Breast implants411.com
Since coming back on the market over 3 years ago, silicone gel- filled implants
have captured 60% of market share.
Both Allergan and Mentor produce excellent silicone gel and saline inflatable
implants.
Silicone-gel filled implants are more natural than saline to touching or palpation
and sometimes visually as well.
One advantage of saline filled implants over silicone concerns leakage. If the
shell of the saline implants is disrupted, only sterile saline is absorbed and excreted,
making the leakage obvious, and the saline is harmless.
Gel-filled implants can “bleed” gel through the intact shell (at least in the older
implants), and if the shell is disrupted the gel can leak around the implants. However, as
long as the scar capsule around the implant remains intact, the gel may be contained
within the scar capsule. Gel can get embedded in the scar capsule and in the pectoral
muscles, and has been known in some instances to get into the axillary lymph nodes.
One of the major advantages of placing mammary implants behind the pectoral
major muscle is that there is far less interference with getting mammograms; also the
incidence of hardness or scar contracture is very rare. Sensory loss is uncommon behind
the muscle.
Massage of the implants to counteract scar contracture is important behind the
muscle, and critical in front of the muscle where the incidence of scar contracture is much
greater.
“Rippling” is the visual and palpable presence of waves commonly associated
with saline-filled implants, and is more common and more obvious in front of the muscle,
particularly in thin and small-breasted women.
Leaking implants is not usually due to forcible rupture, but by chronic creasing,
which can thin the shell and eventually develop a pinhole.
Leakage rates of saline implants are known as they are usually reported back to
the manufacturers. The rates are approximately one out of 400 per year for smooth shell
saline-filled implants. Leakage rates for textured shell saline implants are higher.
Both manufacturers have both basic and enhanced warranties, which the client
may purchase for a small fee within a few weeks after the procedure. The enhanced
warranties pay greater compensation to the surgeon doing the replacement procedure.
Basic warranty included with original placement of the implants pays about one-half of
the enhanced warranty. Both US manufacturers warranty the actual implants for lifetime
and offer free replacement if the implants fail, for both saline and gel-filled. The
warranty on the replacement implants resumes on placement for another 10 years. Both
manufacturers will replace both implants at no charge for leakage and the client can
change sizes (usually going larger).
Disadvantages of placing the implants behind the muscle are temporary distortion
and motion of the implant when doing slow forceful exercise of the arms. Placement
behind the muscles also may have more post-operative discomfort.
Post-operative pain control following augmentation mammaplasty can be
enhanced by using a device, which injects local anesthetic around the implants via a
small catheter inserted through the skin during the surgery. The catheter is removed in
several days, or when the sterile external reservoir pump is empty.
When using the periareolar incision for breast augmentation it is not necessary to
cut through the actual breast tissue as one can easily open the subcutaneous (fatty layer)
between the skin and gland, open up in front of the muscle, then spread between the
pectoral major fibers to open the space behind the muscle. This is important to reduce
the chance of sensory loss of the nipple/areola and also so as not to damage the
lactiferous ducts, which could make lactation less successful.
The current gel implants will hopefully have lower leakage rates, and have more
“coherent” gel, which is less “runny” if the shell is disrupted.
Transaxillary, and particularly transumbilical incisions, offer more difficult
visualization and less “easy” access to the internal operative site.
Loss of nipple/areolar sensitivity is more common with implants placed in front of
the muscle, as the sensory nerve supply is more vulnerable.
Silicone gel-filled implants and saline-filled implants have essentially been
cleared from the hysteria that they caused various illnesses after the 1992 implant
“crisis.” All illnesses have the same incidence in patients with or without implants.
Gel-filled implants are being studied under an ongoing research study to ascertain
their safety and effectiveness by the FDA, and one must read the outline of the study and
agree to be a “research” subject. The system is closed, and you become a number. You
have to agree to get an MRI each third year, but are not compelled to do so. Saline filled
implants can be used after age 18 has been attained, but with gel-filled the guideline is
that age 22 should be attained before using gel-filled implants. Exceptions are possible
due to anatomic considerations,
Gel-filled implants require larger incisions and are very awkward to place through
axillary incision, and are virtually impossible to place through the umbilical incision. If
the implants are stressed during placement the shell could be damaged resulting in higher
leakage rates.