Cosmetic Surgery: Promises and Pitfalls™

Breast Implants in Dallas: Information from NDPS
 

Implant Shapes and Coverings

Round Implants
The most commonly used implant is round in shape. When the patient is lying down, the breast remains round, but when the patient is in an upright position, the shape of the implant becomes fuller at the bottom due to gravity and skin elasticity (just like a natural breast).

Shaped Implants (Contoured, Tear-Drop, Anatomic)

• This shape has been around for many years and, in fact, the original implants were “tear-drop” shaped.
• This implant has been marketed as producing a more naturally shaped breast. However, there is no scientific data proving any superiority over the round type.
• Shaped implants have a thicker, textured shell and are often more palpable.
• Shaped implants rotate in about 10% of patient giving a misshapen look and requiring surgery to correct.

Recent clinical studies have shown on mammography that in an upright position, contoured and round implants appear identical in shape and projection. The FDA actually has prohibited the manufacturer from using the term “anatomical” because it was ruled deceptive.

The debate of shaped vs. round implants continues and there are many surgeons with very strong opinions one-way or the other. Breast implant manufacturers continue to release new models of shaped re-energizing the debate. Currently though, the majority of board-certified plastic surgeons prefer the round implant.

Implant Surface
Original gel implants were smooth-walled and had a high incidence of capsular contracture (breast hardening). When a textured envelope was used, the incidence of capsular contracture was dramatically reduced (Journal of Plastic and Reconstructive Surgery, March 1993, Pollock). This relationship of surface texture to incidence of capsular contracture has not held true for saline implants -- the incidence is essentially the same for both types.

• Smooth Wall Implants
  • Advantages: reduced tendency for visible wrinkles and decrease palpability, able to move freely in a large pocket and take the shape of a natural breast, and lower rupture rate.
• Textured Wall Implants
  • Advantage: more adherent to the tissue. Use of a textured contoured implant may help prevent the implant's rotation or malpositioning.
  • Disadvantages: more palpable and they are associated with a higher incidence of visible wrinkles, each manufacturer has a different texturing process with its own individual properties, and textured implants have a higher rupture rate.

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Saline vs. Silicone Implants

Silicone Gel Implants

• The major advantage of silicone gel implants is the soft and natural feel of the augmented breast.
• This type of implant is the original implant described over 40 years ago. They were used extensively until 1991 when use was restricted by the U.S. Food and Drug Administration (FDA) due to concerns for a link between silicone and a disease -- specifically, a lupus-like syndrome. Many good scientific studies have proved these fears unfounded. In numerous studies over the past 10 years, there is no scientific evidence that silicone causes illness.
• The FDA has recently labeled silicone implants approvable, meaning they will soon be available with certain restrictions. Until then, the use of these implants remains restricted to reconstructive procedures, patients having breast lifts with augmentation and silicone gel implant replacement.

Saline Implants

• Saline implants are hardened silicone bags, which are placed in a surgically created space then filled with sterile saline (salt water).
  • The major advantage of this implant is the general agreement that the saline is harmless in case of a rupture.
  • The disadvantages are a generally firmer breast and increased palpability of the implant.
• Prefilled saline implants: No longer available in the United States due to an unfavorable ruling by the FDA.

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Determining Breast Size

One of the most challenging aspects of breast augmentation is to achieve the size goals of the patient. Patients often request a certain cup size or relate implant sizes that their friends had placed. First, cup size is not standardized and varies amongst bra manufacturer. Secondly, one size implant cannot produce the same results if the two women are not exact in size and pre-operative breast dimensions.

There are many techniques for ascertaining the proper size. Implants can be selected based on patient measurements. This is probably the most consistent method to select implants that match patient and implant size. Patients can try on implants under a shirt or sweater to get an idea of how they may look post-operatively but be aware that this doesn't always correlate. For the best result, bring plenty of pictures to demonstrate to your surgeon what you like and what you don't like. Listen to your surgeon's advise and heed concerns about going too big as this could have a delayed and often difficult to correct impact on your breasts.

 
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