Breast Augmentation

What are the different types of tuberous breasts?

Type I, (hypoplasia) underdevelopment of the lower inner (medial) fourth (quadrant); type II, (hypoplasia) underdevelopment of the lower inner (medial) fourth (quadrant) and outside (lateral) fourth; and type III, severe breast tightening and narrowing (constriction) and overall underdevelopment (global hypoplasia).Tuberous Breast Deformity: Classification and Treatment Strategy for Improving Consistency in Aesthetic CorrectionKolker, Adam R.; Collins, Meredith S.Plastic & Reconstructive Surgery. 135(1):73-86, January 2015.

What medical conditions have not had safety and effectiveness established in accordance with FDA standards with respect to saline breast implantation?

Safety has not been established in hematologic disorders that interfere with blood clotting, blood thinning, wound healing, immune system derangements, such as immunosuppressive regiments for cancer, HIV, autoimmune conditions like scleroderma, or lupus, and compromised blood supply, as would be found after radiation for cancer.

What is wound dehiscence after breast augmentation surgery, what are the consequences, and what is the treatment?

Wound dehiscence is a disruption of the incision used to access the breast implant pocket in breast enlargement. It may be due to infection, impaired healing, or post-operative trauma. If due to infection, antibiotic therapy or even removal may be necessary as outlined in the question on infection. If due to impaired healing, the precise factor(s) must be identified and addressed, though the breast implant needs may be salvaged. If Caused by trauma, and no breast implant exposure is noted, either primary, or delayed wound closure may be used.

Smooth Vs. Textured

There are advantages and disadvantages to using each type of implant for both the surgeon and the patient. Let’s address the concerns of the patient and then discuss the benefits of one type over another in terms of technical pluses and minuses.A lot of information on the differences in outcomes between using textured or smooth implants for breast augmentation comes from anecdotal reporting or confounded studies and is thus as useful as preference or hearsay. With that in mind here are the supposed advantages of one over another with respect to different characteristics that affect breast enlargement.Textured breast implants have a rough surface. The thinking behind this is that if the texture is irregular, cells that form a scar will not as be organized on such a surface, which would result in a softer, more pliable breast capsule, and diminish contracture rates. This disparity in breast capsule formation has never been conclusively demonstrated in studies. Because the textured breast implant does not have a regular surface, it is thicker, but at the same time thought to be weaker, because of its surface flaws. A well-known consequence of using the textured breast implant is its more tenacious adherence to the breast capsule that is laid down around it. This may be an advantage in a woman who has had a teardrop or anatomical implant placed at the time of breast augmentation to hold position. The reason that is important is that the shaped breast implant is not symmetric and must sit in the subglandular or submuscular pocket just so. In a thinner woman, or a woman with minimal native breast tissue, a breast implant that has adhered to the capsule and is not free to move around, will pull on the adjacent breast skin and cause breast surface irregularities. It will also be more palpable, and it may need to be placed through a larger incision owing to its lack of pliability when compared to a smooth breast implant. Textured breast implants may also carry a higher risk of breast implant rupture because any traction or pushing on the breast would also shear the breast implants by virtue of their close association with the breast pocket capsule. Finally, it may be more difficult to remove textured breast implants, again because of their adherence to the breast capsule.

What are the Spectrum® Postoperatively Adjustable Breast Implants? Particularly the Siltex Contour Profile® Spectrum® Breast Implants?

What are their advantages and disadvantages? The Spectrum® Postoperatively Adjustable Breast Implants are made only by Mentor. The obvious advantage to the adjustability of such breast implants is the ability to enlarge or diminish the size of a breast after the operation. Many women that are quite pleased with the results of their breast augmentation surgery wish that they would have opted for breast implants that were slightly larger, or slightly smaller. Indeed, the decision as to how large of a breast augmentation to request is a tough one. Short of wearing a silicone prosthesis to determine the optimal size for breast enlargement in any particular woman, there are not very many options. This is not what one would call high tech, and at times some patients are unsure in spite of such a maneuver. The Spectrum® Postoperatively Adjustable Breast Implants give a plastic surgeon the ability to adjust the dimensions of an enlarged breast for up to half a year after the fact. This is performed via a tiny fill tube left in place at the time of surgery. The breast implants are filled to a point deemed perfect by the patient, and the tube is removed in the office. Another very powerful reason to use such adjustable implants is when performing breast enlargement surgery along with breast lift surgery. Because the complication rate for this procedure is unacceptable to some aesthetic surgeons they chose to stage it, or perform the breast augmentation separately from the breast lift. The reason for this is that the two procedures stress breast skin more than either one alone. The breast augmentation will stretch breast skin, and place it under tension. The breast lift will excise skin and place it under tension. This excessive tension, in the very least can make for very wide and unattractive scars, and at the worst cause breakdown of the incisions and implant exposure, breast skin and fat (necrosis) death, and possible life-threatening infection. Because the adjustable breast implant does not need to be inflated to full capacity at the time of a simultaneous breast lift and breast enlargement surgery, the augmentation mastopexy can be carried out all in one step. The breast can then be gently and gradually stretched over time. This will obviate the need for an extra surgery. Siltex Contour Profile® Spectrum® Style 2500 breast implant, as the name suggests, is a textured implant of anatomic or teardrop shape, that more accurately reflects the silhouette of a mature breast, with a gentle slope, that can be filled to the desired size as describe above. It is available in the size listed below.

What are the Spectrum® Postoperatively Adjustable Breast Implants? Particularly the Smooth Round Spectrum® Breast Implants? What are their advantages and disadvantages?

The Spectrum® Postoperatively Adjustable Breast Implants are made only by Mentor. The obvious advantage to the adjustability of such breast implants is the ability to enlarge or diminish the size of a breast after the operation. Many women that are quite pleased with the results of their breast augmentation surgery wish that they would have opted for breast implants that were slightly larger, or slightly smaller. Indeed, the decision as to how large of a breast augmentation to request is a tough one. Short of wearing a silicone prosthesis to determine the optimal size for breast enlargement in any particular woman, there are not very many options. This is not what one would call high tech, and at times some patients are unsure in spite of such a maneuver. The Spectrum® Postoperatively Adjustable Breast Implants give a plastic surgeon the ability to adjust the dimensions of an enlarged breast for up to half a year after the fact. This is performed via a tiny fill tube left in place at the time of surgery, adjacent to the incision. The breast implants are filled to a point deemed perfect by the patient, and the tube is removed in the office. The fill volume is generally determined by the amount of injection that a patient would tolerate, and typically that is on order of 50 – 100 cc. Although it is possible to attempt to fill the Spectrum® expandable breast implant years after the surgery in theory, this would probably not be very feasible practically. This is because of the presence of a breast capsule that forms to varying degrees in every breast augmentation patient. Another very powerful reason to use such adjustable implants is when performing breast enlargement surgery along with breast lift surgery. Because the complication rate for this procedure is unacceptable to some aesthetic surgeons they chose to stage it, or perform the breast augmentation separately from the breast lift. The reason for this is that the two procedures stress breast skin more than either one alone. The breast augmentation will stretch breast skin, and place it under tension. The breast lift will excise skin and place it under tension. This excessive tension, in the very least can make for very wide and unattractive scars, and at the worst cause breakdown of the incisions and implant exposure, breast skin and fat (necrosis) death, and possible life-threatening infection. Because the adjustable breast implant does not need to be inflated to full capacity at the time of a simultaneous breast lift and breast enlargement surgery, the augmentation mastopexy can be carried out all in one step. The breast can then be gently and gradually stretched over time. This will obviate the need for an extra surgery. The Smooth Round Spectrum® Style 1400 breast implant, as the name suggests, is a smooth implant of moderate projection that can be filled to the desired size as describe above. It is available in the size listed below.

What are the Spectrum® Postoperatively Adjustable Breast Implants? Particularly the Siltex Round Spectrum® Breast Implants? What are their advantages and disadvantages?

The Spectrum® Postoperatively Adjustable Breast Implants are made only by Mentor. The obvious advantage to the adjustability of such breast implants is the ability to enlarge or diminish the size of a breast after the operation. Many women that are quite pleased with the results of their breast augmentation surgery wish that they would have opted for breast implants that were slightly larger, or slightly smaller. Indeed, the decision as to how large of a breast augmentation to request is a tough one. Short of wearing a silicone prosthesis to determine the optimal size for breast enlargement in any particular woman, there are not very many options. This is not what one would call high tech, and at times some patients are unsure in spite of such a maneuver. The Spectrum® Postoperatively Adjustable Breast Implants give a plastic surgeon the ability to adjust the dimensions of an enlarged breast for up to half a year after the fact. This is performed via a tiny fill tube left in place at the time of surgery. The breast implants are filled to a point deemed perfect by the patient, and the tube is removed in the office. Another very powerful reason to use such adjustable implants is when performing breast enlargement surgery along with breast lift surgery. Because the complication rate for this procedure is unacceptable to some aesthetic surgeons they chose to stage it, or perform the breast augmentation separately from the breast lift. The reason for this is that the two procedures stress breast skin more than either one alone. The breast augmentation will stretch breast skin, and place it under tension. The breast lift will excise skin and place it under tension. This excessive tension, in the very least can make for very wide and unattractive scars, and at the worst cause breakdown of the incisions and implant exposure, breast skin and fat (necrosis) death, and possible life-threatening infection. Because the adjustable breast implant does not need to be inflated to full capacity at the time of a simultaneous breast lift and breast enlargement surgery, the augmentation mastopexy can be carried out all in one step. The breast can then be gently and gradually stretched over time. This will obviate the need for an extra surgery. Siltex® Round Spectrum® Style 2400 breast implant, as the name suggests, is a textured implant of moderate projection that can be filled to the desired size as describe above. It is available in the size listed below.

What is subglandular breast implant placement in breast augmentation?

Subglandular placement refers to placement of breast implants under the skin, fat, and breast tissue, but on top of the muscle. As a result of this, patients who are thin, and lack significant breast tissue will have an increased chance for implant palpability. The risk for capsular contracture is also significantly higher for both saline and silicone breast implants when placed over the muscle. The advantage to using this approach is the ability to take up loose skin at the lower poles of the breasts, and avoid the longer incisions necessary for a breast lift in some cases.

Subglandular Vs. Submuscular Vs. “Dual-Plane” Breast Implant Placement

Subglandular placement refers to placement of breast implants under the skin, fat, and breast tissue, but on top of the muscle. As a result of this, patients who are thin, and lack significant breast tissue will have an increased chance for implant palpability. The risk for capsular contracture is also significantly higher for both saline and silicone breast implants when placed over the muscle. The advantage to using this approach is the ability to take up loose skin at the lower poles of the breasts, and avoid the longer incisions necessary for a breast lift in some cases.Submuscular placement puts the breast implant pocket between the ribs of the chest wall and the chest (pectoralis) muscle on top. It is much less prone to cause breast implant palpability than subglandular implant placement, and is associated with a lower risk of scarring and hardness around the implants. Its disadvantage is the propensity to cause a higher riding breast implant. When the pectoralis muscles are contracted the implants are also prone to move up in a very unnatural fashion.The “dual-plane” approach allows placement of the upper portion of the implant under the muscle, and by releasing the lower portion of the muscle allows the lower portion of the breast implant to sit under the breast tissue. This eliminates the drawbacks of both the sub-glandular and sub-muscular placement while retaining the advantages of both. It is the most commonly performed placement in today’s breast augmentation surgery.

What is submuscular breast implant placement in breast augmentation?

Submuscular placement puts the breast implant pocket between the ribs of the chest wall and the chest (pectoralis) muscle on top. It is much less prone to cause breast implant palpability than subglandular implant placement, and is associated with a lower risk of scarring and hardness around the implants. Its disadvantage is the propensity to cause a higher riding breast implant. When the pectoralis muscles are contracted the implants are also prone to move up in a very unnatural fashion.

What is breast enlargement or breast augmentation surgery?

Breast augmentation or enlargement surgery is an operation in which the breasts are made bigger by the addition of mammary implants. The implants may be saline or silicone. The implant is also known as a mammary prosthesis. It typically takes from one half hour to one and a half hours to place the breast device, depending on such things as pocket location, incision, and the type of implant used.

Should I have breast augmentation using textured or smooth breast implants?

There are advantages and disadvantages to using each type of implant for both the surgeon and the patient. Let’s address the concerns of the patient and then discuss the benefits of one type over another in terms of technical pluses and minuses.A lot of information on the differences in outcomes between using textured or smooth implants for breast augmentation comes from anecdotal reporting or confounded studies and is thus as useful as preference or hearsay. With that in mind here are the supposed advantages of one over another with respect to different characteristics that affect breast enlargement.Textured breast implants have a rough surface. The thinking behind this is that if the texture is irregular, cells that form a scar will not as be organized on such a surface, which would result in a softer, more pliable breast capsule, and diminish contracture rates. This disparity in breast capsule formation has never been conclusively demonstrated in studies. Because the textured breast implant does not have a regular surface, it is thicker, but at the same time thought to be weaker, because of its surface flaws. A well-known consequence of using the textured breast implant is its more tenacious adherence to the breast capsule that is laid down around it. This may be an advantage in a woman who has had a teardrop or anatomical implant placed at the time of breast augmentation to hold position. The reason that is important is that the shaped breast implant is not symmetric and must sit in the subglandular or submuscular pocket just so. In a thinner woman, or a woman with minimal native breast tissue, a breast implant that has adhered to the capsule and is not free to move around, will pull on the adjacent breast skin and cause breast surface irregularities. It will also be more palpable, and it may need to be placed through a larger incision owing to its lack of pliability when compared to a smooth breast implant. Textured breast implants may also carry a higher risk of breast implant rupture because any traction or pushing on the breast would also shear the breast implants by virtue of their close association with the breast pocket capsule. Finally, it may be more difficult to remove textured breast implants, again because of their adherence to the breast capsule.

What are Titanium Coated Breast Implants?

The only difference between silicone impants and titanium coated implants is the presence of titanium coating. This is not a palpable, visible difference. It is a thin layer, and is said to impart more strength to the implant. The inert nature of titanium is also predicted to confer to the coating less of a propensity to cause an inflammatory reaction, and thus diminish the rate of capsular contracture.

Am I too old for breast enlargement or breast augmentation surgery?

“Old” age should never be a determining factor for breast enlargement. Breast augmentation surgery should only be withheld from a patient for two reasons. The first reason would be that the patient is medically unfit to have the surgery. They may have lung, heart, kidney, etc. problems. Operating on such patients would put their life in jeopardy. The second subset of patients should not be operated for psychological reasons. They may have the wrong motivation, they may believe that breast enlargement is the answer to all of their life’s problem, they may a have a skewed perception of their body image, or they may be frankly psychologically unfit to make an informed decision and give consent for breast augmentation surgery. Age itself may slow healing, and require some adjustments in the post-operative period, but provided a patient is healthy, they should not be barred from having their breasts enlarged, simply because they are too old.

Am I too young for breast enlargement or breast augmentation surgery?

Although the media likes to harp on a “disturbing trend,” of high school aged kids getting breast augmentation, this is probably more of a trend in the seedier, non Plastic Surgery Board certified “cosmetic” surgeons. Any responsible plastic surgeon knows full well that results are far more predictable after a breast augmentation performed in a patient who has reached her mature breast size. There are exceptions, of course, the two most common ones are women who have almost no breast tissue to begin with, significant growth is not expected, women with tubular breast deformity, and patient’s with Poland’s syndrome.

What is a transumbilical breast augmentation incision?

The trans-umbilical incision is placed at the top of the belly-button. Its obvious advantage is a lack of scars on, around, or near the breasts. Its disadvantages are blind dissection, making asymmetry more common, and making the likelihood of one side being submuscular and the other subglandular more likely. If an undesirable result is obtained, a new incision will be needed to correct the problem. It may also damage the breast implants, and cannot be used with pre-filled silicone breast implants.

What are Trilucent Breast Implants (Peanut Oil Breast Implants, Soy Oil Breast Implants, Soya Oil Breast Implants, Soybean Oil Breast Implants)?

As the above suggests, such breast implants were filled with various organic oils. The hope was that, as in the case of saline, organic oils would be absorbed in the case of a leak without setting up an inflammatory reaction, in the case of implant rupture. Safety data lacking, along with reports of local inflammatory effects on rupture, the implant was taken off the UK market. Further information from the British MHRA (Equivalent of FDA, except for the food part), can be studied below.Trilucent breast implantsThese implants were removed from the market in 1999, and in 2000 the Medical Devices Agency (now MHRA) recommended that these implants should be explanted.The Trilucent™ Care Centre (TCC), which was set up for patients with these implants, closed on December 31 2004. AIE Inc has taken over the functions carried out by the TCC.A clinical research programme was sponsored by AIE Inc and was carried out by an independent panel of experts to investigate the long-term health effects of Trilucent™ implants. This was completed in 2004. The full report concluded that there is no evidence for local or systemic disease risk once the implants have been removed.MHRA issued a device alert (MDA/2004/047) in September 2004 to notify interested parties of the conclusions of this study and the closure of the TCC.Background informationTrilucent™ breast implants were available for sale throughout the EU between 1995 and March 1999. They consisted of a silicone elastomer shell with a lipid filler based on soyabean oil. Since they were first marketed in 1995 over 9,000 implants were sold in the UK, and implanted into almost 5,000 women.As a result of an investigation into reports of inflammation associated with rupture of Trilucent™ breast implants, MDA reviewed the manufacturer’s safety assessment. This revealed serious concerns relating to the long term safety of Trilucent™ breast implants, in particular in relation to the breakdown of the lipid filler. As a result of MDA’s concerns the company voluntarily withdrew the product from the market in March 1999 and MDA issued an Advice Notice AN 1999(01). The withdrawal was a precautionary measure until further information could be gathered about the biological safety and clinical experience with these implants. The advice given at that time was that there was no evidence to suggest that removal of Trilucent™ breast implants was indicated but that women should be advised to seek an immediate consultation if they noticed unusual breast swelling or inflammation associated with their Trilucent™ breast implants.In AN 1999(01) clinicians were advised not to use MRI (magnetic resonance imaging) on women implanted with Trilucent™ breast implants, because of concerns about heating up of the transponder (a device contained within the implant to provide identification information electronically). In the light of subsequent enquiries on the value of MRI for detecting implant rupture, this advice was modified. Clinicians have since been advised to use MRI with caution on women implanted with Trilucent™ breast implants.The first results of further analytical studies on the filling material in Trilucent™ breast implants became available in May 2000. MDA convened a group of independent experts (the Trilucent™ Advisory Group) to consider the available scientific evidence. This Group made an assessment of the risk to women with these implants and provided advice to MDA. A statement summarising the Trilucent™ Advisory Group’s conclusions and advice is available, with the minutes of a meeting held on 19 May 2000 . Based on this advice, MDA issued a Hazard Notice (HN 2000(05)).In 2000, a programme of research was initiated to investigate any potential risks to women implanted with Trilucent™ breast implants. This programme was directed, on behalf of AEI Inc, by a panel of independent experts. The programme was completed in 2004. The panel concluded that:the recommendation that Trilucent™ breast implants should be removed remains appropriate because exposure of local tissue to toxic compounds has been confirmed;there is no evidence for local or systemic disease risk once the implants have been removed; no further studies are needed to assess the potential risk of Trilucent™ breast implants. This information was the subject of MHRA Medical Device Alert MDA/2004/047.Although the research programme has been completed, MHRA continues to record and investigate reports of adverse events associated with Trilucent™ breast implants. If further problems are identified, MHRA will issue advice.Safety information published by MHRA relating to Trilucent™ breast implants:AN1999(01) – Trilucent breast implants: Voluntary recallVoluntary recall of Trilucent breast implantsHN 2000(05) – Trilucent™ breast implants: recommendation to removeRecommendation to explant Trilucent™ breast implantsMDA/2004/047 – Trilucent (soya bean oil filled) breast implantsConclusions of clinical research programme and closure of TCC

Incision Type

The inframammary approach to breast augmentation surgery allows your plastic surgeon the greatest visibility while dissecting an implant pocket, and as such, allows greater precision and control of symmetry. The inframammary incision is placed in the fold under the breast, in the breast fold, and tends to be more noticeable for two reasons. It is typically larger than other types of breast incisions. It has a tendency to migrate as the implant settles up or down, and its final resting place is less predictable.The periareolar incision goes around the nipple. It is less noticeable, smaller than the inframammary incision, and if a lift is required later in time, it may be utilized again. Its disadvantages in breast enlargement surgery are a higher infection (because the cut goes through breast tissue), it may be more difficult to breastfeed after this type of breast augmentations, and it may decrease breast skin and nipple sensation or infection more of a concern.Placing the incision in the axilla (underarm) allows for a smaller incision. It is useful when there is not much breast tissue present to begin with, and thus no prominent breast fold, and when the nipple-areola complex is small. It is not as well concealed as the periareolar incision, gives less control in terms of the ability to feel around the breast pockets in assuring symmetry, and placement of silicone breast implants will necessitate a larger incision which may be less pleasing.The peri-umbilical incision is placed at the top of the belly-button. Its obvious advantage is a lack of scars on, around, or near the breasts. Its disadvantages are blind dissection, making asymmetry more common, and making the likelihood of one side being submuscular and the other subglandular more likely. If an undesirable result is obtained, a new incision will be needed to correct the problem. It may also damage the breast implants, and cannot be used with pre-filled silicone breast implants.

What is implant exposure or breast implant extrusion after breast enlargement surgery with silicone breast implants, what are the consequences, and what is the treatment?

The exact risk percentage may be found for both the Allergan, and the Mentor studies in related questions. The problem most often is the result of inadequate soft tissue (breast and skin) overlying the breast implants. It is unusual in cases of primary augmentation, and is more commonly seen in the compromised soft tissue of the reconstructed breast, with or without a history of radiation. If the extrusion if only threatened, and no implant is actually showing at the time of detection, a salvage procedure may be done to improve the soft tissue cover atop the implant. If the implant is exposed, many plastic surgeons will not attempt salvage, as by definition, and exposed implant is a contaminated implant. The breast implant will be removed, patient allowed to heal, and implant replaced at a later time.

Is implant removal common after breast augmentation surgery with silicone breast implants?

Silicone, and for that matter saline breast implants are deemed by both Mentor and Allergan as “not lifetime devices.” The longer the implants have been present the higher the chances for removal with or without replacement for various reasons. Grounds for removal +/- replacement may include displeasure with the cosmetic appearance of the breasts, severe capsular contracture, etc. Silicone breast implant removal and replacement puts the patient at greater risk for complications and reoperations in the future.In Mentor’s Core Study, patients who’d undergone primary breast augmentation, 5% had implant removal at least once over the first 3 post-operative years. In revision-augmentation patients, the rate was 12% over the same time span. In both populations, patient choice and capsular contracture were the primary reasons for removal.In Allergan’s Core Study, patients who’d undergone primary breast augmentation, 9% had implant removal at least once over the first 4 post-operative years. In revision-augmentation patients, the rate was 12% over the same time span. In both populations, patient choice and capsular contracture were the primary reasons for removal.Most patients in who have had their implants explanted, will opt for replacement. Some women do not. This may have adverse cosmetic effects in itself, such such puckering, wrinkling, loose skin, dimpling, and drooping.

Is there a way to tell my own breast tissue from silicone breast implants during self examination?

Distinguishing native breast tissue from silicone breast implants is a necessary part of breast self-examination. It may be more difficult to tell breast tissue from silicone breast implants as compared to saline breast implants given the softer consistency of silicone. If you encounter difficulties, ask your plastic surgeon to demonstrate the appropriate technique for breast self-examination and point out the difference between breast implants and breast tissue.

Is infection common after breast enlargement surgery with silicone breast implants, what are the consequences, and what is the treatment?

Any surgery, in any discipline carries a risk of infection. The risk is calculated based on the degree of contamination for a particular operation. Breast augmentation is considered a “clean” surgery, and carries an overall infection rate of less than two percent. If infection should take place, it will most often affect one or more of three patterns, assuming there is no disseminated spread, and the infection remains localized. Infection can occur in the skin, in the soft tissue surrounding the implant, and in the form of a pus pocket. Skin infection will usually respond to oral antibiotics. Soft tissue infections surrounding the breast implant may respond to oral antibiotics, will sometimes require intravenous antibiotics, and in other cases need to be treated with implant removal. If the infection should progress to, or start out as an abscess (pus-pocket), the only treatment that will be effective in treating the infection and preventing more serious systemic complications is drainage of pus and breast implant removal. Toxic Shock Syndrome (TSS) may result from the presence of a foreign body (breast implant in this case) in the setting of an infection, and is a truly life-threatening condition that needs to be addressed immediately. It is marked by high fever, nausea and vomiting, diarrhea, light-headedness and possibly loss of consciousness, and a diffuse rash. The treatment is timely institution of IV antibiotics, and breast implant removal. If the breast implant is removed, the infection should be treated, the inflammation allowed to resolve, and a new implant placed weeks down the road.

Should I have breast augmentation using silicone or saline prosthesis?

To begin with let’s address the controversy surrounding silicone filled breast implants. There is a well known reporter of Asian descent married to an ex-talk show host who built a career on sensational reporting without any basis in fact, that cheated millions of women out of a perfectly soft, and natural silicone breast augmentation. As is the case with many such issues, the truth was not nearly as well publicized. For a decade, the truth was not made public at all. To add to this, countless cases of alleged harms stemming from the implantation of silicone implants were exploited by immoral attorneys. Since the 1990’s, silicone breast implants have been shown to impart no increase in the incidence of breast, cancer, immune disease, or any other malady so eagerly imparted to them by dishonest litigators, and melodramatic fortune seekers with no regard for the effect it would have on women interested in breast augmentation, and especially augmentation combined with a breast lift. Silicone implants have several drawbacks but in the opinion of many plastic surgeons, such shortcomings are far outweighed by the benefits afforded by their use in breast augmentation. Silicone breast implants are thought to produce a softer breast, less breast contour deformities, and a substantially more natural feel on breast contact than saline breast implants. The drawbacks to silicone mammary prosthesis use are twofold. The first is difficulty in the detection of breast implant rupture. When silicone breast implants rupture, the saline that was used to fill them is reabsorbed, and the discrepancy between what was and what is, or between what the size of the unaffected breast and the side of the affected breast is very obvious. When silicone breast implants rupture, the silicone fill is not absorbed. The change in the affected breast is more consistent with a shape change than a size change. As a consequence, this becomes much more difficult to detect. This would not be a problem, however, silicone incites a significant inflammatory reaction in many patients, leading to a dense capsule, and making it difficult to remove the old breast implant, and achieve a predictable result in placing the new one at the same operation. Staging, or breaking the operation presents the patient with the nuisance of two surgeries. For this reason, a patient with silicone breast implants must be very vigilant in monitoring for signs of implant rupture, as early detection, and re-implantation, makes it much less likely that a significant inflammatory reaction, or a tough breast implant capsule will form.

Is pain normal after breast augmentation surgery with silicone implants?

The breast enlargement surgery itself should be painless, whether performed under sedation with local anesthetic, or general anesthesia. It is the postoperative period that some may find brings discomfort. Assuming the postoperative course is without complication, pain from breast augmentation surgery peaks the day after surgery, and diminishes over the course of the following three to four days to be tolerable enough without the use of narcotics. Of course, pain tolerance varies significantly from patient to patient. The 72-96 hrs time frame is a “ballpark” figure, and a reflection of personal experience. Several other important factors are crucial to consider in breast enlargement surgery. Pre-incisional administration of local or dilute local (called tumescent) anesthetic greatly diminishes postoperative breast enlargement surgery pain. Postoperative pain and tenderness can be further affected by breast implant placement position. Sub-muscular placement or “dual plane” placement may cause substantially more discomfort than sub-glandular placement because of muscle dissection. If a skin excision is necessary, pain may be more pronounced. The injection of local anesthetic at the conclusion of breast augmentation surgery greatly diminishes postoperative discomfort. In addition, a more effective multiple intercostal nerve block may be performed. Finally, a small catheter may be placed, within the breast implant pocket, for the purpose of delivering local anesthetic in the post breast enlargement surgery period. This has been shown in studies to help significantly with postoperative discomfort. In short, breast enlargement surgery is very well tolerated in most patients.Having stated all of this, it is important to note that pain should get progressively better. Pain that is persistent, uncontrolled by pain medication, or increases in duration and/or intensity after breast augmentation may be a sign of post-operative complication and requires prompt attention.

Is seroma (fluid accumulation as your body attempts to fill a potential space) common after breast enlargement surgery with silicone breast implants, what are the consequences, and what is the treatme

In breast augmentation surgery, a space is created under the soft tissues of the chest wall. This is the space where the breast implant is placed. The size of the pocket and the size of the implant are seldom identical, and the discrepancy creates a potential space where fluid can collect. The dissection through the soft tissue to the breast implant pocket also makes a potential space for fluid to collect. Sometimes a long standing blood collection can leave a space after it is resorbed. Most seromae resolve with only a few drainage attempts, without an incision. In cases where post-breast augmentation seromae fail to resolve, lining of the fluid pocket needs to be excised because this is what makes the fluid.

Is breast tissue or skin flap death (necrosis) common after breast augmentation surgery with silicone breast implants?

Necrosis of breast tissue or soft tissues and skin is very unusual after breast augmentation only, it is much more likely in the case of a breast lift where a significant amount of tissue is removed. Necrosis is the result of loss of blood supply, hence oxygen, leading to tissue death. Blood supply is lost when dissection proceeds through tissue containing vessels that supply a given area, and transects them. Since multiple vessels usually supply any given area of breast and skin, sacrifice of a few vessels is usually well tolerated. The use of nicotine in any form (smoking, chewing, gum, patch, etc.), chemotherapy, radiation, corticosteroids, contamination all compromise blood supply and make the sacrifice of even a few vessels a significant risk for breast tissue death.

Am I a good candidate for the use of silicone gel-filled breast implants in my breast augmentation surgery?

Silicone implants have several drawbacks but in the opinion of many plastic surgeons, such shortcomings are far outweighed by the benefits afforded by their use in breast augmentation. Silicone breast implants are thought to produce a softer breast, less breast contour deformities, and a substantially more natural feel on breast contact than saline breast implants. The drawbacks to silicone mammary prosthesis use are twofold. The first is difficulty in the detection of breast implant rupture. When silicone breast implants rupture, the saline that was used to fill them is reabsorbed, and the discrepancy between what was and what is, or between what the size of the unaffected breast and the side of the affected breast is very obvious. When silicone breast implants rupture, the silicone fill is not absorbed. The change in the affected breast is more consistent with a shape change than a size change. As a consequence, this becomes much more difficult to detect. This would not be a problem, however, silicone incites a significant inflammatory reaction in many patients, leading to a dense capsule, and making it difficult to remove the old breast implant, and achieve a predictable result in placing the new one at the same operation. Staging, or breaking the operation presents the patient with the nuisance of two surgeries. For this reason, a patient with silicone breast implants must be very vigilant in monitoring for signs of implant rupture, as early detection, and re-implantation, makes it much less likely that a significant inflammatory reaction, or a tough breast implant capsule will form. The ideal candidate for a primary breast augmentation with silicone, therefore, is a patient who is secure with silicone as implantation material, is very aware of the shape of her breasts, and vigilant in monitoring for rupture, has a very small amount of native breast tissue, or has a significant amount of droop and desires sub-glandular placement to correct it with minimal incisions.

Is silicone gel-filled breast implant rupture obvious, or easily detected?

When a saline implant ruptures, the saline absorbed within a matter of days. When a silicone breast implant ruptures, the silicone is not absorbed. It remains within the capsule. The shape of the breast may change, but the difference is often undetected in the majority of cases, by patient and by surgeon, and the diagnosis must be established via MRI. If rupture is detected, the breast implant should be removed.In the Allergan Core Study, primary silicone breast augmentation patients who were screened by MRI had a rupture rate of 2.7%, and silicone breast implant revision-augmentation patients had a rupture rate of 4% over 4 years. A European study found a rupture rate of 11% over 15 years. In either study there were no instances of gel migration. There are currently large Allergan post-approval studies being conducted for further safety data.In the Mentor Core Study, primary silicone breast augmentation patients who were screened by MRI had a rupture rate of .5%, and silicone breast implant revision-augmentation patients had a rupture rate of 7.7% over 3 years.

Are unsatisfactory results common after breast augmentation surgery with silicone breast implants?

A patient may be displeased for any number of reasons. The incidence of reoperation for a unsatisfactory result was shown to be roughly 2% of the 15-24% overall re-operative incidence in primary breast augmentation. So, the incidence of reoperations for unsatisfactory results seems to be well below 1%. This is not to say that all patients who are dissatisfied, are dissatisfied to the point of wanting another operation to address the problem, but the answer to whether or not unsatisfactory results are common is no.

Is breast tissue or skin flap death (necrosis) common after breast augmentation surgery?

Necrosis of breast tissue or soft tissues and skin is very unusual after breast augmentation only, it is much more likely in the case of a breast lift where a significant amount of tissue is removed. Necrosis is the result of loss of blood supply, hence oxygen, leading to tissue death. Blood supply is lost when dissection proceeds through tissue containing vessels that supply a given area, and transects them. Since multiple vessels usually supply any given area of breast and skin, sacrifice of a few vessels is usually well tolerated. The use of nicotine in any form (smoking, chewing, gum, patch, etc.), chemotherapy, radiation, corticosteroids, contamination all compromise blood supply and make the sacrifice of even a few vessels a significant risk for breast tissue death.

What Were The Main Reasons For Implant Removal in The Allergan Core Study for Primary Augmentation with INAMED® Silicone Breast Implants?

What Were The Complication Rates After 4 Years of Follow-up?

Complications rates reported In The Allergan Core Study for Primary Augmentation with INAMED® Silicone Breast Implants are shown below.



*Most events were assessed with severity ratings, and the rates shown in the table include only complications rated moderate, severe or very severe (excludes mild andvery mild ratings). All occurrences of reoperation, implant removal, implant rupture,implant extrusion and pneumothorax are included.**There was one patient with a suspected rupture of one of her implants. This rupture has not yet been confirmed with removal and visual inspection of the implant.Complications rates reported In The Allergan Core Study for Revision Augmentation with INAMED® Silicone Breast Implants are shown below.

Revision-Augmentation: Complications



*Most events were assessed with severity ratings, and the rates shown in the table include only complications rated moderate, severe or very severe (excludes mild andvery mild ratings). All occurrences of reoperation, implant removal, implant rupture,implant extrusion and pneumothorax are included.**There were two patients with a suspected rupture in one of their implants. These two ruptures have not yet been confirmed with removal and visual inspection of the implants.

What Were The Benefits to Silicone Breast Augmentation according to the Allergan Core Study on INAMED® Silicone-Filled Breast Implants?

Positive outcomes in the Allergan Core Study with INAMED® Silicone-Filled Breast Implants were reported as follows.In patients who have undergone primary silicone breast augmentation, 396 (87%) of the total 455 patients underwent breast measurement within 1 and ½ years of surgery. 41% increased by 1 cup size; 45% increased by 2 cup sizes; 8% increased by more than 2 cup sizes; and 6% had no increase or decrease. Patient contentment was based on a 5-point scale evaluation of satisfaction with their silicone breast implants at the time of the follow-up visits. Of the total 455 breast augmentation patients in the study, 364 (80%) gave a satisfaction rating four years after surgery. 346 (95%) were satisfied with their silicone breast implants. According to the commonly used mental and physical health scales (SF-36) and self-esteem scale (Rosenberg), primary augmentation patients showed no significant changes after 4 years. There was a decrease in self-concept on the Tennessee Self Concept Scale in the same time span.Breast measurement were not obtained in revision-augmentation patients since implants were already in place and being exchanged.Patient contentment was based on a 5-point scale evaluation of satisfaction with their silicone breast implants at the time of the follow-up visits. Of the total 146 breast revision-augmentation patients in the study, 111 (76%) gave a satisfaction rating four years after surgery. 96 (87%) were satisfied with their silicone breast implants. According to the commonly used mental and physical health scales (SF-36) and self-esteem scale (Rosenberg), primary augmentation patients showed no significant changes after 4 years. There was a decrease in self-concept on the Tennessee Self Concept Scale in the same time span.

What was the followup rate in the Allergan Core Study on INAMED® Silicone-Filled Breast Implants?

The Allergan Core Study on INAMED® Silicone-Filled Breast Implants has divulged an overall risk for any given complication over the first four years of 41% in primary breast silicone augmentation patients, and 57% for revision-augmentation patients. Of the 455 primary silicone breast augmentation patients enrolled in the study, 83% followed up (378 patients). Of the 147 primary silicone breast augmentation patients enrolled in the study, 83% followed up (378 patients). Of the 147 silicone breast reconstruction patients enrolled in the study, 82% followed up (121 patients).

What Were The Main Reasons For Reoperation in The Allergan Core Study for Primary Augmentation with INAMED® Silicone Breast Implants?

The Allergan Core Study for Primary Augmentation with INAMED® Silicone Breast Implants showed an additional 345 procedures performed in 135 reoperations involving 103 primary augmentation patients. 39 of the procedures may be attributed to capsular contracture. The follow-up spans 4 years.

What were the Allergan Core Study Results on INAMED® Silicone-Filled Breast Implants for primary augmentation and revision-augmentation?

The Allergan Core Study is the primary clinical study for INAMED® Silicone-Filled Breast Implants. Individual outcomes cannot be predicted by the study, but expectations, benefits, and chances for a particular negative event may become more clear. The study took place over a 10-year period and was performed to determine the safety and value of the use of silicone breast implants in breast augmentation, breast reconstruction, and breast revision, whether after enlargement or augmentation patients.Silicone breast implant patients were seen weekly for a month, at half a year, and then yearly for 10 years. Safety evaluated through noting the incidence of complications, like infection, capsular contracture, silicone implant rupture, and the need for more surgery. Benefits were ascertained via patient satisfaction and quality of life measures. The Allergan Core Study of INAMED® Silicone-Filled Breast Implants involved 715 patients. Procedures performed included 455 primary silicone breast augmentations, 147 revision-augmentations, 98 breast reconstructions, and 15 revision-reconstructions. Silent rupture was assessed via MRI in 158 primary silicone breast augmentation patients, 50 revision-augmentation patients, 51 primary breast reconstruction patients, and 5 revision-reconstruction patients. The imaging was performed at year after operation, and then at 2 year intervals. It was designed to end at year 9 after surgery, and is updated on a rolling basis. The study has thus far reported on the first four years.

What is the difference between silicone and saline filled breast implants?

The difference between the two types of implants is obvious. Silicone breast prostheses are filled with a silicone, while saline breast implants are filled with saline. The actual breast implant sack, called a breast implant shell, is made of a rubbery silicone elastomer, regardless of whether the implants are silicone, or saline. Apart from certain advantages and disadvantages with respect to the technical outcome of breast augmentation surgery, the basic difference is that silicone implants come filled, while saline implants are filled at the time of surgery. One advantage to saline breast implants that stems from this, is the ability to fill the two breasts with slightly different volumes to correct any small changes in size between the two breasts present before surgery. The answer to the question as to which type of implant to use in breast augmentation surgery has supporters on both the saline breast implant, and the silicone breast implant side. To begin with let’s address the controversy surrounding silicone filled breast implants. There is a well known reporter of Asian descent married to an ex-talk show host who built a career on sensational reporting without any basis in fact, that cheated millions of women out of a perfectly soft, and natural silicone breast augmentation. As is the case with many such issues, the truth was not nearly as well publicized. For a decade, the truth was not made public at all. To add to this, countless cases of alleged harms stemming from the implantation of silicone implants were exploited by immoral attorneys. Since the 1990’s, silicone breast implants have been shown to impart no increase in the incidence of breast, cancer, immune disease, or any other malady so eagerly imparted to them by dishonest litigators, and melodramatic fortune seekers with no regard for the effect it would have on women interested in breast augmentation, and especially augmentation combined with a breast lift. Silicone implants have several drawbacks but in the opinion of many plastic surgeons, such shortcomings are far outweighed by the benefits afforded by their use in breast augmentation. Silicone breast implants are thought to produce a softer breast, less breast contour deformities, and a substantially more natural feel on breast contact than saline breast implants. The drawbacks to silicone mammary prosthesis use are twofold. The first is difficulty in the detection of breast implant rupture. When silicone breast implants rupture, the saline that was used to fill them is reabsorbed, and the discrepancy between what was and what is, or between what the size of the unaffected breast and the side of the affected breast is very obvious. When silicone breast implants rupture, the silicone fill is not absorbed. The change in the affected breast is more consistent with a shape change than a size change. As a consequence, this becomes much more difficult to detect. This would not be a problem, however, silicone incites a significant inflammatory reaction in many patients, leading to a dense capsule, and making it difficult to remove the old breast implant, and achieve a predictable result in placing the new one at the same operation. Staging, or breaking the operation presents the patient with the nuisance of two surgeries. For this reason, a patient with silicone breast implants must be very vigilant in monitoring for signs of implant rupture, as early detection, and re-implantation, makes it much less likely that a significant inflammatory reaction, or a tough breast implant capsule will form.

Will I be able to breast feed after breast enlargement surgery with silicone breast implants?

Breast augmentation surgery should not affect breast feeding. Because breasts gain more projection and substance after enlargement, they are typically easier to hold. Because they protrude more, and are easier to hold, breast feeding becomes much easier. Paradoxically breast feeding is actually less difficult for some women, after breast augmentation surgery. Given all of this, however, there are studies showing that women with breast implants report an inability to feed in up to 2/3’s of the implanted population, compared to 7 in 100 for women without breast implants. It is doubtful, however, that matching for size and age such results would ever hold up.

Is breast tissue atrophy common after breast enlargement surgery with silicone breast implants?

Breast tissue atrophy may be a result of aging, or the pressure exerted by a usually large breast implant in relation to the patient breast and chest wall size. This adverse effect is not very common.

Can calcium collections in the breast after silicone breast implant surgery be mistaken for cancer?

Besides cancer, calcium accumulates in areas of trauma or inflammation such as surgical sites. Although calcium present in and/or around tumors has a distinct configuration, it may be mistaken for a possible malignancy with a resultant recommendation for biopsy and/or extirpative surgery. Such procedures may result in the need for implant removal and replacement, or even breast reconstruction. A baseline mammogram prior to breast augmentation , and radiologic centers experienced in the Eklund technique would likely diminish the chances for this.

Is there an association between breast augmentation surgery with silicone breast implants and cancer, or other serious conditions?

According to multiple studies, there is no association between breast enlargement surgery and breast cancer.The following is an excerpt from a US breast implant manufacturers on the subject.“Breast CancerReports in the medical literature indicate that patients with breast implants are not at a greater risk than those without breast implants for developing breast cancer. Some reports have suggested that breast implants may interfere with or delay breast cancer detection by mammography and/or biopsy; however, other reports in the published medical literature indicate that breast implants neither significantly delay breast cancer detection nor adversely affect cancer survival of women with breast implants.Brain cancerOne recent study has reported an increased incidence of brain cancer in women with breast implants as compared to the general population. The incidence of brain cancer, however, was not significantly increased in women with breast implants when compared to women who had other plastic surgeries. Another recently published review of four large studies in women with cosmetic implants concluded that the evidence does not support an association between brain cancer and breast implants.Respiratory/Lung CancerOne study has reported an increased incidence of respiratory/lung cancer in women with breast implants. Other studies of women in Sweden and Denmark have found that women who get breast implants are more likely to be current smokers than women who get breast reduction surgery or other types of cosmetic surgery. Cervical/vulvar cancer – One study has reported an increased incidence of cervical/vulvar cancer in women with breast implants. The cause of this increase is unknown.Other CancersOne study has reported an increased incidence of stomach cancer and leukemia in women with breast implants compared to the general population. This increase was not significant when compared to women who had other types of plastic surgeries.Neurological Disease, Signs, and SymptomsSome women with breast implants have complained of neurological symptoms (such as difficulties with vision, sensation, muscle strength, walking, balance, thinking or remembering things) or diseases (such as multiple sclerosis), which they believe arerelated to their implants. A scientific expert panel report found that the evidence for a neurological disease or syndrome caused by or associated with breast implants is insufficient or flawed.SuicideIn several studies, a higher incidence of suicide was observed in women with breast implants. The reason for the observed increase is unknown, but it was found that women with breast implants had higher rates of hospital admission due to psychiatriccauses prior to surgery, as compared with women who had breast reduction or in the general population of Danish women.Effects on ChildrenAt this time, it is not known if a small amount of silicone may pass through from the breast implant silicone shell into breast milk during breastfeeding. Although there are no current established methods for accurately detecting silicone levels in breast milk, astudy measuring silicon (one component in silicone) levels did not indicate higher levels in breast milk from women with silicone gelfilled implants when compared to women without implants. In addition, concerns have been raised regarding potential damaging effects on children born to mothers with implants. Two studies in humans have found that the risk of birth defects overall is not increased in children born after breast implant surgery. Although low birth weight was reported in a third study, other factors (for example, lower pre-pregnancy weight) may explain this finding. This author recommended further research on infant health.Potential Health Consequences of Gel BleedSmall quantities of low molecular weight (LMW) silicone compounds, as well as platinum (in zero oxidation state), have been found to diffuse (“bleed”) through an intact implant shell. The evidence is mixed as to whether there are any clinical consequences associated with gel bleed. For instance, studies on implants implanted for a long duration have suggested that such bleed may be a contributing factor in the development of capsular contracture and lymphadenopathy. However, evidence against gel bleed being a significant contributing factor to capsular contracture and other local complications, is provided by the fact that there are similar or lower complication rates for silicone gelfilled breast implants than for saline-filled breast implants. Saline filled breast implants do not contain silicone gel and, therefore, gel bleed is not an issue for those products. Furthermore, toxicology testing has indicated that the silicone material used in the Mentor implants does not cause toxic reactions when large amounts are administered to test animals. It also should be noted that studies reported in the literature have demonstrated that the low concentration of platinum contained in breast implants is in the zero oxidation (most biocompatible) state. In addition, two separate studies sponsored by Mentor have demonstrated that the low concentration of platinum contained in its breast implants is in the zero oxidation (most biocompatible) state. Mentor performed a laboratory test to analyze the silicones and platinum (used in the manufacturing process), which may bleed out of intact implants into the body. Over 99% of the LMW silicones and platinum stayed in the implant. The overall body of available evidence supports tat the extremely low level of gel bleed is of no clinical consequence.”

What is capsular contracture after breast enlargement surgery with silicone breast implants?

A breast implant capsule is the firm, sometimes hard and thick, scar tissue that forms on the inside of the breasts and surrounds the breast implants after breast enlargement surgery. This sphere can contract over time, and squeeze the breast implants (capsular contracture). This would certainly place the breast implants in one position with almost no mobility. The positions of the left and right implants may be distorted with respect to each other, and also in relation to the chest wall. The shape of the breasts may also be made abnormal in any direction. The breasts may also feel unnaturally hard. Finally, significant pain may also be present. The incidence of capsular contracture is thought by many plastic surgeons to be related to blood collection, fluid collection, contamination, or infection at the time of breast enlargement surgery. It is also more common when the breast implants are placed on top rather than behind the pectoralis muscle, and in revision-augmentation. Capsular contracture after breast augmentation is also a risk factor for implant rupture owing to the squeezing of the breast implant by the capsule. This capsular contracture is the most common overall reason for re-operation in breast augmentation patients. It is assigned various grades of severity as noted below, with grades 3 and 4 generally requiring re-operation.Baker Grade I:the breast is normally soft and looks naturalBaker Grade II:the breast is a little firm but looks normalBaker Grade III:the breast is firm and looks abnormalBaker Grade IV:the breast is hard, painful, and looks abnormalSurgical options for the treatment of capsular contracture include releasing the capsule circumferentially, completely excising the capsule, or even the former or latter combined with breast implant replacement. Regardless of the intervention, there is no guarantee against the recurrence of capsular contracture.The Mentor Core Study put the risk of capsular contracture at 8% for the first 3 years after operation for primary augmentation patients. In revision-augmentation the risk was much higher at 19% over the first 3 years.The Allergan Core Study put the risk of capsular contracture at 13% for the first 4 years after operation for primary augmentation patients. In revision-augmentation the risk was much higher at 17% over the first 4 years.

Is chest wall deformity common after breast enlargement surgery with silicone breast implants?

Chest wall deformity may be a result of aging, or the pressure exerted by a usually large breast implant in relation to the patient breast and chest wall size. This adverse effect is not very common.

Is there an asociation between silicone breast implants and connective tissue disease?

Pseudoscientific “studies” reported on cases of connective tissue disease supposedly associated with breast implant use in breast augmentation surgery. No study to date has ever demonstrated this. Many women who went on to develop connective tissue disease after breast augmentation attributed the problem to the implants, but the truth is that the incidence of such patients within the breast enlargement population and the general population is the same.The following is an excerpt from a US breast implant manufacturer on the subject.“Connective Tissue Disease (CTD)Connective tissue diseases include diseases such as lupus, scleroderma, and rheumatoid arthritis. Fibromyalgia is a disorder characterized by chronic pain in the muscles and soft tissues surrounding joints, with tenderness at specific sites in the body. It is often accompanied by fatigue. There have been a number of published epidemiological studies which have looked at whether having a breast implant is associated with having a typical or defined connective tissue disease. The study size needed to conclusively rule out a smaller risk of connective tissue disease among women with silicone gel-filled breast implants would need to be very large. The published studies taken together show that breast implants are not significantly associated with a risk of developing a typical or defined connective tissue disease. These studies do not distinguish between women with intact and ruptured implants. Only one study evaluated specific connective tissue disease diagnoses and symptoms in women with silent ruptured versus intact implants, but it was too small to rule out a small risk.CTD Signs and SymptomsLiterature reports have also been made associating silicone breast implants with various rheumatological signs and symptoms such as fatigue, exhaustion, joint pain and swelling, muscle pain and cramping, tingling, numbness, weakness, and skin rashes. Scientific expert panels and literature reports have found no evidence of a consistent pattern of signs and symptoms in women with silicone breast implants. Having these rheumatological signs and symptoms does not necessarily mean you have a connective tissue disease; however, you should be aware that you may experience these signs and symptoms after undergoing breast implantation. If you notice an increase in these signs or symptoms, you should consider seeing a rheumatologist to determine whether these signs or symptoms are due to a connective tissue disorder or autoimmune disease.”

Does baby get exposed to silicone that diffuses from silicone breast implants?

Silicon concentrations in breast milk were not shown to be higher in women with silicone breast implants versus women without silicone breast implants. Silicon is a component in silicone, so that the study looking at this was not wholly conclusive, and if any component of silicone is in fact present in breast milk the effects of this will not be known until further studies are performed.

Does the use silicone gel-filled breast implants in breast enlargement surgery affect my insurance premiums?

Policies vary among individual health insurance providers, but there is a chance your health insurance premiums may increase as a result of breast enlargement surgery. Coverage of post-surgical complications also varies substantially. You should check with your insurance company prior to your breast enlargement surgery. It may be wise to purchase a one time coverage for possible complications for a relatively low one time payment.

What is a periareolar incision in breast enlargement surgery?

The periareolar incision goes around the nipple. It is less noticeable, smaller than the inframammary incision, and if a lift is required later in time, it may be utilized again. Its disadvantages in breast enlargement surgery are a higher infection rate (because the cut goes through breast tissue), possible difficulty in breastfeeding, and the risk of decreased sensation in breast skin and nipple sensation.

What are PIP Saline Breast Implants?

(PIP=Poly Implant Prosthesis) Saline Breast Implants are simply silicone elastomer shell breast implants pre-filled with saline. The touted advantages of this breast implant is two-fold. The first is that the implant shell is thinner and, has a more natural feel, like that of silicone implants. The second is that no filling is required at the time of surgery minimizing the risk of contamination, and cutting down operative time. Bot points are moot since the PIP Saline Breast Implants are not available in the US, secondary to a lack of submitted safety data.

Should I opt for Subglandular, Submuscular, or the “Dual-Plane” Breast Implant Placement?

Subglandular placement refers to placement of breast implants under the skin, fat, and breast tissue, but on top of the muscle. As a result of this, patients who are thin, and lack significant breast tissue will have an increased chance for implant palpability. The risk for capsular contracture is also significantly higher for both saline and silicone breast implants when placed over the muscle. The advantage to using this approach is the ability to take up loose skin at the lower poles of the breasts, and avoid the longer incisions necessary for a breast lift in some cases.Submuscular placement puts the breast implant pocket between the ribs of the chest wall and the chest (pectoralis) muscle on top. It is much less prone to cause breast implant palpability than subglandular implant placement, and is associated with a lower risk of scarring and hardness around the implants. Its disadvantage is the propensity to cause a higher riding breast implant. When the pectoralis muscles are contracted the implants are also prone to move up in a very unnatural fashion.The “dual-plane” approach allows placement of the upper portion of the implant under the muscle, and by releasing the lower portion of the muscle allows the lower portion of the breast implant to sit under the breast tissue. This eliminates the drawbacks of both the sub-glandular and sub-muscular placement while retaining the advantages of both. It is the most commonly performed placement in today’s breast augmentation surgery.

What are Polyurethane Coated Breast Implants?

Polyurethane Coated Breast Implants are not available in the U.S. at this time. They were taken off the UK market in 1991, but brought back in 2005 after “The Committee on Carcinogenicity” deemed the carcinogenic risk “small and unquantifiable.” The advantage of the polyurethane implant is thought to be less capsular contracture. A lot of the more seasoned plastic surgeons swear by this type of implant. Further information from the British MHRA (Equivalent of FDA, except for the food part), can be studied below.“Polyurethane-coated breast implants”Polyurethane-coated silicone gel breast implants are now available for implantation in the UK.These implants consist of a silicone elastomer shell filled with silicone gel. The shell is coated with a polyurethane foam which breaks down over time. Polyurethane-coated breast implants were removed from the UK market in 1991, following concerns about the possible carcinogenic risk from the polyurethane breakdown product. The Committee on Carcinogenicity1 concluded that carcinogenic risk from these implants is small and unquantifiable. In April 2005, the manufacturer of one type of polyurethane-coated breast implant reintroduced them to the UK. The manufacturer claims that the incidence of capsular contracture is lower than with other types of breast implant, and that the movement or rotation is less.”

How did MHRA bring the Polyurethane Coated Breast Implant issue to plastic surgery patients?

Information for women considering polyurethane-coated breast implants…What are polyurethane-coated breast implants?Micro-Polyurethane Surfaced (MPS) mammary implants, manufactured by PolytechSilimed Europe GmbH, consist of a silicone elastomer shell, filled with silicone gel.This design is similar to other silicone gel breast implants, except that the shell iscoated with a polyurethane foam, intended to reduce the rate of capsular contracture.What is capsular contracture?Fibrous tissue forms around any implant as part of the body’s response to the implant material. The formation of a fibrous capsule around a breast implant is thus a normal reaction. In some women, however, the fibrous capsule can contract and ‘squeeze’ the implant resulting in an altered appearance and consistency of the breast, and is sometimes associated with pain. This is known as capsular contracture. The amount of contracture varies from person to person and cannot be predicted before implantation. An additional operation to remove the fibrous capsule, and possibly the implant, is sometimes necessary.What are the advantages of polyurethane-coated breast implants?The manufacturer claims that the incidence of capsular contracture is lower for MPS implants than for other silicone breast implants with smooth or textured shells. The texture of the foam coating is believed to disrupt the organisation of the cells that form the fibrous capsule, thus making the capsule less likely to contract. They also claim that movement or rotation of the implant is less likely due to better adhesion to the underlying tissue.What are the risks associated with polyurethane-coated breast implants?Following implantation, the polyurethane foam coating breaks down over several years. After this time, it is thought that the protective effect against capsular contracture may be lost or diminished. One of the chemicals that is released into the surrounding tissue during the breakdown of the coating is known to cause cancer in animal experiments. The risk of developing cancer in humans due to the presence of these implants is small and unquantifiable.How do I decide whether to have polyurethane-coated breast implants?Many factors need to be taken into account when deciding which type of implant is most suitable for a particular person, and the relative importance of these factors varies with individual circumstances. Your plastic surgeon will be able to discuss the options available to you and the advantages and drawbacks of each, so that, between you, you can reach a decision on which type of breast implant would be the most appropriate for you.This information sheet has been produced by the Devices Division of the Medicines and Healthcare products Regulatory Agency (MHRA), which was formerly the Medical Devices Agency (MDA). MHRA is an executive agency of the UK Department of Health whose role is to protect and promote public health and patient safety by ensuring that medicines, healthcare products and medical equipment meet appropriate standards of safety, quality, performance and effectiveness, and are used safely.

How did MHRA bring the Polyurethane Coated Breast Implant issue to plastic surgery professionals?

The following letter was issued by MHRA.“12th April 2005Dear…Reintroduction of polyurethane-coated breast implants in the UKI am writing to you about the decision by Polytech Silimed Europe GmbH, to supply their Micro-Polyurethane Surfaced (MPS) mammary implants for use in the UK, as from April 2005. Polyurethane-coated implants have not been available in the UK since 1991. The purpose of this letter is to bring to the notice of plastic surgeons the risks and claimed benefits associated with these implants, so that surgeons can reach an informed judgement on the suitability of the implants and be able to give appropriate advice to women considering their implantation.BackgroundSilicone gel filled breast implants covered with polyurethane foam coating were introduced to clinical use in the 1970s with the aim of reducing the rate of capsular contracture. They were withdrawn worldwide in 1991 following concern that the polyurethane coating might release a carcinogenic breakdown product. One such breast implant (the MPS implant) was subsequently reintroduced in Europe and the Medical Devices Agency (MDA, now MHRA) issued two Advisory Notices1 to draw attention to the carcinogenic risk and to advise surgeons that these implants should not be used in the UK.Evidence of RiskThe carcinogenic risk arising from polyurethane-coated breast implants was assessed by the Committee on Carcinogenicity2 (COC) in 1991 and 1994. The COC concluded that the implants give rise to a small, unquantifiable carcinogenic risk because the breakdown of the polyurethane coating over a number of years leads to the release of small amounts of the probable genotoxic carcinogen, 2,4-toluenediamine (2,4-TDA). No evidence has emerged since 1994 that would alter the COC’s conclusions. In 2001, MDA prepared a report on the safety of polyurethane-coated breast implants. This report presented the opinion of the COC and discussed factors relevant to the carcinogenic risk assessment. It noted that there were reports of a reduction in capsular contracture with polyurethane-coated breast implants but insufficient evidence was available at that time to demonstrate the long-term benefits of these devices over other products.Further DevelopmentsIn 2003, in response to the MDA report, Polytech Silimed provided MHRA with a review of evidence for a lower, quantifiable rate of capsular contracture with polyurethane-coated breast implants. The manufacturer claimed that the clinical benefits of these implants therefore outweighed the potential risks. In November 2003, the above reports were reviewed by the Committee on the Safety of Devices3 (CSD). The CSD concluded that, on the basis of the evidence available at that time, the benefits were not substantial and did not outweigh the remote but unquantifiable carcinogenic risk. They therefore could not recommend the re-introduction of polyurethane-coated breast implants into clinical use in the UK. In 2004 the manufacturer provided additional evidence which they claimed further supported the clinical benefit of these implants. In January 2005, the manufacturer informed MHRA of their intention to supply MPS mammary implants in the UK. As the implants are CE marked medical devices, the MHRA accepts that they can legitimately be placed on the UK market, provided users and potential recipients are appropriately informed about their risks and benefits. MHRA has placed details of the CSD discussion and a copy of its 2001 report on the safety of these implant on its website for the information of plastic surgeons 4. Information on the benefits claimed for these implants can be obtained from the manufacturer5. Plastic surgeons may also find the attached information sheet useful when discussing the suitability of these implants with their patients.Yours sincerely,Dr Susanne LudgateBSc(Hons) MB ChMB DMRT FRCR FRACRClinical Director (Devices)Medicines and Healthcare products Regulatory Agency (MHRA)”

What can I expect in the post-operative period following breast enlargement surgery?

The following information is given to Dr. Gerzenshtein’s patients before surgery to inform them of a typical course after breast augmentation. Your plastic surgeon may have a different working environment, and his or her patients a different experience. Consult with your physician about their impressions of patient experience. On waking from anesthesia, you will find yourself in the recovery room with dressings and/or bra in place. You will be able to depart once sufficiently recovered from anesthesia. A friend or family member should drive you home and stay with you for the next 2 days to help you with activities of daily living. You will feel tired and run down for the first several days after general anesthesia, this will improve substantially over the first week. Discharge should be minimal over the next 48 hours; bleeding may occur with excessive activity. If dilute local solution was used (superwet or tumescent technique) pain and discomfort will be mild initially, it will increase and peak within two days, it will then subside over the course of one to two weeks, please use pain medication as needed to help. Nausea and vomiting in the postoperative period is not uncommon and has to do with the type of anesthesia used, and overall patient sensitivity to the various medications, it generally resolves within one to two days after surgery, increasing fluid intake, especially via one of the “ade” (gatorade, powerade, etc.) solutions available for sports use, combined with anti-emetic medication should minimize this problem. Use of opiate pain medication, combined with inactivity, and dehydration may lead to constipation, increasing fluid intake will help this as well, especially in combination with walking, and the use of the prescribed stool softener. Swelling and bruising peak within three days of surgery and gradually subside over the following week. Healing incisions will adopt a pinkish hue which should gradually fade over the next six months to a year. Some patients react to absorbable (inside) suture, small pustules or whiteheads along the incision may signal this, the suture may be removed in the office if the problems becomes bothersome. Numbness may affect the breast skin, and/or the nipple, most commonly this involves the lower pole of the breast skin, and resolves on its own within six months.

Are there any particular questions you should ask of your plastic surgeon in consultation?

Any of the questions within this FAQ section may be asked, however because of time constraints, it is best to ask questions that focus on the negatives, possible complications, and possible re-operations.
What is the rate of re-operative breast augmentation surgery?
What are the reasons for early re-operative breast enlargement surgery?
What are the reasons for late re-operative breast enlargement surgery?
Will I ever need another breast operation?
What are the pros and cons of silicone versus saline breast implants?
Why are there all kinds of different shapes, sizes and textures for implants, which one is right for me?
Will the position of my implants change over time?
Will I ever need a breast lift?
If I decide to have the breast implants removed, and not replaced, will my breasts look deformed?
Will I be able to breast feed?
Will the shape and size of my breasts change during, or after pregnancy?
How does the look of implanted breasts change over time?
What happens if I don’t like the way my breasts look?
Asking about a surgeon’s credentials and experience should not make one apprehensive. Allowing a surgeon to alter your body is very personal. You must be very comfortable with the surgeon’s credentials, and with his or her understanding of your expectations.
Can I see some preoperative and postoperative photographs of your work?
Are you board certified in plastic surgery?
Do you do many breast augmentations?
What is your “re-do” percentage?
What is the most common problem you’ve encountered post-operatively?
You should have at least a general idea of what you expect your breasts to look like after augmentation. After all, if you don’t know, how can you expect your plastic surgeon to get a result you will be happy with. Things to consider include breast implant size, and the particulars of shape such as cleavage, upper breast fullness or slope, and implant projection, or perkiness, placement under the muscle, or over it, incision site, and smooth versus textured implants. You should also consider the advantages and disadvantages of silicone breast implants vs. saline breast implants. All of this information will aid your surgeon in choosing the right implant size and type for you.

If I need revision breast augmentation surgery, or “touch up” breast enlargement surgery do I have to pay?

Generally, surgeon fee should be waived for breast augmentation revision surgery. That would leave the cost of the facility fee, supplies, and possibly anesthesia to worry about, which should run a fraction of the cost of the original surgery. A plastic surgeon will typically gladly correct mistakes associated with positioning, size discrepancy, and obvious asymmetry, as this clearly reflects on the surgeon’s ability, but also integrity. Some surgeons will do the same regardless of whether the mistake was their own, or due to patient compliance, accident, etc. The time frame for something like this is typically one year. All conditions must be discussed, and agreed upon by the patient and surgeon; so that there are no misunderstandings should a repeat surgery be necessary. Both implant companies based in the U.S. have extended warranties on both their breast implants, and repeat breast augmentation surgery for a very small fee. This breast augmentation insurance should be seriously considered by anyone undergoing breast enlargement surgery.

What Were The Main Reasons For Implant Removal in The Allergan Core Study for Revision-Augmentation with INAMED® Silicone Breast Implants?

The Allergan Core Study for Revision-Augmentation with INAMED® Silicone Breast Implants showed 32 implant removals performed in 18 prevision-augmentation patients. 26 of the 32 implants were replaced. 9 of the procedures may be attributed to capsular contracture – the most common reason for removal. The follow-up spans 4 years.

Revision-Augmentation: Main Reason For Implant Removal Through 4 Years

What Were The Main Reasons For Reoperation in The Allergan Core Study for Revision-Augmentation with INAMED® Silicone Breast Implants?

The Allergan Core Study for Revision-Augmentation Augmentation with INAMED® Silicone Breast Implants showed an additional 181 surgeries performed in 83 reoperations involving 49 revision-augmentation patients. 14 of the procedures may be attributed to capsular contracture. The follow-up spans 4 years.

Saline Vs. Silicone

To begin with let’s address the controversy surrounding silicone filled breast implants. There is a well known reporter of Asian descent married to an ex-talk show host who built a career on sensational reporting without any basis in fact, that cheated millions of women out of a perfectly soft, and natural silicone breast augmentation. As is the case with many such issues, the truth was not nearly as well publicized. For a decade, the truth was not made public at all. To add to this, countless cases of alleged harms stemming from the implantation of silicone implants were exploited by immoral attorneys. Since the 1990’s, silicone breast implants have been shown to impart no increase in the incidence of breast, cancer, immune disease, or any other malady so eagerly imparted to them by dishonest litigators, and melodramatic fortune seekers with no regard for the effect it would have on women interested in breast augmentation, and especially augmentation combined with a breast lift. Silicone implants have several drawbacks but in the opinion of many plastic surgeons, such shortcomings are far outweighed by the benefits afforded by their use in breast augmentation. Silicone breast implants are thought to produce a softer breast, less breast contour deformities, and a substantially more natural feel on breast contact than saline breast implants. The drawbacks to silicone mammary prosthesis use are twofold. The first is difficulty in the detection of breast implant rupture. When silicone breast implants rupture, the saline that was used to fill them is reabsorbed, and the discrepancy between what was and what is, or between what the size of the unaffected breast and the side of the affected breast is very obvious. When silicone breast implants rupture, the silicone fill is not absorbed. The change in the affected breast is more consistent with a shape change than a size change. As a consequence, this becomes much more difficult to detect. This would not be a problem, however, silicone incites a significant inflammatory reaction in many patients, leading to a dense capsule, and making it difficult to remove the old breast implant, and achieve a predictable result in placing the new one at the same operation. Staging, or breaking the operation presents the patient with the nuisance of two surgeries. For this reason, a patient with silicone breast implants must be very vigilant in monitoring for signs of implant rupture, as early detection, and re-implantation, makes it much less likely that a significant inflammatory reaction, or a tough breast implant capsule will form.

Should I perform self breast examinations after breast enlargement surgery?

Self breast examinations are very important regardless of the presence of breast implants. Imaging studies combined with breast self-examinations may help discover a cancer in its early stages, thereby making treatment more effective.

How can breast implants change the shape of my breasts?

Breast implants are designed to increase the size of the breasts into which they are implanted. The way in which breast shape changes is dictated by the type and size of breast implants used. Wider implants add cleavage, while narrower implants of the same volume increase the projection, or perkiness of the operated breasts. Anatomically shaped, otherwise referred to as contoured, or teardrop breast implants, produce more upper pole fullness, but less of the other characteristics, given that that at the same volume, more fill sits higher in the breast. Using larger breast implants may obviate the need for a mastopexy, or a breast lift, because the larger volume may be able to adequately take up the extra skin present in the cases of significant breast sagging or drooping.

Shaped Vs. Round

This decision depends as much on what the surgeon can accomplish using either the round or the anatomically contoured implants as on which type of implants to use. Assuming the breast pockets are dissected in to the inferior or lowermost extent in the exact same manner, the shaped implants will impart more fullness at the top, and provide a more natural, gently curving slope to the augmented breast. For this to happen, however, the lowermost portion of the dissection or pocket must be the same no matter which mammary implants you use. If a surgeon habitually dissects low enough inferiorly to drop round breast prosthesis low enough that upper pole fullness is lost, that surgeon will likely favor the teardrop shaped, or anatomically shaped implant to compensate for that dissection. For anatomically shaped or contoured implants to do what they were intended for, pocket dissection has to extremely precise. This is because contoured breast implants are not symmetric; they have a top and bottom. If the subglandular or submuscular pockets are too wide, the shaped implants can shift or even flip, imparting asymmetry and even worse an unnatural shape to the augmented breast. Even though shaped mammary implants are textured, this is still no guarantee against malposition. Finally using the round type of breast implants can impart more medial or inner breast fullness. This significantly improves cleavage, because more fill volume winds up toward the more central part of the breast.There are several advantages to the use of high profile breast implants. First, just as the name suggests, for any given fill volume, high profile breast implants will implant more projection or profile when compared to moderate or “normal” breast prosthesis, and most certainly more than low profile, or anatomically shaped breast implants. The way to picture this is that if you had a cone with a highly sitting tip versus a cone with a wide base, the narrower, taller cone would point more (think of Madonna’s show bra!) and thus give more projection to the breast. What this means is that women with a narrower, smaller chest wall can still have larger breasts. The advantage to some women, and disadvantage to others comes from a basic difference in perception as what a natural breast should look like. If a patient prefers a highly “perky,” high profile, or well projecting breast, the high profile breast implant would be considered ideal. High profile breast implants would not be ideal to place in a patient who prefers natural, gently sloping, and slightly ptotic (hanging) breasts, or in a client who is large and wide chested. Placing full profile breast implants in the case of a wide chest would impart a very unnatural “double cone” appearance. For women with a mid-range chest-wall diameter the choice is one of partiality. That is, the decision has to be made between projection, and cleavage. This is because lower profile implants with a wide base will naturally fill up the inner, otherwise known as the medial breast, and produce cleavage. Finally, it is mostly the anecdotal opinion of some authorities that full or high profile implants tend to generate less rippling.

What are MemoryGel™ Smooth Round Moderate Profile Breast Implants? What are their advantages and disadvantages?

As the name suggests the MemoryGel™ Smooth Round Moderate Profile Breast Implants are round in shape (not anatomically shaped), have a moderate profile (not too low, and not too perky), and are encased in a smooth silicone elastomer shell. The advantages of using textured versus smooth breast implants are discussed in another section of this text, but are more related to physician preference, and beliefs regarding skin palpability than scientific data. The biggest advantage of the round moderate profile breast implants is a compromise between upper pole fullness, cleavage, and projection. It is a sort of “jack-of-all trades, master of none.” Because it does not emphasize one aspect of the implanted breast over another the augmentation takes place throughout, producing a full, rounded appearance. In addition, the use of silicone allows for the use of the MemoryGel™ Smooth Round Moderate Profile Breast Implants in breasts with less skin and soft tissue cover. Some physicians prefer to use the larger size breast implants in moderate breast ptosis (sagging breasts) to avoid extra incisions. Use of silicone implants, because of their consistency, is ideal in such cases, especially when the lower pole of the breast has little soft tissue cover. The particular proprietary polymer employed in the Mentor devices is a cohesive gel that is purported to have more consistency such that even in cases of ruptured breast implants it is said not to leak as fast or as much. The obvious disadvantage to the moderate round breast implants is that if one particular area of concern needs special attention, a more specialized implant will give better improvement than this all-purpose breast implant.

Smooth Round Gel Moderate Profile Sizing Chart

What are MemoryGel™ Smooth Round Moderate Plus Profile Breast Implants? What are their advantages and disadvantages?

As the name suggests the MemoryGel™ Smooth Round Moderate Plus Profile Breast Implants are round in shape (not anatomically shaped), have a moderate plus profile (not too low, but more perky), and are encased in a smooth silicone elastomer shell. The advantages of using textured versus smooth breast implants are discussed in another section of this text, but are more related to physician preference, and beliefs regarding skin palpability than scientific data. The biggest advantage of the round moderate plus profile breast implants is a compromise between upper pole fullness, cleavage, and projection. It is a sort of “jack-of-all trades, master of none.” Because it does not emphasize one aspect of the implanted breast over another the augmentation takes place throughout, producing a full, rounded appearance. In addition, the use of silicone allows for the use of the MemoryGel™ Smooth Round Moderate Profile Breast Implants in breasts with less skin and soft tissue cover. Some physicians prefer to use the larger size breast implants in moderate breast ptosis (sagging breasts) to avoid extra incisions. Use of silicone implants, because of their consistency, is ideal in such cases, especially when the lower pole of the breast has little soft tissue cover. The particular proprietary polymer employed in the Mentor devices is a cohesive gel that is purported to have more consistency such that even in cases of ruptured breast implants it is said not to leak as fast or as much. Because it does not emphasize one aspect of the implanted breast over another the augmentation takes place throughout, producing a full, rounded appearance. The Plus Profile Breast Implants does, however add a bit more projection, or the protuberance noted on side view at a slight expense to the width of the breast, and thus the cleavage. The obvious disadvantage to the moderate plus round breast implants is that if one particular area of concern needs special attention, a more specialized implant will give better improvement than an all-purpose breast implant.

Smooth Round Gel Moderate Plus Profile Sizing Chart

What are Contour Profile® High Breast Implants Style 2900? What are their advantages and disadvantages?

As the name suggests the Contour Profile® Moderate Breast Implants are contoured to resemble the slope of a natural breast (a subject of debate), have a high (perky) profile, and are encased in a textured silicone elastomer shell, to aid in maintaining their position. The advantages of using textured versus smooth breast implants are discussed in another section of this text, but are more related to physician preference, and beliefs regarding skin palpability than scientific data. The use of a textured in shell in an anatomic or teardrop implant is absolute. This is because textured implants adhere more intimately to the implant capsule, and have less of a tendency to move. When placing shaped breast implants it is very important to achieve correct positioning, as there is a definite orientation to the implants, hence textured shells are used with contoured breast implants exclusively. The biggest advantage of the contoured breast implants is their ability to add more volume to the upper pole of the breast, and to provide a gentler slope to the breast silhouette. Cleavage is more affected in the high profile implant, as its base is narrower, and the inside part of the breast does not extend as far inward. Projection is improved through a taller implant with a narrower base. The obvious disadvantages to the high profile contoured implants are decreased cleavage, as explained above, and the danger of implants malposition, or flipping within the pocket of dissection. Although at times a turned-about breast implant may be restored to “normal” position without surgery, sometimes a trip to the operating room becomes necessary.

Contour Profile®, High Profile Style 2700 Sizing Chart

What are Contour Profile® Moderate Breast Implants Style 2900? What are their advantages and disadvantages?

As the name suggests the Contour Profile® Moderate Breast Implants are contoured to resemble the slope of a natural breast (a subject of debate), have a moderate profile (not too low, and not too perky), and are encased in a textured silicone elastomer shell, to aid in maintaining their position. The advantages of using textured versus smooth breast implants are discussed in another section of this text, but are more related to physician preference, and beliefs regarding skin palpability than scientific data. The use of a textured in shell in an anatomic or teardrop implant is absolute. This is because textured implants adhere more intimately to the implant capsule, and have less of a tendency to move. When placing shaped breast implants it is very important to achieve correct positioning, as there is a definite orientation to the implants, hence textured shells are used with contoured breast implants exclusively. The biggest advantage of the contoured breast implants is their ability to add more volume to the upper pole of the breast, and to provide a gentler slope to the breast silhouette. Cleavage is less affected than projection, as breast implant width is maintained, but projection is diminished. The obvious disadvantages to the contoured implants are decreased projection, as explained above, and the danger of implant malposition, or flipping within the pocket of dissection. Although at times a turned-about breast implant may be restored to “normal” position without surgery, sometimes a trip to the operating room becomes necessary.

Contour Profile® Moderate Breast Implants Style 2900 Sizing Chart

What are the various silicone implants available from Mentor?

What are Siltex® Round Moderate Profile Breast Implant Style 2600? What are their advantages and disadvantages?

As the name suggests the Round Saline Breast Implants are round in shape (not anatomically shaped), have a moderate profile (not too low, and not too perky), and are encased in a textured silicone elastomer shell. The advantages of using textured versus smooth breast implants are discussed in another section of this text, but are more related to physician preference, and beliefs regarding skin palpability than scientific data. The biggest advantage of the round moderate profile breast implants is a compromise between upper pole fullness, cleavage, and projection. It is a sort of “jack-of-all trades, master of none.” Because it does not emphasize one aspect of the implanted breast over another the augmentation takes place throughout, producing a full, rounded appearance. The obvious disadvantage is that if one particular area of concern needs special attention, a more specialized implant will give better improvement than this all-purpose breast implant.

Siltex® Round, Moderate Profile Style 2600 Sizing Chart

What are Round Saline Breast Implants? Particularly the Smooth Round High Profile Breast Implants, Style 3000 from Mentor? What are their advantages and disadvantages?

As the name suggests the Round Saline Breast Implants are round in shape (not anatomically shaped), have a high profile, giving them more of a bulge on side view (the most perkiness for your buck), and are encased in a smooth silicone elastomer shell. The advantages of using textured versus smooth breast implants are discussed in another section of this text, but are more related to physician preference, and beliefs regarding skin palpability than scientific data. The biggest advantage of the round high profile implants is this protuberance, considered youthful by many patients, and plastic surgeons. Another considerable advantage is the ability to use higher volume implants in patients with narrow chest walls because the width of the implant base is narrower. The disadvantages include a sacrifice of cleavage, owing to the decrease in the base diameter of the implant, and a drop in upper pole fullness for the same reason. In addition some women find the look imparted by the high profile breast implant too perky.

Smooth Round, High Profile, Style 3000 Sizing Chart





Please Note: Individual implant dimensions may vary slightly in products of this type. Not all units will conform exactly to the dimensions noted above.

What are Round Saline Breast Implants? Particularly the Smooth Round Moderate Profile Breast Implants, Style 1600 from Mentor? What are their advantages and disadvantages?

As the name suggests the Round Saline Breast Implants are round in shape (not anatomically shaped), have a moderate profile (not too low, and not too perky), and are encased in a smooth silicone elastomer shell. The advantages of using textured versus smooth breast implants are discussed in another section of this text, but are more related to physician preference, and beliefs regarding skin palpability than scientific data. The biggest advantage of the round moderate profile breast implants is a compromise between upper pole fullness, cleavage, and projection. It is a sort of “jack-of-all trades, master of none.” Because it does not emphasize one aspect of the implanted breast over another the augmentation takes place throughout, producing a full, rounded appearance. It is touted by Mentor to betheir most popular implant for over 2 decades. The obvious disadvantage is that if one particular area of concern needs special attention, a more specialized implant will give better improvement than this all-purpose breast implant.

Smooth Round Moderate Profile Style 1600 Sizing Chart

What are Round Saline Breast Implants? Particularly the Smooth Round Moderate Plus Profile Breast Implants, Style 2000 from Mentor? What are their advantages and disadvantages?

As the name suggests the Round Saline Breast Implants are round in shape (not anatomically shaped), have a moderate profile (not too low, and not too perky), and are encased in a smooth silicone elastomer shell. The advantages of using textured versus smooth breast implants are discussed in another section of this text, but are more related to physician preference, and beliefs regarding skin palpability than scientific data. The biggest advantage of the round moderate profile breast implants is a compromise between upper pole fullness, cleavage, and projection. It is a sort of “jack-of-all trades, master of none.” Because it does not emphasize one aspect of the implanted breast over another the augmentation takes place throughout, producing a full, rounded appearance. The Plus Profile Breast Implants do, however add a bit more projection, or the protuberance noted on side view at a slight expense to the width of the breast, and thus the cleavage. The obvious disadvantage is that if one particular area of concern needs special attention, a more specialized implant will give better improvement than this all-purpose breast implant.

Smooth Round Moderate Plus Profile Style 2000 Sizing Chart



Please Note: Individual implant dimensions may vary slightly in products of this type. Not all units will conform exactly to the dimensions noted above.

What was presented to the committee on safety of devices (MHRA)?

COMMITTEE ON SAFETY OF DEVICES – 20 NOVEMBER 2003 MEETING POLYURETHANE-COATED BREAST IMPLANTS
Background
Conventional breast implants consist of a silicone shell surrounding a silicone gel filling. The silicone shell can be smooth or textured. Silicone gel filled breast implants covered with a polyurethane foam coating were introduced to clinical use by an American manufacturer in the 1980s with the aim of reducing the risks of capsular contracture compared with those seen in conventional breast implants. They were withdrawn from the market in 1991 following concern that the coating might release a carcinogenic breakdown product. An equivalent product was subsequently reintroduced outside the USA and is currently authorised for marketing throughout Europe and is on sale in several European and South American countries. However, the product has not been available in the UK since 1993 and MDA issued advisory notices to draw attention to this in 1994 and 1996 (Annex 1).
In 2001, MDA responded to approaches from a European manufacturer and plastic surgeons on the anomalous position in the UK, compared with the rest of Europe, by preparing an updated analysis of the biological safety of the implants. This found that earlier conclusions on the carcinogenic risk still stood, but the benefits claimed of the polyurethane coating could not be substantiated by the evidence available. There was therefore no basis for altering the advice given in 1994 and 1996.
In July 2003, in response to the MDA report, the European manufacturer provided MHRA with a literature review, which concluded that the superiority of polyurethane-coated breast implants, in terms of capsular contracture rates, had been demonstrated.
Review of carcinogenicity
The carcinogenic risk arising from polyurethane-coated breast implants was assessed by the Committee on Carcinogenicity (COC) in 1991 and 1994. The COC concluded that the breakdown of the polyurethane coating over a number of years leads to the release of small amounts of the probable genotoxic carcinogen, 2,4-toluenediamine (2,4-TDA) into the tissues surrounding the implant. This gives rise to a small, unquantifiable carcinogenic risk.
No evidence has emerged since 1994 that would alter the COC’s conclusions, although MDA noted recent evidence for the in vivo genotoxicity of 2,4-TDA and for its presence in the tissue of implanted women.
The 2001 MDA Review of the biological safety of polyurethane-coated breast implants (Annex 2) summarised the relevant data, reported the opinions of the COC and presented a discussion