Breast Implant Q & A

Are breast implants safe?

The question of breast implant safety has been extensively investigated over the past several years, following the controversy over the possibility of various diseases attributed to silicone. At this point in time, however, there is probably no product which has undergone more thorough scrutiny than breast implants. The safety question has been reviewed in detail by the Institute of Medicine, which considered all available scientific data in addition to testimony from breast implant patients; the full text of their report can be found at www.nap.edu. It is interesting to note that silicone has been approved for injection directly into the eye for treatment of retinal detachment. Doesn't it seem reasonable to infer that it would be appropriate for use in breast implants also? The saline and silicone implants made by mentor and Allergan are FDA-approved.

Herbal supplements for breast enlargement found ineffective, possibly dangerous

Several products have appeared in recent years claiming to enlarge breasts using "safe, all natural" herbal supplements. yet despite the marketing claims, no clinical studies have ever been published to verify either the safety or effectiveness of these supplements. An article published in the June 2003 edition of the medical journal Obstetrics & Gynecology raised serious questions about both aspects. Of primary importance is the question of safety. Since these products act by stimulation of the breast tissue in a manner similar to estrogen, there is a real possibility that the risk of breast cancer could be increased. Only large scale, long-term studies could answer this question.

Are “gummy bear” implants better?

There is a lot of confusion about the potential benefits of  “gummy bear” implants, also known as cohesive implants, but most correctly called “form stable” silicone implants. In order to sort this out, we first need a little history: a while back, implants with a “teardrop” profile were introduced because that was believed to create a more natural shape. However, it was later shown that the round implants that were commonly used actually had the exact same profile in the upright position; the shaped implants faded from the scene because they provided no demonstrable benefit, while the round implants “behaved” more like a natural breast.

But there remained a concern about silicone gel leakage; what happens when the implant ruptures? The answer is, basically nothing. That is because gel is a semi-solid, not a liquid. In scientific words, it is cohesive. The newer called “gummy bear” implants, used that term to emphasize that the silicone is highly cohesive, meaning that you could slice into it like gelatin and it holds its form. (Hence the correct term form stable.) But the softer gel in round implants is also cohesive, just softer, so it may very well continue to be the more natural-feeling implant. And the form-stable implants have a further disadvantage of requiring a larger incision for insertion, so there is a longer scar.

But because form-stable implants are shaped, not round, they provide an option where the foundation of the breast isn’t round. This may help avoid issues like double- bubble, and they provide another choice where the round implants may just not fit the size and projection that the patient wants. Bottom line is, for anatural result you need to take into account your goals as well as the limitations of your existing anatomy, not make a choice based only on the features of the implant.

Should implants be placed under or over the muscle?

There are several compelling reasons to place the implants under the pectoral muscle which is behind the breast tissue: lower risk of capsular contracture, more thorough and easier mammograms, a more natural look for many patients, less visible rippling of the implants, and less sagging of the breast over time. The downside is that more effort and experience is required by the surgeon to ensure that the implants are not too high, too far apart, or create an unnatural contour on the bottom of the breast in patients who have some sagging preoperatively.

Subfascial breast augmentation

A third option instead of over or under the muscle is called “subfascial” has recently been reported (pronounced like "fashion" without the "n"), which is a sort of compromise between the two. Although it is thin, it is usually substantial enough to provide a layer behind the breast and in front of the implant. We are offering the subfascial option in selected cases. If you would like to know more, we would be happy to discuss it in consultation.

Breast Augmentation Anatomy	Subglandular Breast Augmentation
Subfascial Breast Augmentation	Subpectoral Breast Augmentation
Please note that all photos are for illustrative purposes only.

Can deformity of the breast with muscle flexion be corrected?

The traditional technique for submuscular placement of implants often re sults in a problem characterized by distortion of the breast when the muscle is flexed. Typically, the breast moves up and indents along the bottom portion. This is due to the fact that a portion of the muscle has to be detached, so it pulls on the implant capsule. The subfascial (or subglandular) technique generally eliminates this, but sometimes at the expense of inadequate coverage of the upper portion of the implant. A variation of the subfascial technique called the split subpectoral/subfascial method is often a good solution. This uses the upper portion of the muscle for implant coverage but the lower portion which is usually detached is left behind the implant instead. Many of my primary augmentations are now done this way, and I have published and reported the technique.

Can fungus or bacteria grow inside the implant?

Reports of bacterial or fungal infections developing inside of an implant are rare. Implants are now inflated with a "closed fill" system, eliminating the possibility of contamination of the fluid. There has never been a confirmed report of bacterial or fungal growth in a saline implant filled using a closed fill system.

What are the chances that the implants will leak and need to be replaced?

The primary reason for replacing a saline implant is deflation, which is a harmless event and not usually related to any specific activity.

While it is unlikely that every implant will last a lifetime, there is no reason to replace an implant arbitrarily after a certain period of time.

What are the advantages of high profile saline implants?

High profile round implants have a smaller diameter but more projection compared to the standard implants. My experience is that when the implant diameter matches the natural base diameter of the breast, the result is more natural appearing and there is less rippling. With the availability of the new HP implants (introduced in 2002) we are now able to match the diameter with a choice of different sizes.

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