{Aired 03.15.14}

One of the most popular cosmetic procedures in the United States is Breast Augmentation or Breast Implants. Augmentation means to add to or enhance, having an indication to enlarge.  Today’s focus on the show is breast augmentations – a cosmetic procedure designed to increase the size, shape and fullness of the breasts that are naturally small or become smaller after weight loss. Other factors that can change breast size and volume includes pregnancy which is common especially after breast feeding children.

Cosmetic vs. Reconstructive Breast Augmentation

Typically breast augmentation is considered a cosmetic and an elective surgery however there are exceptions to the cosmetic rules. If a woman has had a mastectomy, it is now federal law for insurance providers to cover the cost of breast reconstruction including breast implants for both breasts to create symmetry.  Another non-cosmetic reason to have breast augmentation is for women suffering from congenital breast defects where breasts develop unnaturally unsymmetrical.

Breast Implant Options

Breast Implants are medical prosthesis or artificial devices used to augment, reconstruct or to create the physical form of a breast.  Outer layers of breast implants made of a form of silicone and are filled with either saline (salt water), silicone gel or an alternative substance.

All implants have their pros and cons. 98% of women said their expectations were met with their implants. However 13% wished they had been larger or went back to their original breast size twenty-five days post surgery.  Make sure you discuss implant options with your board certified plastic surgeon and you understand your own reasoning & expectations for having breast augmentation.

  • Saline Breast Implants – saline filled implants are silicone shells filled with sterile salt water (saline).
  • Silicone Breast Implants – silicone filled implants are silicone shells filled with a plastic gel (silicone). Although many women say that silicone implants feel more like real breasts.
  • Body Fat Transfer – recycle fat from one area of the body to the breasts; may need  multiple procedures to get the desired shape; can possibly result in calcification; NYU School of Medicine study suggests that half the volume created by injecting body fat reabsorbs into the body within months

Position of Breast Implants

  • Subglandular – placement of the implant is above the pectoral muscles but below the mammary gland.
  • Submuscular –  placing the implant under not only the pectoralis major muscle but also under related muscles at the lower half of the implant.

Surgical Breast Implant Techniques

  • Transaxillary- armpit
  • Periareolar  –  around areola and nipple complex
  • Inframammary – under the lower crease of the breast – (under-wire)
  • Non conventional approach – through the belly button

Are Breast Implants Safe?

In 2012, 330,631 breast augments were performed – 28% were saline implants; 72% were silicone these are huge shifts from just 6 years earlier – 81% saline; 19% silicone. This shift may have been due to voluntary moratorium in 1990 on silicone implants. The FDA imposed a moratorium on silicone breast implants in 1992 and lifted the ban in 2006.  This was not done because they thought silicone was dangerous, it was because there was not enough evidence demonstrating that they were safe. 200,000-400,000 women per year  who received breast implants yearly in that period received saline implants. Since they were reapproved in 2006, increasing numbers of women are now getting silicone implants, and today most women are getting silicone.

There are still reasons to use saline, some women and surgeons are still wary of silicone; saline is less costly; only saline can be used through the belly button incision; saline incisions can be shorter than silicone because saline implants are placed deflated and filled only after they are inside the patient.

Myths & Facts About Breast Implants

  • MYTH – Breast implants are linked to autoimmune disease and cancer
  • MYTH – Breast Implants cause connective tissue disease
  • FACT – Brought back to market initially only for patients having reconstructive surgery;

Risks Related to Breast Implants – Capsular Constracture

Capsular Contracture is scar tissue that forms around any foreign device placed in the body a natural part of healing but it often associated with breast implants. Hardening of the breast tissue around the breast implant can occur in one or both breasts and over time the condition worsens.

There are 4 grades of Capsular Contracture known as Baker’s Grade:

  • ranging from the breasts having a normal feel and appearance
  • to the breasts literally being very hard, painful and distorted or abnormal in appearance

Breast Implant Rupture

Breast implants can rupture in the following scenarios:

  • Tear or hole in the outer shell of the breast implant
  • Can be a spontaneous rupture – with no known cause, known as “SILENT” rupture
  • Compression during a mammogram
  • Normal ageing of the implant
  • Trauma or intense pressure  such as a motor vehicle accident

If your implant ruptures call your plastic surgeon immediately and plan for replacement surgery.

Breast Implant Manufacturers

There are 3 major American breast implant manufacturers:

Sientra is the newest breast implant manufacturer to distribute breast implants since being approved by the FDA in 2012. Sientra’s  complication rate was studied in detail with the lowest capsular contracture rate in the industry and has a unique warranty that includes up to $3600 toward surgery, if needed due to a rupture within 10 years after your breast implant surgery. There is also a lifetime product replacement if the implant ruptures including a free contralateral (opposite side) implant if needed.

Unlike the other breast implant manufacturers Sientra only distributes their implants to Board Certified Surgeons only to ensure that an expert is in fact leading the surgery. For more info about Sientra click here.

Click here for a list of questions to ask your board certified plastic surgeon.