Breast Implants surgery

What are breast implants?

These are the artificial circular or domed shaped prosthetics used to increase the size of a woman’s breasts. The surgery undertaken to do this is known as breast augmentation, breast enlargement, mammoplasty etc. A series of incisions are made in the breast area and a special pocket is made. The implant is inserted in either of two ways:

• submuscular: the implant is placed beneath the major muscle of the chest.
• subglandular: the implant is placed above the chest muscle.

The implant themselves are rubber shells which are either filled with a saline solution or a silicone gel.

Is there more than one type of breast implants?

Breast implants come in different shapes, textures, sizes and fillers. The filler refers to the saline solution or the silicone gel.

Breast implant shape:these can either be round or ‘anatomical’ (tear drop shaped). The round shape is the most popular shape although the anatomical shape is seen as more natural looking.

There are advantages and disadvantages to both.

The round implantis cheaper and can look just as natural as the anatomical model. It was felt that the anatomical shape looked more like a ‘real’ breast but that is not always the case. A lot depends on your body type, the amount of breast tissue you have and the type of procedure your surgeon performs.

The teardrop or anatomical implantis often viewed as providing a more ‘natural’ looking appearance than the round implant. But, that is not always the case. The teardrop implant appears to be oval in shape when viewed from the front and more volume at the bottom when seen from the side. This enables it to project in a conical fashion. In the past, there has been a risk of teardrop implants ‘flipping’ over in the pocket. They are now created with a textured surface to prevent this.

Breast implant texture: they can either be smooth or textured. Smooth are as the name says whereas textured implants have a rough surface and feel rather like sandpaper. There is less risk of capsular contracture with textured implants.

The smooth implanttends to have freedom of movement in the pocket whereas the textured one stays still. Smooth implants have a thinner shell and last longer whereas textured shells are thicker and are more likely to break.

Textured implantsare firmer and can help protect against capsular contracture. In respect of size; this is an important part of your treatment. You will be measured beforehand so that we can balance the size of your breasts with what you and what like them to be. It’s about achieving a realistic balance between what you have already and what you would like.

During your consultation the surgeon will look at what type of implant, the size, the placement and the incision. He/she will also look at ‘nipple droop’: the amount of this will inform him/her whether you will require other surgery to reshape the breast such asbreastuplift. You need to bear in mind that although you are looking at bigger breasts and so a bigger bra size that implants do not come in ‘bra sizes’. They come in weight and volume sizes. Basically, the bigger the implant the greater the increase in bra size after your surgery. You are probably looking at an increase of one bra size or letter after your surgery. So, if you were a 34B then you could become a 36B. The fillers are the two types of solutions used in the implants. There are saline filled implants and silicone gel filled implants.

The saline implantsconsist of a firm, silicone elastomer shell which contains a saltwater or saline solution. This solution is very similar to the ones inside your body. The idea behind that is that if the implant breaks or leaks then this solution will be absorbed by your body. If this does happen then the implant will deflate instantly. You will certainly notice this result.

The silicone gel implantis soft, pliable and produces a natural look and movement. This latest type of gel has a textured surface so will reduce the risk of hardening or capsular contracture. There is no confirmed link between silicone leakage and serious health problems such as cancer or connective tissue disease.

There is another type of silicone gel implant called ‘cohesive silicone gel’ implant. This is both strong and durable and contains several layers which help to prevent against leaking. It also protects against rupture. If the shell does rupture then the gel will not leak out and the implant will retain its shape. Basically, cohesive silicone is a much more solid form of silicone filler whereas non-cohesive silicone is liquid type filler. It is also the most advanced silicone implant available. Other advantages include the inclusion of a ‘shape memory’: this means it will return to its normal shape so no rippling or folding. It also has a natural soft appearance. Another type of implant is the ‘ Hydrogel’ implant. This implant has a double advantage in that it combines the safety of the saline implant with the benefits of the gel. It will simulate the appearance of a firm and supple breast and looks completely natural. This implant is safe and if in the unlikely case of rupture the contents can be safely absorbed by the body. If you require breast reconstruction surgery as a result of a mastectomy (breast removal) then there is the option of a reconstructive breast implant. This involves the surgeon using a tissue expander: this is a temporary silicone shell which is inserted under the breast tissue and gradually inflated with saline solution. As the surgeon does so the expander stretches the skin which causes the formation of healthy new tissue. Once it has done it will be replaced with a permanent implant. If you have had a single or double mastectomy then this can be performed as an ‘immediate’ procedure or a ‘delayed’ procedure. If you opt for the ‘immediate’ procedure then this involves breast implant surgery at the same time as the mastectomy. The ‘delayed’ procedure is suitable for those women who have had a mastectomy but are still undergoing chemotherapy or radiotherapy. A third alternative is to have reconstructive surgery without the breast implants. This is called ‘Tissue Transfer Surgery’ and involves the surgeon taking skin, muscle and tissue from another part of the body to construct a new breast.

Are breast implants safe?

There has been quite a bit of media attention surrounding the safety of silicone implants. They have been linked to breast cancer and autoimmune diseases. These diseases include arthritis, skin conditions, hair loss, changes in saliva and eye fluid, muscle and joint pains. These conditions have been reported by women who have also had silicone breast implants. They have assumed that the implants have leaked and that the leaked gel is responsible for these illnesses. Another complication iscapsular contraction. This happens when the body forms a protective layer or capsule around the implant. It is the body’s natural response to what it perceives to be a foreign body. This happens every time an implant is inserted and is usually trouble free. The capsule is, in effect, scar tissue which seals the implant from the tissue surrounding it. However, this scar tissue can thicken and increase over time. If it thickens to the point where it is compressing the implant and so distorting its shape then it will need to be treated. If that happens to you then your implant will feel hard and will take on the appearance of a ‘ball’. Surgery is required to break open the scar tissue to release the tension. The capsule is removed and the implant will have to be replaced. The cohesive silicone implant does not leak but the non-cohesive type of implant can leak and will do into the surrounding tissue. This has also been seen in women who have chosen to go abroad forcosmetic surgery. If you have the non-cohesive implant and it leaks, then you will notice that the firmness of your breast is affected. If this happens then further surgery is required

How long do breast implants last?

The implants are tough and durable but like anything, are not permanent. They do suffer from daily ‘wear and tear’ in much the same way as anything else. The outer shell of the implant will show small cracks after 12 to 15 years. On average, breast implants last for 15 to 20 years. But everyone is different and the amount of wear and tear will depend upon your lifestyle such as the amount of exercise you take etc. It is a good idea to have your breast implants checked at regular intervals, 11 years following your surgery.

What can go wrong with breast implants surgery?

Breast implant surgery is very safe but like all surgery, things can go wrong. There are risks which are common to all forms of surgery and ones which are specific to a particular type of procedure. These are:

• Leakage:there is a small risk of leakage from the non-cohesive silicone implant as it contains a liquid type of filler.
• Capsular contracture:the name given to the body’s natural process in which it forms a protective layer of scar tissue or ‘capsule’ around the implant. The problem is when this capsule tightens over time which can squeeze and harden the implant.
• Implant deflation:if the implant has tiny rips in the surface then fluid can leak out. As this fluid leaks it causes the implant to deflate in size. This is more of a problem with saline implants. If this happens then the implant can ‘fold over’ itself. Deflation can happen quickly over a period of a few days.
• Implant rippling:this is particular prevalent with saline implants and non-cohesive silicone implants. It is where the liquid inside the implant moves around. This causes the breast skin to wrinkle, known as ‘rippling’. It tends to be a problem with those implants that are inadequately filled and positioned over the chest muscle.
• Implant migration:this is where the implant runs the risk of moving out of position. It can happen to both the saline and silicone implants. It is pretty rare but can happen. The larger the implant the greater the risk of displacement.
• Siliconomas:this is a condition in which silicone can spread outside of the implant and capsule, and into the breast area. This can cause small lumps called ‘siliconomas’ to develop. These lumps can be tender to the touch. The silicone can spread into the muscles under the armpit, under the arm or around the nerves to the arm. If they cause pain then they may need to be removed.
• Implant extrusion:this is extremely rare. It is when the stitched incision breaks open which means you can see the implants. The implants will have to be removed and replaced 6 to 12 months later.
• Implant rotation:the ‘tear drop’ or anatomical implant has to be inserted into the right sized pocket and so ensure a snug fit. If there is any excess space the surgeon may use a drain to remove this space. These implants can engender a more natural looking appearance although this is spoilt if they rotate in their position.
• Reduced or loss of nipple sensation:this can happen after breast augmentation surgery. After the implants are inserted the nipples can lose sensation which can be permanent. This is something that will be mentioned to you at your initial discussion with your surgeon.

What is breast implant removal surgery? This is also known as revision surgery. It is performed in order to address complications related to breast implants followingbreast augmentationorbreast uplift surgery. Implant removal is as the name says: the breast implants are removed if the patient experiences a ‘problem’ or a complication. In general, implants are removed due to several reasons:

• It has changed in shape or size
• Capsular contracture
• Implant rippling, extrusion and deflation
• It has ruptured or is leaking
• The patient is dissatisfied with the results

These reasons account for more than 70% of implant removal surgery. Breast implants can last between 15 to 20 years. After that time they will show signs of ‘wear and tear’ and will need to be replaced. If the implants are removed then there is the risk that the patient will requirebreast uplift surgeryto reshape or lift drooping breasts.Breast asymmetry surgerymay be needed to correct uneven breasts.

What is breast implant replacement surgery?

This is surgery undertaken to remove a faulty or ‘problematic’ implant. Implants are safe but things can go wrong which means the insertion of a new set of implants.

Breast Implant Replacement

Breast implants are safe and durable but they don’t last forever. They tend to last for up to 20 years but during that time will show signs of wear and tear. This can take the form of small tears or a rupture in the outer shell. This damage will result in leakage in both the saline and silicone gel types of implant. Other issues include a compression of the implant due to abnormal thickening of the scar tissue or capsule surrounding the implant. This is known ascapsular contracture. Other issues associated with breast implants include rippling, extrusion and migration. These are situations in which the implant moves out of position, is seen by the patient because the incisions have burst or appears to ripple. Rippling is where the liquid inside the implant moves, usually because the implant has not been completely filled. The first indication that an implant is ‘faulty’ is a change in shape or size. If the implant is leaking then you will notice that your breast has become smaller and softer. If it is a saline implant then the salt water liquid will be absorbed by and flushed out of the body. If you have had the silicone gel version then this too will be absorbed by the body. Another factor is that some women are not happy with the implants: they may feel that they are positioned too high or too low. They may also feel that they do not look ‘natural’.

What are the main reasons for replacing breast implants?

One reason iscapsular contracture. This is the condition in which scar tissue thickens to the point that it distorts the shape of the implant. The body naturally produces this scar tissue or ‘capsule’ as a protective barrier over the implant. The problem arises when this scar tissue starts to increase in size and compresses the implant. This capsule needs to be broken in order to release the tension around the implant. The implant is removed from the special breast pocket and if damaged, will be replaced. If it is intact then it will be reinserted into the pocket. Other reasons include wanting smaller or bigger implants; rippling, migration, extrusion and deflation. Another important reason is that of limited shelf life: breast implants last for many years but not forever. Silicone gel implants tend to last up to 21 Years whereas saline implants average 12 to 14 years. If you wish to preserve the size of your new breasts then you will be looking at replacement implants after 10 to 15 years.

How much will breast implant replacement surgery cost?

Breast implant surgery can cost between $5,400 and $8,000 although it can vary from one surgeon to another. Costs depend on the surgeon fees, the clinic, aftercare etc.

Who is not suitable for implant replacement?

The reasons for this are the same as for implant removal. Unless the implants are causing a physical problem, then you will find that your surgeon would prefer to leave them where they are. It is often the case that the risk of removing them outweigh the risk of leaving them where they are. Your reasons for wanting the implants to be removed or replaced will have to be discussed with your surgeon

What is the breast implant replacement procedure?

The procedure is performed under general anaesthetic or via IV sedation. It involves the surgeon making an incision around the areola or in the natural crease underneath the breast. He/she will cut open the protective capsule and carefully remove the implant from its pocket. If the implant is the silicone gel type then it will be checked for signs of damage. If it is the saline version then the surgeon may deflate it before removal. The surgeon will then insert a new implant. There is likely to be minimal pain following the surgery. If you do experience any pain then you will be given painkillers to deal with this. As regards recovery, you will be sore and tired for the first few days following surgery. Arrange for someone to drive you home and to be on hand in case you need anything.

Are there any risks associated with breast implant replacement surgery?

Breast implant replacement (or removal) is a safe procedure but like all surgery, comes with a small amount of risk. There is a possibility of complications which applies to allsurgical procedures. These are:

• Blood clots
• Heavy bleeding
• Poor wound healing
• Disappointing results
• Infection
• Bad reaction to anaesthesia
• Diminished or loss of nipple sensation