What are breast implants?
What are breast implants?Breast implants are medical devices that are surgically placed to create, maintain and improve the shape of the breast. They are used both for cosmetic improvement of the average breast and in breast reconstruction where the appearance, feel or size is, what plastic surgeons term “less than average”. It is implied that breast shape, size and feel that is less than normal is likely, or more commonly caused by some preexistent factor such as breast cancer with resultant surgical or medical treatment, congenital or developmental diagnosis or traumatic injuries to the breast.
Despite the fact that cosmetic patients and reconstruction patients may be starting at different breast quality levels, plastic surgeons recognize each person’s right for self improvement and work to gain the most improvement for every patient. Implant surgery techniques and the implants themselves are very similar in the treatment of both cosmetic and reconstructive patients and, in fact, cosmetic breast surgery blossomed form the techniques and information learned from doing reconstructive surgery.
The best plastic surgeons also recognize that despite a patient might be labeled as a “cosmetic patient” or a “reconstructive patient”, each type of patient is both cosmetic and reconstructive. For example, patients who have lost a breast as the result of cancer treatment, the main goal is to achieve the best cosmetic result possible for that patient . Another example is that patients who seek cosmetic surgery to enlarge their breast would also want to be able to wear different types of clothing and most women would like to “fit in” with other women and not appear as “totally different” and so a breast size is chosen to achieve certain aesthetic (shape) goals while staying within certain size goals that may relate to the patient’s chest size, height and hip width.
What are the different types of breast implants?
In order to maintain softness and a natural feel for the breast, implants are composed of a shell and it’s contents. The shell is a solid rubber sheet that is shaped during the implant fabrication process and has been always made up of silicone. Silicone is a polymer, like nylon and can be made into a solid, a gel or even an oil. The contents within the breast implants are either saline or silicone gel and both are used in equal numbers today by cosmetic and reconstructive surgeons. Over the past several years, different densities of the gel fill have become available with the idea that patients and doctors may further customize patient treatment. Studies on these new types of gel breast implants are still forthcoming.
Differently shaped shells have also been developed and marketed by implant manufacturers. The commonest implant used for breast augmentation today is the round implant. This implant exhibits a round shape when a patient with implants is lying down and when the patients sits or stands, the contents of the implant “flows” downward and the implant confers a shape that is more like a natural breast. It appears more like a natural breast because the upper part of the breast sticks out less than the lower part of the breast which becomes more full. By changing the contents of the breast implant, manufacturers can offer implants with not only a different feel but, as mentioned different flow characteristics that may make breast enhancement patients have different shapes when they are either lying down or sitting up.
The opposite of the round shell is what plastic surgeons refer to as anatomic implants. Patients refer to these implants as “tear drop implants”. They maintain the same tear drop shape whether a patient is lying down or standing up. Since anatomic implants are more complicated, for example they must be textured on their surface to maintain their position, they generally are more difficult to get the best cosmetic result and also have more complications associated with them. Despite this, anatomic implants are still in use today but are much less commonly used than round implants.
As mentioned above, contents can either be saline or silicone gel. There are equal amounts of these types of implants used today in cosmetic surgery. Both types of fills are equally safe. What differentiates them are two issues, commonly referred to as rippling and contracture. Saline implants have a more watery feel in the hand (when they are being examined directly) than silicone gel implants which feel more “gooey” when held in one’s hand. In patients with minimal “coverage”, which means not much breast tissue, it may be possible to feel or see waves from the implant. Since saline implants can have a more watery feel to them, silicone gel breast implants may be a better option. Patients who have a significant amount of breast tissue may have a low chance for rippling. In patients with thicker tissues it may not even be able possible to feel the implant at all.
A hot area for research in plastic surgery is why some patients develop scar tissue around their breast implants after surgery. This scar formation is referred to as “capsular contracture”. After breast implants are placed into what plastic surgeons refer to as a pocket, or space, a scar forms around the implant. This scar is not attached to the implant but rather attached to the tissues around the implant like wallpaper is attached to the wall upon which it is placed. So the implant is free to move around the pocket and is limited only by the scar around it, which is called the capsule. The implant moves freely inside the pocket which is defined by the capsular scar that is attached to the outside tissue. Normally, the capsular scar is quite thin and stretchy and movement of the implant in one direction cause the scar it then presses on to stretch and so the breast itself feels soft and natural, like breast tissue.
There are some patients who, for some reason that is not known yet, produce thick capsular scar that doesn’t stretch and even can contract around the implant. This contraction of the scar can make the space around the implant smaller and can even change the shape and apparent size of the breast implant itself! So there are different effects that overproduction of scar can have on the breast implant but the term used to describe the effect of excess scar production is “capsular contracture”.
Capsular contracture is an unwanted and adverse reaction to breast implant surgery. This is because contracture can change what patients and plastic surgeons wish for the shape, location and size of a patients breasts. Historically, silicone breast implants have had a higher chance for capsular contracture than saline implants. Recent studies have shown that the rate of capsular contracture is more similar between these two implants but long term data on the newer series of implants is still forthcoming. Since capsular contracture rates are relatively low for both saline and silicone implants, both remain attractive alternatives for use in cosmetic breast augmentation.
What is the best size breast implant for a patient?
This is the most important question a breast augmentation patient should consider. It’s critical to understand two things about breast augmentation surgery. Implants make patients larger breasted and the implant also changes the shape of the breast. There is a range of sizes for each patient where the breast shape is the best it can possibly be. One might call that “the golden zone”. Within this range of volume, or cc’s of the implant, the shape is the best it can be because the size of the implant is doing all it can do to solve certain issues required to improve the shape. Lets discuss what those issues are.
We need volume, or size to fill out the breast to certain edges of the chest in all patients. Those edges start with the cleavage area. We need to have volume that extends the inner parts of the breast towards the center. They don’t need to be touching, but there needs to be an apparent relationship of the inner aspects of both breasts to each other. Next, the outside of the beast should form a relationship with the outer part f the chest wall. Therefore, the wider the chest, the more volume is required to fill that space. The breast implant and it’s volume should also support the upper part, or pole of the breast. This fill creates a natural and a youthful appearance to the breast but again, volume is required to achieve this beauty. Finally, the breast also requires adequate volume to provide for projection of the breast because this also makes the breast look youthful and natural appearing. All of these goals for breast augmentation require volume. Generally, the lowest volume that achieves most of these goals represents the lower end of the golden zone.
There are two ways a plastic surgeon can create space to put in more volume. One way is to place the implant only behind the breast and for the breast tissue and the muscle to stretch. The other way is to make a space beyond the edges of the breast. Adding space by expanding past the breast is a great way to add more volume and can help patients get to their goal. It can also help improve shape. But expanding the space past a certain point can worsen the shape. The point at which adding volume to the breast no longer helps shape is the upper limit of the golden zone.
It is also important to understand that patients are shaped differently and they have different wishes. Some patients wish to have an increase in their cup size but also the best shape possible and would therefore be described as wanting to be within the golden zone and perhaps at it’s upper end. Other patients don’t want to be much large but want the shape improving effects that breast augmentation can provide. These patients would be in the lower range of the golden zone. Finally, there are patients who want improvement in their size more than they want improvement in their shape. These patients want implant sizes beyond the golden zone. Controlling breast size with implants is something that can be controlled prior to surgery and so it is very important for patients to thoroughly discuss what size they wish as well as the effect of that specific size on their shape.
View before and after photos of our patients who have had breast implants.