Breast Affairs – Silicone?

The first word that comes to anyone’s mind when thinking of Breast Augmentation is “silicone”. But this overused word doesn’t provide a complete picture of the complex devices that the new, safer, FDA approved breast implants have become. The new generation implants have different compositions, shapes and textures. Know more. On Composition There are two types of implants based on composition: Silicone implants and Saline Implants. Multiple factors can influence the choice of either for your breast augmentation surgery. The silicone implant has been used since very early in the breast implants history, more precisely, since 1962. The first versions of silicone based implants were permeable to rupture,  what could lead to severe health consequences for the bearer. Several improvements have been made to the inner silicone filling and outside shell of the implant through the years and improved versions of the silicone filled implants have been introduced consequently till the mid-90s,when the “5th generation” of silicone implants introduced the Cohesive Silicone Gel, a semi-solid gel that finally eliminated the risk of filler leakage and silicone migration inside the body. This new cohesive Gel is presented in 3 types of cohesiveness which reflects in the stability of the shape and in the external feeling they provide. Cohesive Type I implants are the softer, more like liquid (but still cohesive, don’t flow out of the shell). This gel is more commonly used in round shaped implants for a periareolar insertion. Cohesive Type II are firmer and more resistant to pressure and gravity. Finally, Cohesive Type III are the “gummy bear” composition, more resistant to deformation due to gravity or pressure over time, being called “shape stable” and, therefore, widely used for the new contoured  (also called anatomical) shape implants. On the other hand, they are firmer to touch. A softer type of gel mimics better the feel of natural breast tissue than a more cohesive gel, but a more cohesive gel is necessary to maintain the shape of the implant, important issue in the use of anatomical implants. So, when choosing the implant, one most consider the desired result, both in terms of appearance and feel of the breast. Curiously, the thicker outer shell of the implant enables current silicone gel-filled breast implants to withstand more than 25 times the force of a normal mammogram without failure. Until the introduction of Cohesive Silicone Gel implants, the FDA did not agree with the use of silicone implants for breast surgery. It was only until very recently that the authority approved the use of these implants in the US. For that reason, saline implants are still the most common type of implant in the US and silicone implants are more widely used in other regions, like Europe. Saline implants are filled with a sterile saline solution and the first saline implants were very delicate and tended to break and leak. Although this wasn’t necessarily harmful, the prosthesis was usually removed due to the deflation (due to loss of filling). Contemporary versions of this type of implant are made of a stronger, room-temperature vulcanized shell  of silicone elastomer, made to last as long as possible. Although some of the first versions of saline implants were pre-filled, nowadays the saline implants are placed empty and then filled with the saline solution through a fill-tube to the desired size. They have an inner closing valve, so when the fill-tube is removed, the implant automatically seals itself. This type of implant was actually developed to allow a type of placement that would require less and smaller cuts to the breast, or even, no cut in the breast at all if placed through a transumbilical approach (incision and placement through the navel). These implants have the advantage of being adjustable and allowing variability, leaving room for the surgeons approach to the size and look, while filling the implant, very useful in cases of breast asymmetry, for example. These implants also helped to open the possibilities of breast reconstruction since they can be placed empty at the time of the mastectomy, reducing the risk of posterior complications. When the tissue is healed, it can be safely expanded and due to the adjusting properties, adapt the new breast size to the existing one accurately. This procedure also allows a patient to avoid a double surgical procedure. Anyway, although the saline implants yield good results in terms of breast size and contour look, they are more likely to be noticeable to eye and touch, especially for women with very little breast tissue and some post-mastectomy reconstruction patients. They are also more likely to have problems like rippling and wrinkling and have a firmer feel than gel-filled implants, feeling less like the natural tissue. The larger the implant, the more noticeable, especially at the edges and bottom of the implant. On Shape The first breast implants were round and these are still widely used nowadays, even after the forthcoming of the new contoured (also called anatomical) implants. Why? Because surgeons are not yet unanimous in their preference and because different figures require different approaches. Round implants have been used since the beginning of time, as they mimic the shape of the women’s natural breast tissue composed by the breast glands. The sub-glandular approach places the implant right under this tissue, like an extension of it. Some doctors believe for this motive that this is the most natural shape and prefer round implants.

Diameter, projection and height – contoured implant. source: Mentor® Product Guide

Contoured, or anatomical, breast implants have a tear drop shape that aims to mimic the overall shape of the breast. They are seen as being more close to the natural shape of a mature breast. Contoured implants are defined in terms of their diameter and projection (size), but also in terms of their height (see picture for better understanding), which influences the shape of the tear drop. The shaped implants bring new considerations to the implant techniques, mainly because while a round implant as a overall stable shape and can rotate with no reflection on the outside look of the breast, the tear drop implants cannot suffer this rotation, otherwise it would be visible in the breast (a breast pointing to your underarm is certainly not your idea of a flattering figure). Submuscular placement made by a highly skilled doctor and the use of textured implants help to prevent misplacement, although each surgeon has he’s own approach and should be the one to advise you in all the decisions regarding your breast augmentation. On Texture Implants can have a smooth or textured surface. Smooth implants are seldom used nowadays since the texture surfaced implants were introduced because of the advantages it presented: the textured implants reduce the risk of capsular contracture and, since they help the implant to adhere to the muscular wall, avoid the implants from rotating inside of the breast pocket. A round implant position change inside of the breast pocket implies no problem since it has any reflection on the exterior appearance of the breast. However since the arrival of shaped implants, avoiding the displacement of the implant has become a common concern.

Contoured Textured Implant & Smooth Round Implant Source: Nagor Product Catalogue 2011

The most recent generation of textured implants are nick named of “Furry Brazilian” and have a particular behavior regarding the risk of capsular contracture and the risk of displacement of the implant. The funny name refers to the feeling of the surface of the implant, covered in a layer of polyurethane-foam that creates a ‘furry’ feel to the outer shell and to the fact they are produced by a Brazilian manufacturer. In relation to capsular contracture  the texture of these implants leads the body to create many ‘micro capsules’ around the implant instead of one large capsule, avoiding the protective tissue to contract like a tight bag around the implant. Studies reveal that these implants have a very low rate of incidence in this complication. In relation to misplacement, this type of implant has a “velcro” behavior adhering to the muscular walls and avoiding the implant to move from its original position. On the other hand, the surgeon must be extremely skilled to place the implant correctly in its permanent position during surgery. Anyway, surgeons are not all of the same opinion in relation to these implants, so always discuss all the factors of your surgery with your trusted surgeon. He’s the best one to advise you about all the aspects of your procedure. As a final consideration, let us highlight that, normally, the brand of the implant is not really the patient’s concern. All surgeons have their preferences regarding the brands and use their trusted ones. Anyway, you should check if the brand is approved by your country medical authorities for breast augmentation surgery. The approval of FDA is normally a good reference, even if you don’t live in the US. Other territories have their own medical certifications, like the CE mark certification (conformity marking for products placed on the market in the European Economic Area).

source: Mentor® Product Guide