Breast Implants
This information is of a general nature only and is for public information and education. Your individual problem needs to be assessed by your family doctor who will advise you on appropriate further steps.
Types of implants
Silicone filled implants have been in use for more than 35 years. Saline (salt water) filled implants, with Silicone "envelopes", became the implants of choice in the early nineties, due to concerns raised about the safety of silicon filled implants. The major concern was the fear of silicone from a ruptured implant migrating to other parts of the body. This apprehension has now been allayed, with the development of newer, high cohesive silicone gel implants, where there is no migration of the silicone filling, even after a rupture. An added refinement of these high cohesive "bio dimensional" implants is that they come in a range of sizes and shapes, which make it possible to individualise the choice of implant for each patient.
Reasons for surgery
Women choose to have implants for a number of reasons. In some instances, the woman is unhappy about the size or development of her breasts. In others, the initial size may have been satisfactory, but weight loss or pregnancies or aging cause a reduction in size of the breasts.
Timing of surgery
While breast augmentation can be done any time after the breasts have developed fully, weight loss or gain (as during and after a pregnancy) can alter the size and shape of the breasts, and need to be considered when planning surgery.
Surgical details
Augmentation surgery is usually done under a general anaesthesia, takes about an hour, and can be done in a Day Surgery, or in an inpatient facility, such as a private hospital. It is advised to take time off from work in the office or home, for two to three weeks after the surgery.
The implant is placed under the breast (subglandular), or under a large muscle on the front of the chest (subpectoral), through an incision (cut) under the breast, or in the lower part of the areola (the darker skin around the nipple), or in the armpit. After surgery, dressings are used to support the breasts, and patients are encouraged to use a support garment for at least the first three months.
Risks and potential complications
General
As with all surgical procedures, there are always potential risks such as post operative bleeding and haematoma (collection of blood) in the operated site, and will need appropriate treatment.
Specific to breast implant surgery
Altered nipple sensation
Nipple sensation is a very variable matter, with a range that spans from "very good" to "poor" and everything in between. In most women having implant surgery, there is no change, or any alteration is transient. In a small percentage, approximately 10% there is permanent reduction or loss of sensation.
Implant rotation
Saline implants are round, and hence there is no "right" or "wrong" position. The biodimensional, high cohesive gel implants are shaped to be more natural, and need to be placed and retained in the right orientation. Implant rotation, where the implant changes its orientation, is a risk with the biodimensional implant. Whilst this may not always cause a significant problem especially if it is on both sides, there may be a need for revision surgery.
Implant rippling
Saline implants are usually over filled by about 10% for the best results. Despite this, surface rippling is sometimes noted, and this may occur 6 or 12 months after the surgery.
Implant leakage
This is a definite risk in saline filled implants, where filling is done at the time of the surgery. The valve, which seals in the implant, can leak, and cause implant deflation. Silicone gel implants are prefilled and sealed, so there is a much lower risk of any leakage occurring.
Breastfeeding
Implant surgery does not interfere with breastfeeding. However, as there is often a significant breast volume increase with pregnancy, the shape of the breast can be affected.
Capsular contracture
When an implant is placed in the breast, the body recognises it as a foreign substance, and walls it off with a scar called a capsule. This is a protective mechanism and is desirable. In a majority of women, the capsules are soft or slightly firm. Unfortunately, in a percentage of women, the capsule becomes thickened and firm, and causes distortion of the shape of the breast, discomfort or even pain, for the patient. In this instance, further surgery will be needed, as appropriate.
Mammograms
These are more difficult in the patient with breast implants, moreso, where the implants have been placed in a subglandular fashion. There may be a place for other types of examination such as a MRI (Magnetic Resonance Imaging) or ultrasound.
Connective Tissue Disease (CTD)
This has been a cause for anxiety, with fears that breast implants cause an increased incidence of these diseases. A number of major studies have allayed these concerns, with no evidence of increase in the risk of CTD in women with implants, as compared to those with no implants.
Breast cancer
Again, while there were concerns about an increased risk of cancer in women with implants, there is now enough evidence to show that this is not true.
