breast implantsBreast implants is a prosthesis used to alter the size and shape of a woman’s breasts (known as breast augmentation, breast enlargement, mammoplasty enlargement, augmentation mammoplasty or the common slang term boob job) for cosmetic reasons, to reconstruct the breast (e.g. after a mastectomy or to correct congenital chest wall deformities), or as an aspect of male-to-female gender transition. A breast tissue expander is a temporary breast implant used during staged breast reconstruction procedures.

There are two primary types of breast implants: saline-filled and silicone-gel-filled implants. Saline implants have a silicone elastomer shell filled with sterile saline liquid. Silicone gel implants have a silicone shell filled with a viscous silicone gel. Several alternative types of breast implants had been developed, such as polypropylene string or soy oil, but these are no longer manufactured.

Pectoral implants are a related device used in cosmetic and reconstructive procedures of the male chest wall.

History
Implants have been used since at least 1895 to augment the size or shape of women’s breasts. The earliest known implant was attempted by Vincenz Czerny, using a woman’s own adipose tissue .

Indications
Breast implants are used primarily for:

primary reconstruction (to replace breast tissue that has been removed due to cancer or trauma or that has failed to develop properly due to a severe breast abnormality such as the tuberous breast deformity)

revision-reconstruction (revision surgery to correct or improve the result of an original breast reconstruction surgery)

primary augmentation (to increase breast size for cosmetic reasons)

revision-augmentation (revision surgery to correct or improve the result of an original breast augmentation surgery)

Patient Characteristics
Patients seeking breast augmentation have been reported as commonly younger females. Many of these patients have reported greater distress about their appearance in a variety of situations, and have endured teasing about their appearance.

Post-operative surveys on mental health and quality of life issues have reported improvement on a number of dimensions including: physical health, physical appearance, social life, self confidence, self esteem and sexual function. Longer term follow-up studies suggest these improvements may be transitory, with the exception of body esteem related to sexual attractiveness. Overall, most patients report being satisfied long-term with their implants even when they have required re-operation for complications or aesthetic reasons.

Procedure
The surgical procedure for breast augmentation takes approximately one to two hours. Variations in the procedure include the incision type, implant material and implant pocket placement.

Incision types
Breast implants for augmentation may be placed via various types of incisions:

Inframammary – an incision is placed below the breast in the infra-mammary fold (IMF). This incision is the most common approach and affords maximum access for precise dissection and placement of an implant. It is often the preferred technique for silicone gel implants due to the longer incisions required. This method can leave slightly more visible or thicker scars.

Periareolar – an incision is placed along the areolar border. This incision provides an optimal approach when adjustments to the IMF position or mastopexy (breast lift) procedures are planned. The incision is generally placed around the inferior half, or the medial half of the areola’s circumference. Silicone gel implants can be difficult to place via this incision due to the length of incision required (~ 5 cm) for access. As the scars from this method occur on the edge of the areola, they are often less visible than scars from inframammary incisions in women with lighter areolar pigment. There is a higher incidence of capsular contracture with this technique, and this incision causes the most problems with breast feeding, due to cutting milk ducts and nerves that lead to the nipple.

Transaxillary – an incision is placed in the armpit and the dissection tunnels medially. This approach allows implants to be placed with no visible scars on the breast, but is more likely to produce asymmetry of the inferior implant position. Subsequent revisions of transaxillary-placed implants usually require inframammary or periareolar incisions. Transaxillary procedures can be performed with or without an endoscope.

Transumbilical (TUBA)[24] – a less common technique where an incision is placed in the navel and dissection tunnels superiorly. This approach enables implants to be placed with no visible scars on the breast, but makes appropriate dissection and implant placement more difficult.[citation needed] Transumbilical procedures are performed bluntly, with or without an endoscope (tiny lighted video camera) to assist dissection. This technique is not appropriate for placing silicone gel implants due to potential damage of the implant shell if attempting insertion through the small 2 cm incision in the navel, and as those implants are pre-filled they cannot be passed through that incision.

Transabdominoplasty (TABA)[25] – procedure similar to TUBA, where the implants are tunneled up from the abdomen into bluntly dissected pockets while a patient is simultaneously undergoing an abdominoplasty procedure.


Types of implants Saline Implants

Saline-filled breast implants were first manufactured in France in 1964, introduced by Arion[26] with the goal of being surgically placed via smaller incisions. Current saline devices are manufactured with thicker, room temperature vulcanized (RTV) shells than earlier generations of devices. These shells are made of a silicone elastomer and the implants are filled with salt water (saline) after the implant is placed in the body. Since the implants are empty when they are surgically inserted, the scar is smaller than is necessary for silicone gel breast implants (which are filled with silicone before the surgery is performed). A single manufacturer (Poly Implant Prosthesis, France) produced a model of pre-filled saline implants which has been reported to have higher failure rates in vivo.

Saline-filled implants were most common implant used in the United States during the 1990s due to restrictions that existed on silicone implants, but were rarely used in other countries. Good to excellent results may be obtained, but as compared to silicone gel implants, saline implants are more likely to cause cosmetic problems such as rippling, wrinkling, and to be noticeable to the eye or the touch. Particularly for women with very little breast tissue, or for post-mastectomy breast reconstruction, silicone gel implants are considered as superior. In patients with more breast tissue in whom submuscular implant placement is used, saline implants can look very similar to silicone gel.

Silicone gel implants
Thomas Cronin and Frank Gerow, two Houston, Texas, plastic surgeons, developed the first silicone breast prosthesis with the Dow Corning Corporation in 1961. The first woman was implanted in 1962. Silicone implants are generally described in terms of five generations which segregate common characteristics of manufacturing techniques.

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