer recovery time. Depending on the patient and the desired outcome, breast augmentation surgery can be a very simple or very complex procedure.
After pre-operative preparation, the surgery starts by cutting one incision into the patient for each implant. The incisions are small and placed so that the scarring is minimal and hard to see. Once the incision is created, the surgeon must cut a path through the tissue to the final destination of the implant. Once that path has been created, the tissue and/or muscle (depending on placement) must be separated to create a pocket for the implant. This is where the surgeon's skill really comes into play: When deciding where to cut the pocket in the breast, the surgeon must predict what the breasts will look like once the implants are filled. In more extreme augmentation surgeries, this involves repositioning the nipple, adjusting for cleavage and creating a new crease under the breast.
In some cases, augmentation surgery is accompanied by mastopexy (breast lift) surgery so that everything ends up in the right place. To aid in positioning, the surgeon may decide to use a sizer or disposable implant. Sizers are temporary implants attached to a tube that the surgeon can work inside the pocket and fill up to test placement, implant size and fill levels. Once this has been tested, the sizer is removed and replaced with the permanent implant. When inflatable implants are used, they are rolled up like a cigar and pushed into the incision, through the channel and into place. This is true no matter which type of incision is used (we'll talk about incisions in the following sections). Once the implant is positioned, the incision is closed. In the last step, the surgeon uses a syringe to fill the implant with saline through the valve, filling it to the predetermined size. If the patient has opted to use pre-filled implants, the incision will be larger. Inserting textured, pre-filled implants requires the longest incision, providing more room for inserting an implant with a rough shell and for manipulating the less-pliable implant once it's in place. Plastic surgeons can use one of four different types of incisions to insert the implant into the breast: peri-areolar, inframammary fold, transaxillary, and TUBA. In the next sections, we will learn the difference between these types of incision.
Breast implants are not considered to be lifetime devices. Whether implant surgery is for the purpose of reconstruction or augmentation, you will likely need additional surgeries and visits to your surgeon over time. At some point, your implants will probably have to be removed, and you will have to decide whether or not to replace them. In addition, most women with breast implants will experience complications of some kind. These include rupture, pain, disfigurement, serious infections, and a condition called capsular contracture. This is a tightening of the scar tissue, or capsule, that the body forms around breast implants.