Breast Implants - Plastic & Cosmetic Surgery Center of Texas

Learn More About Breast Implants
If you've been thinking about getting breast implants, consider Dr. Wilcox and Dr. Dulin. With years of experience and a friendly and helpful staff, we can help make your decision an easy one.

The Differences Between Silicone and Saline Breast Implants
Solid silicone is widely used in many implantable medical devices such as heart valves. The outer shell of both silicone and saline implants is made of solid silicone material. Silicone gel breast implants are filled with silicone gel which is a semi-solid form of silicone. On the other hand, saline-filled breast implants, while comprised of a solid silicone outer shell, are filled with the same kind of salt water that is used in I.V. fluids.

Saline implants are the most frequently used implants in the U.S. These implants vary in shell surface (i.e., smooth or textured), volume, shell thickness, profile and shape (i.e., round or anatomical). The breast implants are filled with sterile saline during the augmentation surgery; they are carefully checked to determine the exact amount of saline needed to achieve the patient's goals and the best symmetry. If a implant does rupture, the body will absorb the saline.

The Safety of Silicone Gel Breast Implants
Silicone gel implants have received a lot of controversial attention over the past decade and more. Some women have claimed that silicone implants cause a variety of ailments such as connective tissue disorders (CTD) or autoimmune diseases. In 1992, the FDA imposed a moratorium on silicone gel implants which meant that silicone implants would no longer be available for the general public. (However, in certain situations, these implants have been utilized but under very strict guidelines.)

In 2000, the Institute of Medicine published its findings on the safety of silicone gel breast implants. This highly regarded scientific panel concluded that silicone gel implants do not increase the risk of autoimmune diseases such as lupus or cancer, as has been suggested in legal claims filed against silicone implant manufacturers. Instead, the Institute found that localized problems that may occur in the area of the breast implant were the primary concern. What is important to remember is the fact that there are no known causes for these CTD or autoimmune diseases, whether they occur in a woman with or without silicone gel breast implants.

In April of 2005, an FDA advisory panel recommended allowing certain silicone gel breast implants to be returned to the market; however, women seeking these should be aware of the strict conditions required. Among these conditions is that only board certified plastic surgeons are allowed to insert these implants.

It should be noted that some silicone gel may leak or "bleed" through the shell of an intact implant into the scar tissue that surrounds it. Rupture of breast implants can be related to the length of time it has been in the body. Like all medical devices, breast implants will fail over time and need to be removed and/or replaced.

The best implant type for you will be discussed in your consultation with Dr. Wilcox or Dr. Dulin.

Surface of Implants
Another variable in breast implant types is the surface of the device. It may be either smooth or textured (i.e., multiple fine bumps on the surface). Some evidence suggests that textured implants have lower occurrences of tight scar formation around them (known as a capsular contracture). However, they may cause visible rippling on the breast skin.

The best implant surface for you will be discussed in your consultation with Dr. Wilcox or Dr. Dulin.

Breast Implant Positions
Two options exist for positioning of the implant. In both cases, the surgeon will create a pocket where the implant will be placed. In the subglandular position, the implant is placed beneath the breast tissue but on top of the pectoralis muscle. In the submuscular position, the implant is placed either partially or completely beneath the pectoralis major muscle. In both cases, the breast implants will be centered underneath the nipples.

There are pros and cons of each of these placement positions. In general, the submuscular position provides an extra layer of muscle coverage and may offer less interference with mammograms. The subglandular position offers less postoperative discomfort and quicker recovery time.

The risks and benefits of each position (subglandular or submuscular) will be discussed in your consultation with Dr. Wilcox or Dr. Dulin.

Incisions
As with implant type, texture, and placement options, incision location is another variable. There are four incision types available.

Inframammary fold incision or crease incision can vary in length from 3-6 cm and is probably the most common incision site currently used. The incision is made in the fold (or crease) beneath the breast. The scar should not be visible with the exception of when a woman is lying flat on her back.
Periareolar incision or nipple incision is also a very commonly used incision today. This incision is made around the pink portion of the nipple/areola complex and has the advantage that the scar will blend in upon healing. In addition, if a breast lift (mastopexy) is necessary at the same time of the breast augmentation surgery, this incision is the likely choice as breast lift requires an incision around the areolae as well.
Transaxillary incision or armpit incision offers the benefit of no scars to the breasts. The incision is made in the natural folds of skin in the armpit and the implant inserted into the prepared pocket in the breast; therefore, there is no telltale scar on the breast.
TUBA (Transumbilical Breast Augmentation) is the newest procedure available for saline breast implants. This incision is made in the edge or rim of the bellybutton (or umbilicus). Using an endoscope (a slender instrument), a tunnel is fashioned through the subcutaneous fat just under the skin until it reaches the loose breast tissue. Once a pocket has been developed, the implant is inserted in the tunnel up to the pocket and inflated with saline.

The TUBA method is less invasive than other methods; therefore, there are many advantages to this approach. The patient recovery period is shorter due to less trauma to the breast tissues during surgery. The single incision scar is very small and remotely located from the breasts. The risk of injury to nerves supplying sensation to the breasts or nipples is reduced.

The risks and benefits of each incision type will be discussed in your consultation with Dr. Wilcox or Dr. Dulin.

All Surgery Carries Some Uncertainty and Risk
Every surgical procedure has risks and possible complications such as bleeding, infection and scarring.

Breast augmentation is relatively straightforward; however, there are specific potential complications associated with this procedure. It is very important for women who are considering breast implants to understand these potential complications and weigh their options and decisions before proceeding with the surgery.

The most common problem is capsular contracture. As part of the healing process after breast augmentation surgery, your body will form a lining of scar tissue or capsule around the implant. It is possible that over time, this capsule will begin to harden or tighten excessively. This contracture can cause the breast to change shape and cause pain and discomfort. Capsular contracture may occur on one side or both or not at all. Capsular contracture can be treated in several ways and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the breast implant.

As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood.

A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.

Some women report that their nipples become oversensitive, less sensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.

There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse. If, however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This may cause some discomfort, but can be treated with medication prescribed by your doctor.

Breast Implants and Cancer Risk
While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.

While the majority of women do not experience these complications, you should discuss each of them with your physician to make sure you understand the risks and consequences of breast augmentation.

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