NEW BEAUTY: Breast Implants: What You Need to Know But Didn't Know Who to Ask

There is one thing that all breast implants have in common. Whether they're used to enhance breast size and shape through breast augmentation in conjunction with a breast lift or to create the breast mound in breast reconstruction--they are hotly debated medical devices. The only way to decide which implant is right for you is to schedule a consultation with a board-certified plastic surgeon.

Breast implants that are approved by the FDA are biocompatible, says Mark Jewell, MD, of Eugene, Oregon. "They are made of materials that have been researched and deemed safe for placement inside the human body." Implants have a smooth or textured silicone shell and the shell shape may be round or contoured. "The varying implant shapes and sizes available allow each woman seeking breast augmentation surgery to obtain optimal long-term results," says Jewell.

If you are receiving breast implants, the brand and type of implant you receive should be defined. Following treatment, you should be given a serial number and a warranty card from the manufacturer for the implants placed. This is the only type of warranty (although limited) you will ever receive with any cosmetic procedure.

 

The new generation of silicone

In 2005, the FDA issued pre-market approval for two specific silicone implants filled with cohesive silicone, which is a more elastic form of silicone gel that is less likely to migrate should the implant leak or rupture. Among other advantages, Dr. Jewell states, "These also come in a greater variety of shapes that will match each patient's individual needs." These new generation implants, which have not yet been released in the marketplace, should not be confused with the fourth generation of silicone implants, or form-stable cohesive gel devices which are still in clinical trials. Like any implants, silicone implants can develop capsular contracture or other similar implant problems. In addition, these form stable silicone implants are somewhat heavier and more dense than saline or other types of silicone implants." You may have heard them referred to as "gummy bear" implants, but don't be fooled by the novel name--unlike the candy that can be pulled and stretched, the form-stable cohesive gel implants maintain their shape once inside the body, which, Dr. Jewell says, "allows them to produce a nice tapered upper edge of the breast and maximum projection where it's needed most."

 

Saline implants

Saline (sterile salt water) has been the only FDA-approved implant filler for first-time breast augmentation patients since 1992. Saline implants can be prefilled to a specific size or filled at the time of placement, which has the advantage of allowing smaller incisions to insert the implant and minor size adjustments during placement. If a saline-filled implant leaks or ruptures, it's readily noticeable because breast volume will diminish rapidly. The saline is completely absorbed by the body and naturally eliminated. Saline implants can feel firmer than natural breast tissue, particularly if they are filled to shell capacity.

 

Silicone implants

Since 1992, silicone implants have been available only to breast-reconstruction patients and those patients replacing older silicone implants. "Patients who were born with a congenital breast abnormality and some patients who have had rippling with saline because of the thinness of the skin may also be candidates for silicone implants," says Dr. Sweis. In addition, a very limited number of first-time augmentation patients participating in approved FDA studies have silicone implants. However, in 2005, the FDA rendered pre-market approval for two types of silicone implants as an option for women seeking first-time breast augmentation. Formal market release is still pending. For the latest information, visit breastimplantsafety.org. Today's silicone implants vary significantly from the earlier, more controversial silicone-gel-filled implants that implant manufacturers voluntarily took off the market for augmentation in the early 1990s. "The concern at that time was the possibility that leaking or migrating silicone gel contributed to autoimmune diseases," says Dr. Jewell. "However, to date, not one major medical study among the hundreds that have been performed worldwide has concluded that there is a link between silicone- or saline-filled breast implants and any form of disease."

 

How Long Do They Last?

Breast implants are not lifetime devices: They have the potential to leak or rupture, and they do not change as a woman's body ages over time. There is no telling how long your implants will maintain their function and appearance, which is why it's imperative to maintain an ongoing professional relationship with your plastic surgeon. "It is important to follow up with your doctor on the first anniversary of your implant placement, even if you have no concerns," says Joseph J. Disa, MD, of New York City. "Thereafter, you should have your breasts annually evaluated by your plastic surgeon or the doctor who performs your routine breast health exam and mammogram screenings." There are many options should your implants need to be replaced or if you choose to replace them.

Breast Surgery: What You Need to Prepare For

Anesthesia:

Either under general anesthesia or local anesthesia with sedation.

 

In or Out:

Breast augmentations, lifts and, in many cases, reductions are commonly outpatient procedures. Surgery takes place in an office-based surgical suite, a freestanding ambulatory facility or a hospital surgical facility. For some women, an overnight hospital stay is occasionally recommended.

 

After Surgery:

You'll wake up after surgery wearing a support bra that was either purchased before surgery or supplied by your plastic surgeon. In the case of breast reconstruction, you may be simply wrapped with a surgical dressing like gauze. You may have small, thin tubes placed in your incisions to drain any excess fluid, or a tube that is attached to a pain pump. You'll be stiff and sore; however, alert your doctor immediately if you experience severe pain or develop a tense, swollen breast. You should be up and walking around the day of surgery. If you are not staying in the hospital overnight, you will need a responsible adult to care for you and monitor your condition for at least 24 hours after you arrive home.

 

Risks:

Capsular contracture; unexpected milk production following surgery (which is rare and usually temporary). All breast surgery carries the risk of anesthesia-related problems.

 

Side Effects:

Breast tenderness; swelling and bruising; regional tightness or discomfort; redness, discomfort or itching at the incision sites; heightened or decreased breast sensation

 

Special Considerations:

Sleep on your back in a reclining position for the first few days following surgery. During recovery, follow all instructions for proper breast support, including sleeping in your support bra if instructed. A cotton bra that closes in the front may be the most comfortable. Do not wear underwires until your plastic surgeon gives you the green light. Long-term support is essential for the well-being and longevity of your new breast appearance. Start walking around and doing light activity as soon as possible, but avoid pushing, pulling, lifting, twisting and strenuous exercise until your plastic surgeon gives you the go-ahead.

 

Back to Work:

Return to work within a week or two, give or take a few days, depending on the extent and type of procedure. Scars begin to fade within three months; topical steroid cream or silicone gel can promote healing and reduce the chance of developing raised, red or irregular scars.

 

Cause for Concern:

Hematoma, or blood pooling beneath the skin (to minimize risk, avoid taking anti-inflammatory medications, blood thinners, aspirin, ibuprofen or certain herbs and vitamins before surgery); breast asymmetry (call your doctor immediately if you notice dramatic differences in breast size, shape and nipple position); skin or tissue loss and infection (occurrence is very rare, antibiotics may be prescribed preventively).

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