It is well known that one of the most common cosmetic procedures performed in the Unites States is
breast augmentation. The most common reasons women desire breast augmentation are the changes that occur to the female
breasts after child birth (post-partum atrophy), changes that occur with weight loss, wanting to be more proportionate
and fit better in their clothes, women with asymmetries and post mastectomy reconstruction. Recently, there has been a
great deal of discussion about Silicone implants in the media and the FDA is considering their approval.
What is a breast implant?
Breast augmentation is a procedure that has been performed for over a hundred years. Multiple substances have been injected
in to the breast to try and improve the shape and volume of the breast. Since the 1960’s breast augmentation has been performed
with an insertion of an implant. The implant is a bag made of a silicone rubber shell and is filled with saline or silicone gel.
Saline Implants
Saline filled implants are filled with salt water. The human body is essentially 60% salt water. Therefore, if the saline implant
leaks, the salt water solution is absorbed without difficulty. The only problem is that it leads to an embarrassment and an obvious
asymmetry, since it usually occurs on one side. This can be corrected with a replacement surgery. These implants are inserted
empty in to the breast pocket and then filled with the sterile saline. The surgeon therefore can adjust the final implant volume
to correct for minor asymmetries that exist in almost everyone. Since the implants are inserted empty they can also be placed
through distant incisions such as the armpit or belly button that leave no scars on the breasts.
The FDA approved the saline implants as safe devices in 2000. The implant manufacturers’ clinical testing, to determine the
most common risks and complications associated with the implants, showed that devices may deflate or leak (1% per year). They
also reported risk rates of developing capsular contracture (hardening of the scar tissue around the implant), infection, bleeding,
pain, numbness and/or loss of nipple sensation and rippling or wrinkling. Despite the high rate of re-operation (20%) within 3-5
years the satisfaction rate remained at 96-98%. The main disadvantage is that saline implants are more palpable (patient may feel
their implants more readily) and they may lead to more rippling or wrinkling especially in thin women. Currently, more than 95%
of implants placed in the US are saline filled prosthesis.
Silicone Implants
In 1992, the FDA restricted the use of silicone filled implants to patients that require reconstruction, patients with scoliosis
and rib cage deformities and severe laxity requiring a significant lift due concern that there may be a link between these implants
and connective tissue disorders (Lupus, scleroderma, arthritis) and even cancer.
Silicones are manufactured in variety of forms, including oils, gels and solids and have many medical uses. Since the
consistency of silicone is closer to the female breast, the silicone gel filled implants tend to fill more natural, especially
in thin women. If the silicone implant ruptures and the silicone gel leaks outside the pocket it cannot be absorbed. This may
lead to nodules that are called granulomas, which are usually asymptomatic. The manufacturer’s now developed better gel filled
implants with thicker shells as well as more cohesive silicone gels which have reduced the incidence of leakage and rupture
significantly. Cohesive gels, to which some people refer to as the "gummy bear" implant, are less likely to lead to formation
of granulomas or foreign body reactions if the implant shell ruptures since the gel remains cohesive within the pocket.
Safety Research
Numerous studies have been performed regarding the safety of the silicone gel filled implants. In most of these studies large
groups of women that received silicone breast implants were compared to a control group. The short term and long-term studies
confirmed repeatedly that there was no association between silicone breast implants and breast cancer or any connective tissue
diseases. Evidence suggests that such diseases are no more common in women with breast implants than women without them.
With this evidence at hand and the improvements made by the implant manufacturers, it is only a matter of time before women
in the United States like the women in the rest of the world will be able to choose which type of implant they would like to
have in consultation with their surgeon. For millions of women who have undergone breast augmentation, the procedure has
resulted in an aesthetic appearance that has improved their self image and quality of life.
Choosing a Surgeon
When choosing a surgeon who is experienced with breast augmentation, you should know the answers to the following questions:
- How many breast augmentation procedures does he/she perform per year?
- What is the most common complication he/she encounters with breast augmentation?
- What is the rate of infection, capsular contracture and leakage with breast augmentation in their practice?
- What is his/her re-operation rate with breast augmentation and what is the most common type of re-operation
he/she performs?
Familiarize yourself with the options in breast implant surgery and be prepared to discuss with your surgeon any questions
you may have regarding implant shape and size, implant placement, incision site, surgical setting, anesthesia and post-operative care.
Dr. Haiavy specializes in breast augmentation, breast lifts, body contouring and facial rejuvenation with years of experience,
training and expertise in a range of cosmetic surgery procedures. He is well known for performing the Belly Button Breast Augmentation,
which can be done with saline implants and does not leave any scars on the breast. For more information regarding this and other
breast augmentation incisions that are available, please contact 1-800-6-COSMETIC or
310-470-9678 or visit their website at www.inlandcosmetic.com.
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