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Breast Reduction Cosmetic
Reconstruction of a breast that has been removed
due to cancer or other disease is one of the most rewarding surgical procedures
available today. New medical techniques and devices have made it possible for
surgeons to create a breast that can come close in form and appearance to
matching a natural breast. Frequently, reconstruction is possible immediately
following breast removal (mastectomy), so the patient wakes up with a breast
mound already in place, having been spared the experience of seeing herself with
no breast at all.
But bear in mind, post-mastectomy breast
reconstruction is not a simple procedure. There are often many options to
consider as you and your doctor explore what's best for you. Most mastectomy
patients are medically appropriate for reconstruction, many at the same time
that the breast is removed. The best candidates, however, are women whose
cancer, as far as can be determined, seems to have been eliminated by
Still, there are legitimate reasons to wait. Many
women aren't comfortable weighing all the options while they're struggling to
cope with a diagnosis of cancer. Others simply don't want to have any more
surgery than is absolutely necessary. Some patients may be advised by their
surgeons to wait, particularly if the breast is being rebuilt in a more
complicated procedure using flaps of skin and underlying tissue. Women with
other health conditions, such as obesity, high blood pressure, or smoking, may
also be advised to wait. In any case, being informed of your reconstruction
options before surgery can help you prepare for a mastectomy with a more
positive outlook for the future.
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Breasts Smaller and
Higher Through Surgery
Macromastia (macro=large, mastia=breast)
Large breasts can cause a multitude of problems, including
neck, back, and shoulder pain, headaches, shoulder-grooving (where the
bra-straps dig in), postural problems (which contribute to upper extremity nerve
problems), interference with activities and exercise, rashes under the breasts,
inability to find clothing that fits properly, and problems with self-image. As
a result, women with large breasts are often in chronic pain, have little
energy, may be overweight because they are unable to exercise, and have
self-image problems, all of which interfere with quality of life.
Possible Solutions to the Problem of Large Breasts
Weight loss and exercise are usually suggested (if not
required) by insurance companies prior to approval for surgery, but often
futile. Weight loss, even if successful, usually does not alleviate the symptoms
of macromastia. Many women are unable to exercise because of the large breasts
themselves - hence, a catch-22. Aspirin, Tylenol, Ibuprofen, and other
medication may benefit some, but usually their effect is limited. Powders may
reduce your chance of developing a rash in hot weather. Chiropractic care is
rarely of help. Invariably, surgery is the most effective, most efficient, and
most successful way to treat the problem of macromastia.
Breast Reduction Surgery
Breast reduction is an operative procedure in which breast
tissue and excess breast skin are removed. The removal of breast tissue results
in a smaller breast. Removal of excess skin results in a breast that is higher
on the chest wall and more aesthetic. This is an important component of this
operation, because it allows the breast to be restored to a youthful appearance
and shape. If excess skin were not removed, the breast would actually look worse
following breast reduction than before surgery.
During the operation, your nipples will be moved to a higher
position on your breasts. This is usually accomplished WITHOUT removing your
nipples and putting them back on. The technique plastic surgeons use to
accomplish this is called transposition, in which the nipple stays fully
attached to the breast - only the surrounding skin is moved. Because the nipple
preserves its attachment, most women retain (or improve) nipple sensation, the
ability to attain an erect nipple, and the ability to breast feed.
Breast Reduction: During and After Surgery
Location of operation: Surgery Center or hospital.
Length of surgery: 2-4 hours
Length of stay: Overnight
Discomfort: Moderate. Anticipate 3-7 days of prescription pain
Swelling and Bruising: Improve in 2-4 weeks.
Bandages: Will be removed in 1-7 days.
Stitches: Will be removed in 5-7 days or will be absorbable.
Support: You will wear a sports bra or ace wrap for 1-4 weeks. Avoid an
under wire bra until your surgeon approves it.
Back to work: 1-3 weeks.
Exercise: May be resumed in 2-4 weeks.
Final result: Will be seen after the scars have matured, which will be
about 1-3 years.
Risks of Breast Reduction Surgery
Scars: The only drawback to
removing excess skin is that it necessarily causes scars. Fortunately, the scars
can be limited to areas that are hidden when you are wearing a bra - they are
located around the nipple, below the nipple, and along the crease beneath the
breast. The scars fade after surgery, but it can take years for them to do so.
There are some techniques of breast reduction which may eliminate the scar along
the crease, but most of these techniques are in the development stage at this
time. Usually the scars are acceptable, especially when considering the benefits
gained in quality of life following breast reduction, but no one can guarantee
that you will be pleased with your scars. If you are going to have this
operation, you simply must accept the fact that you are exchanging the problem
of macromastia for scars.
Nipple or breast numbness or sensory change:
Numbness is uncommon. It is more likely that your nipple sensation will improve
because the nerve to your nipple will no longer be stretched due to the weight
of your breasts.
Nipple Loss: This is a tragic
problem, because, in it, one or both nipples lose their circulation and die.
There would also be an open wound, requiring care. Eventually, the wound would
close, or surgery would be necessary to close it. The nipple would then be
recreated artificially by using your own skin or tattooing a nipple. Nipple loss
is most likely to occur in smokers, but may occur in anyone. If you smoke, you
should quit at least 2-4 weeks prior to surgery to reduce your risk of this
Infection, bleeding, fluid collections (seromas), asymmetry
(unevenness between sides), and healing problems may occur following any
surgery. If you are young and healthy and follow your
doctor's instructions, you may reduce your likelihood of these events.
Final Size: No one can guarantee
your final cup size, because cup size is not standardized. Have a detailed
discussion with your plastic surgeon prior to surgery to communicate your
desired size. Explaining you preference in comparison to your current size is
sometimes very helpful. For example, you might want to be somewhere between one
third and one half of your current size.
Tips and Traps of Breast Reduction
- Realize that this operation involves scars. If you are
unwilling to accept scars, you should not have this operation, as no surgeon
can predict how the scars will heal on you.
- Quit smoking for at least two weeks before surgery.
Breast Augmentation Cosmetic
Breast augmentation, technically known as
augmentation mammoplasty, is a surgical procedure to enhance the size and shape
of a woman's breast for a number of reasons:
- To enhance the body contour of a woman who,
for personal reasons, feels her breast size is too small.
- To correct a reduction in breast volume
- To balance a difference in breast size.
- As a reconstructive technique following
By inserting an implant behind each breast,
surgeons are able to increase a woman's bustline by one or more bra cup sizes.
It can't answer all of your questions, since a lot depends on your individual
circumstances. Please ask your surgeon if there is anything you don't understand
about the procedure.
Breast Enlargement with Breast Implants
Breast augmentation is one of the most popular plastic surgery procedures in
the United States. Through the placement of breast implants, women have been
able to achieve changes in their figure (breast enlargement) that otherwise
would have been impossible. In spite of their overwhelming popularity, breast
implants have limitations. Breast augmentation surgery will not improve nipple
asymmetry, move your breasts closer together, lift droopy breasts, or remove
stretch marks. If you have droopy breasts, you may need a breast lift (mastopexy).
Also, breast implants are not free of problems (see "Risks" on side panel). In
order to determine whether breast augmentation surgery is for you, you must
weigh the risks and the benefits of breast augmentation.
Breast Implant surface (textured or smooth)
By implant surface, plastic surgeons are referring to whether the implant is
smooth or textured. A smooth implant is just that - as smooth as the surface of
a balloon. Textured implants are rough, somewhat like sandpaper. Once they are
in placed under your breasts, it is impossible to tell whether you have smooth
or textured implants. Textured implants were developed because plastic surgeons
thought that they would be less likely to cause capsular contractures. Unfortunately, studies have not shown a consistent advantage of
textured implants over smooth when it comes to capsular contractures. Also,
textured implants are more likely to cause rippling which can be a big problem for
thin and small-breasted women. For these reasons, most plastic surgeons favor
smooth implants for breast enlargement.
Shape (round or anatomic (teardrop))
By this, plastic surgeons are referring to round or teardrop shape. Round
implants are shaped like jelly donuts. Teardrop implants are shaped more like
the breast. At first, you might be thinking that (of course) teardrop implants
would be better. However, most plastic surgeons disagree: they think that
teardrop implants tend to become round with the forces of healing and that the
teardrop implants do not necessarily give a better result. Furthermore, they
find that teardrop implants may rotate, giving an unnatural appearance, and they
impose restrictions in that they must be textured. Because plastic surgeons tend
to recommend the techniques that work best in their hands, you should heed the
advice of your plastic surgeon in this matter.
This is the all-important size issue. Implants come in all sizes with the
most common sizes ranging from 200-600 cc. This is equivalent to 7-20 ounces.
Within that range, 300-450cc is probably the most common. By the way, a cc
(cubic centimeter) is the same as a ml (milliliter) - just in case you have
visited other sites which refer to volumes in mls. This decision is highly
personal and highly individualized. The best way to determine your size is by
placing breast implant sizers (your plastic surgeon will hopefully have them) in
your bra and then put a sweater, blouse, or t-shirt on (or, perhaps try all of
them, as you will appear different in each). Do not allow your surgeon to
dictate your size. You must have input in this decision.
Breast Implant projection (standard vs. high profile)
Breast implants are designed so that, as volume increases, so does diameter
(the footprint of the implant) and projection (the amount it sticks out, away
from your body). Standard implants are designed so that MOST women who choose a
given volume will be able to accommodate the breast implant's diameter beneath
her breasts. This is so because women with narrower breast diameters often have
smaller bodies and tend to choose smaller breast implants; women with wider
breast diameters often have larger body frames and tend to choose larger breast
implants. In other words, women tend naturally to choose an implant volume that
is in proportion with body size and breast diameter, and the breast implants
were designed in anticipation of that. BUT, what if a woman wants a breast
implant that has a larger volume than would be considered proportionate (by
breast implant manufacturer standards) for her breast diameter, chest wall size,
and body frame? In that case, placing a standard implant would risk an unnatural
result, because it would be too wide for her body frame and would likely also
extend too high and too low on her chest wall. In these cases, a High Profile
implant is recommended. With a high profile implant, the volume is the same, but
the diameter (footprint) is narrower and the projection (the amount that it
sticks out away from your body) is greater. Most women (over 95%) are best
suited to standard implants. The way to tell if you should have standard
implants or high-profile is as follows: First, your surgeon should measure your
breast diameter. Next, you should choose the implant volume that you want.
Finally, your surgeon should compare the diameter of the desired implant size
(standard implant) to the measured diameter of your breast. If the diameter of
the implant size you selected is about the same or smaller than your measured
breast diameter, then a standard implant is appropriate. If the diameter of the
desired breast implant is larger than you breast diameter, then you should
consider high profile breast implants.
Saline Vs. Silicone Gel
Currently, saline filled breast implants are the only ones approved by the
FDA for use in the United States (in other words, you do not need to be involved
in a study to receive saline implants). Silicone breast implants remain under
study regarding their safety and benefits. Because preliminary studies regarding
silicone gel implants have been favorable, broader studies are now being
conducted throughout the United States. This means that if you want silicone
breast implants AND you are willing to be involved in a study, AND you are
considered a candidate for silicone breast implants, then you may have this
option available to you. Silicone gel breast implants are a good option for some
Fill (This Pertains only to Saline Implants, as Silicone implants are
Pre-filled by the Manufacturers)
Saline implants come in increments of about one ounce, which is 30 cc. Mcghan
implants are made in 30cc increments (180cc, 210cc, 240cc, 270cc, 300cc, etc.).
Mentor Implants are made in increments of 25cc (200cc, 225cc, 250cc, 275cc,
etc.). Each implant can be and SHOULD BE overfilled by an additional 25-30 cc.
This is because the implants were meant to be overfilled, and the implant
manufacturers not only stand by their products when they are overfilled, but
they encourage surgeons to overfill them. Here's why: overfilling reduces
deflation, rippling, and sloshing. Under filling has no
advantages and significant disadvantages (rippling, sloshing, and deflation).
So, after you select your desired final volume, your surgeon should select an
implant that is one size smaller, and then overfill it to your desired volume.
Site of Incision (This Pertains only to Saline Implants, as Silicone
Implants are All placed via an Incision Under the Breast)
The options for site of incision are under your breast, around your nipple,
in your armpit, or through your belly button. An incision under the breast is
placed within or near the natural crease beneath your breast. This incision has
the advantage of having the scar hidden in the shadow of the crease under the
breast. It also heals well. It also is the incision you would likely get anyway
if you require revision surgery later in life. Most plastic surgeons use this
incision. Around the nipple can give a good result in some women, but is riskier
because it is at the focal point of the breast, so any irregularities in the
scar will make it far more obvious. It also imposes a higher risk of nipple
numbness and inability to breastfeed. Under the arm is an option and has the
advantage of being hidden in the armpit. Although many of these scars heal
favorably, some armpit (axillary) incisions can be unsightly. Also, revision
surgery, if needed, might not be possible through the existing armpit scar, so
an additional scar would be necessary. Finally, the incision can be made through
the belly button. This is called TUBA, or Trans-Umbilical Breast Augmentation.
The advantage is that the incision is hidden inside the belly button. The
disadvantages are that the implant must be placed in the subglandular plane
(over the muscle), the surgeon may not be able to correct certain breast
asymmetries, the deflation rate may be higher, and revision surgery through the
original scar is not possible, so an additional scar would be necessary (around
the nipple or under the breast). For all of these reasons, few surgeons perform
this incision when placing breast implants.
Options in Breast Implants
Before you sign up for breast augmentation surgery, you and your plastic
surgeon should have a long discussion about these important issues:
1. Position (under or over the muscle)
By implant position, plastic surgeons are referring to whether the breast
implant should be placed above or below the pectoralis muscle. Advantages for
placing the breast implant above the muscle include less discomfort
post-operatively, less swelling, and less chance that the breast will appear to
move when you are exercising your upper body. This last issue has been one of
great concern for many women, especially those who have full workout regimes.
Simply put, if your breast implants are under the muscle, then when you flex
your pectoralis muscles (as you often do during workouts), your breasts may
appear to move. Sometimes (though not commonly) the breast motion will appear
quite distorted. Now, to bring things into perspective, you should realize that
many women who work out (and even some professional female athletes) have
implants under the muscle and are very happy with their appearance. In other
words, if you work out a lot, do not automatically believe that your breast
implants need to go over the muscle. Advantages for placing the implants under
the muscle include less interference with mammography and less rippling in the
upper half of the breast. ( Generally, thin and small-breasted women should
favor implant placement under the muscle. The advantages of less interference
with mammography, less rippling of the upper half of the breast, and more
cushion between the implant and the skin outweigh the drawbacks, many of which
are temporary. Athletic women should consider placement of the implant above the
muscle (as long as they have adequate breast tissue and body fat) to avoid
breast distortion when the pectoral muscles are flexed. Thin, small-breasted,
athletic women must weigh the options. In general, they are probably better off
with implants under the muscle. Even though this can cause distortion of the
breast while working out, this is not too much of a problem unless you work out
in the nude. A more significant cosmetic problem for these women is rippling,
which is less likely to occur in the upper half of the breast if the implants
are placed under the muscle. Of course, this is your call.
Breast Augmentation Risks and
Breast augmentation can offer fabulous results. However, it
also poses some risks which can lead to complications and unfavorable results.
Capsular contracture: This is a
scar that forms around the implant, causing it to feel firm, look unnatural, and
potentially hurt. When you see pictures of a woman with obvious implants who
looks like she has "coconut breasts", she more than likely has a severe capsular
contracture. These are much less common and less severe with saline implants
than with silicone implants. If you develop a mild capsular contracture, you may
not be bothered by it and may not even notice you have one. If you develop one
which is moderate or severe, you will probably require surgery to correct the
problem. Surgery involves removing the scar and placing a new implant. In spite
of this, the capsular contracture may return. Placing the implant under the
muscle has a lower risk of capsular contracture than placing the implant over
Interference with mammography:
Breast implants interfere with the ability of a mammogram to "see" all of your
breast tissue. Placing the implant under the muscle least interferes. With the
breast implant under your muscle, mammograms can "see" about 90% of your breast
tissue. With the breast implant over the muscle (AKA under the breast),
mammograms can "see" 75% of your breast tissue. Either way, implants do not
interfere with self breast examination, which is how the majority of breast
cancers are discovered. They also do not interfere with ultrasound or MRI scans,
which are helpful in evaluation of breast masses.
Implant displacement: Implants
can move out of position at anytime after surgery. They can move upward,
downward, left or right. If they move only a little, you may not even notice. If
they move alot, you may need further surgery to move them back into position.
Fortunately, this problem is not common. One exception is in women who have very
large implants. The larger the implant, the greater the chance that it will
Implant deflation: Saline
implants can develop a leak and deflate. If so, your breast will shrink to its
preoperative size over a matter of a day or so. You will need another surgery to
replace the deflated implant. Risk of deflation is about 4% during the first
year following surgery, then about 1% per implant per year for each year
thereafter. Deflation is most likely to occur in implants that have not been
over filled. Yes, you read that right. Over filling reduces deflation. This is
because deflation is due to folding of the implant shell, which occurs
repetitively in implants that are not over filled. After the implant shell has
folded hundreds or thousands of times with your natural body movements, the
implant shell tears - just like a piece of paper that has been folded time after
Rippling: This is the visible
appearance of waviness of the skin over your implants, like the ripples of a
wave on a lake. Some doctors refer to this as "wrinkling." This occurs due to
saline shifting around inside your implants. It is most troublesome if it occurs
in the upper half of the breast, because it would be evident in low-cut clothing
and swim wear. Rippling is uncommon when the implants are over filled and is
less common with smooth implants than with textured ones. Also, when the
implants are placed under the muscle, there is less chance of rippling in the
upper half of the breast.
Infection: Infection, if it
occurs, usually does so within two months of surgery. The risk is about 1% and
often requires removal of the involved implant and antibiotics. A new implant
can be placed six months later, but that means you would have to go for six
months with very uneven breasts.
Nipple numbness: The national
risk of having permanently numb nipples is about 15%. If the possibility of
having numb nipples is unacceptable to you, you should not have this operation
because no surgeon can guarantee preservation of nipple sensation.
Breast feeding and pregnancy:
Breast feeding ability is not altered by implants. Many women ask about the
effect of future pregnancy on augmented breasts. In most cases, implants will
not affect the fate of your postpartum breasts. Here is why: following pregnancy
(and breast feeding), your breasts will shrink to their pre-pregnancy size (or
there about). During this process of shrinking, your breast skin may either
tighten or not tighten. If it tightens, you will most likely not have breast
droop. If it does not tighten, then your breasts will unfortunately droop.
Whether or not the skin tightens has little or nothing to do with the presence
or absence of implants.
Need for Further Surgery: Women
unwilling to accept the potential need for further surgery should not have
breast augmentation. Understand that if you receive any implant in your body -
whether it be a pace maker, artificial joint, artificial heart valve, or
anything - that one of the inherent risks is that you may need further surgery
on it at some point in your life. With breast implants, you may need further
surgery for capsular contracture, deflation, rippling, displacement, infection,
desire for a different size, or another reason. You may also go a lifetime
without having any problems. But, it is most prudent to assume that at some
point, you will probably want or need another surgery to address one of these
Breast Augmentation Recovery
Your procedure will most likely be performed under general anesthesia. Some
plastic surgeons offer breast augmentation under sedation anesthesia, but if so,
be careful. In some cases, these plastic surgeons are using so much sedation
that it is actually safer to use general anesthesia. In other cases, they use
sedation anesthesia because their office is not approved for general anesthesia.
In some of those cases, they may have difficulty achieving adequate comfort for
you, and this means you could endure pain during the procedure. There are some
plastic surgeons who capably perform breast augmentation under sedation
anesthesia, so be sure to ask about your doctor's experience.
Location of operation:
Your procedure may be performed in your plastic surgeon's private operating room
or at a nearby hospital or surgery center. If performed in your plastic
surgeon's office, be sure to ask whether the office is certified and by whom.
Length of surgery:
The actual procedure takes 1-1 1/2 hours. However, the length of time you will
be in the operating room will be longer. This is because once you are
transferred to the operating room, it takes awhile to get you ready for surgery.
You will have monitors placed. You will then be sedated or put to sleep. Then
you will be "prepped" which means your skin will be carefully cleansed to rid it
of normal skin bacteria. After that, drapes will be placed around your body and
the surgical "field" will be set up. After your procedure is over, your skin
will again be cleaned and a dressing will be applied. You will be awakened and
monitored until stable. Finally, you will be transported to the recovery room.
For these reasons, your procedure could be scheduled for anywhere from 1 1/2 to
Length of stay:
In most cases, you will be allowed to go home the day of surgery.
Discomfort is mild to moderate following implant placement over the muscle and
moderate to severe following implant placement under the muscle.
Swelling is least if the implants are placed over the muscle and most if the
implants are placed under the muscle. Regardless, it is usually at its peak 3-5
days after surgery and thereafter improves. If your implants are over the
muscle, 75% of the swelling will be gone in 2 weeks and the rest will resolve
over the next several weeks. If your implants are placed under the muscle, 75%
of the swelling will be gone in 2-4 weeks, and the rest will resolve over a few
Most women do not bruise after breast augmentation. If you do, however, do not
worry, because it is not unusual and does not affect your final result. If any
exists, it improves within a week or so.
Most plastic surgeons will let you remove your bandages and shower within a few
Most surgeons use stitches which absorb and do not require removal. If your
surgeon uses stitches that require removal, do not be critical or suspicious, as
this is not uncommon. If stitches are to be removed, they will be removed in 5-7
Back to work:
You may return to work in 4-7 days if the implants were placed over your muscle,
and 7-10 days if the implants were placed under your muscle. If your job
requires lifting, you may return to work in the same time frame but will
probably have lifting restrictions.
Most plastic surgeons will ask you to stop all exercising for 1-4 weeks after
implants have been placed over the muscle and 2-8 weeks after implants have been
placed under the muscle. As a side note, doctors have found that women planning
to have implant placement under the muscle have less pain and a speedier
recovery if they can stop pectoral exercises 4 weeks before surgery.
This includes bench press, fly, and push-ups.
Will be seen after your swelling has resolved (see above).
Travel after Surgery:
Most women can travel safely within a few days of breast augmentation surgery.
Silicone Breast Implants
Breast Augmentation with Silicone Gel Implants
Silicone breast implants (also known as silicone gel breast
implants) offer several advantages over saline breast implants. They also have
some disadvantages, so you and your surgeon should carefully weigh the pros and
cons, if you are considering this option.
The Good News:
Advantages of Silicone Breast Implants
Silicone breast implants are filled with silicone gel, which
is softer and more natural (in the way it feels to the touch) than saline
implants. They feel so soft and natural, that it is often impossible to discern
them from natural breast tissue. Rippling is far less likely to occur in women
with silicone implants than in women with saline implants. This is because
silicone gel is far more viscous (thicker) than saline, so it does not move or
slosh, as saline can. Because of this, silicone implants can be placed over the
muscle in women with little body fat or little breast tissue without the
aesthetic concerns (rippling) associated with placing saline implants over the
muscle in these women. Hence, the major benefits of silicone implants are in the
realm of a more natural look and feel.
The Not-So-Good News
Disadvantages of Silicone Breast Implants
Silicone implants may rupture. If they do so, liquid silicone
may leak out of the implant shell. It is important to note that silicone implant
ruptures and leakage have never been shown to cause systemic problems (such as
lupus-like diseases, see below). Yet, in response to silicone implant rupture
(with or without leakage), your body may develop a thick scar around the
implant, called capsular contracture. Ruptures, if they occur, tend to occur in
implants which have been in place for years (as opposed to recently placed
implants). Thus, so do capsular contractures. The overall rate of capsular
contractures among women with silicone implants is higher than in women with
saline implants. A new type of silicone implant has been developed to hopefully
reduce the risk of rupture, leakage, and capsular contracture. It is the
cohesive gel implant (see below). Studies regarding the rate of rupture,
leakage, and capsular contracture for these implants are currently underway, so
the rate of these problems is not yet known.
Silicone implants are all pre-filled by the manufacturer. This
means a longer incision (6-8 cm) is required to place the implant. This is in
contrast to saline implants which are empty (hence smaller) prior to their
insertion. As such, saline implants may be placed through a shorter incision
The cost of silicone implants is about $1000-$1500 higher than
saline. This is due to higher production costs (compared to saline) by the
manufacturer. Your surgeon may also charge a higher surgeon's fee for placement
of silicone implants because of greater follow-up time and paperwork for his/her
Putting it Together...Are Silicone Breast Implants Right
The advantage of having implants with a softer and more
natural feel is more important for women who have the least amount of natural
breast tissue and women who have little body fat. In these women, saline
implants can often be seen or felt through the skin. Although this does not
bother many women, it does bother some. Women who are starting out with a more
generous amount of natural breast tissue will have more "padding" between their
skin and the implants. So, in these women, the difference between saline and
silicone is less evident, and sometimes there is no difference. In other words,
in women who have enough breast tissue, neither implant can be felt through the
skin, so the advantages of silicone breast implants are less important, but the
potential disadvantages remain the same.
If silicone implants came with no risks, no worries, no extra
follow-up, and no extra expense, then everyone would want to have them. But,
because they come with all of these things, they are probably best suited to
women who have nominal breast tissue and are willing to accept the
aforementioned disadvantages. They are also very appropriate for lean women and
body builders, because they can be placed over the muscle with a low risk of
Options in Silicone Breast Implant placement
When planning your operation with your plastic surgeon, you
will need to decide important issues such as whether the implant will be placed
under or over the pectoral muscle; whether the implant will be textured or
smooth; whether the implant will be round or anatomic; and the size of the
implant. Another issue to decide is whether your implants will be cohesive gel
or non-cohesive gel. Cohesive gel implants can be thought of as similar to gummy
bears. They are soft and pliable, but do not leak out when they are cut open.
Therein lies an important advantage of cohesive gel implants.
If you choose cohesive gel, then the next decision is whether
you will choose Type I, II, or III. Type I are the most pliable and are the most
appropriate for the majority of women seeking silicone breast augmentation. They
are smooth and round and have a lower incidence of mal-rotation and displacement
than Type II or III. Type II is textured, teardrop shaped, and more firm than
Type I. It is best for women who have an extreme paucity of subcutaneous soft
tissue, such as body builders. The advantage of Type II is that they have a
lower likelihood of rippling than the Type I. (Note that Type I silicone
cohesive gel implants are less likely to ripple than saline, but the Type II are
even less so). The disadvantage of Type II is that they are more likely to
rotate or displace into an unnatural position. Type III are very stiff and
cannot ripple, but these are not currently available, even under a study
How We got Here
History of Silicone Breast Implant Controversy
From 1960-1990, silicone breast implants were the
most popular type of implant placed for breast augmentation. In 1991, unfounded
news reports emerged that silicone gel breast implants were responsible for
causing connective tissue diseases (CTD's) in some women. (The key word here is
unfounded). CTD's are lupus-like diseases which can include arthritis
and can be disabling, affecting the entire body. Whereas it was true that a few
women with silicone implants developed CTD's, so did women without implants. It
has been shown through multiple studies that silicone implants did not cause the
CTD's. Simply put: women with silicone implants and women without silicone
implants have the same risk of developing CTD's. The presence of silicone
implants does not increase the likelihood of developing a CTD.
Because preliminary studies have supported that
silicone implants are safe in this regard, silicone gel breast implants have
been under wider study for return to the market in the USA. In April 2005, an
FDA advisory panel recommended to the FDA that silicone gel breast implants be
returned to the market. The key word here is recommended. Advisory
panels review the information and make recommendations, but they do not have the
authority to act. So, it is up to the FDA decision-makers to determine when and
how these implants will once again be widely available, outside of a study
protocol. In the meantime, they are still available to those women who qualify
as candidates and are willing to become part of the study.
More Information on the Status of the FDA's
Approval of Silicone Breast Implants...