Breast Augmentation Implants
The sheer number of breast implant variations available to patients and surgeons can lead to confusion; however, careful measurement, proper analysis of your anatomy, and experienced decision-making can help give you the best breast enlargement possible. Unfortunately, some choices are made on the basis of marketing, surgeon habit, or cost, rather than careful listening to the patient’s goals and concerns. As leading Minnesota cosmetic surgery providers, our plastic surgeons and nursing staff help patients choose their breast implants with the benefit of extensive expertise and years of experience with thousands of patients. Since breast augmentation is performed so frequently at Minneapolis Plastic Surgery, Ltd., we maintain an extensive on-site inventory of breast implants in virtually every size and profile, in both silicone and saline.
Breast implants come in numerous sizes (100cc – 800cc, or about 3 to 27 ounces each), shapes (round, oval, or teardrop "anatomic"), surface characteristics (smooth or textured), and fill material. Most breast implants are filled with saline or silicone gel, and occasionally other materials.
Since the material inside breast implants is what gives them their "feel," filler material choices have generated much controversy and media interest, not to mention scientific debate. We can provide both the science and years of expertise to help you determine whether saline or silicone is best for you.
At present, only two companies produce breast implants FDA-approved for use in the United States (Mentor Corp., now part of Johnson and Johnson; and Inamed Corp., previously McGhan Medical, now owned by Allergan, Inc.). Prior to the FDA restrictions of 1991-1992, numerous companies produced breast implants with different designs, surface, and filler materials, including polyurethane-coated silicone gel implants, silicon-saline double-lumen implants (the Becker implant), and PVP hydrogel filled implants designed to pass mammography X-rays and have a feel more like silicone than saline (the Bioplasty Misti-Gold implant). After the FDA restrictions, these implant options and companies were lost to USA patients, though some of these companies and options remain available in other countries.
In the United States, besides the presently-available Mentor and Inamed implants, several companies have produced investigational implants such as the McGhan style 410 cohesive silicone gel “gummy bear” implant, Hutchison saline implants, Ideal saline implants, and others. These implants are not yet FDA-approved and are implanted only by plastic surgeons associated with the FDA investigation/approval process.
Saline identical to intravenous fluid was the most common type of breast implant filler material used in the United States from 1992 until November 2006, when the FDA re-approved the use of silicone gel-filled implants for primary elective breast augmentation. Prior to the 1992 FDA restrictions, silicone gel implants were utilized in over 85 percent of all breast augmentation procedures in the United States, and remain the most commonly used breast implants worldwide. Other types of filler material have been evaluated over the years, and one or more problems are associated with these. Paraffin, sponges, and other unusual materials were used in early efforts to enlarge breasts; results were dismal until silicone came into use in the 1960s. More recently, soybean oil-filled implants were studied extensively, and were used in many patients in Europe, as well as a few U.S. patients in FDA studies. Breakdown of the oil, rancid smell, and other concerns ultimately led to withdrawal of this implant (Trilucent™) in the US and in Europe. Fat as implant fill material has the same concern, and is not used. Fat graft injections of a patient's own liposuction fat (directly into or beneath the breasts) have been performed by some physicians. The American College of Surgeons and the American Society of Plastic Surgeons condemn this procedure because it can cause scar formation, firmness or irregularities, or microcalcifications within the breast that can interfere with the mammographic detection of breast cancer. A recent study confirms that fat cells removed via liposuction are mostly destroyed and non-living; improper freezing the fat kills even more cells (ice crystals puncturing cell walls kill the fat cells), so this is worthless and potentially harmful.
Other implant materials are being studied, including a more firm, teardrop-shaped, textured-surface cohesive silicone gel (the "gummy-bear" implant). This study implant retains its form and innate integrity even when its outer shell is punctured. This implant is more firm (like a “gummy bear” or silicone bathtub seal) than the softer "standard" silicone gel implant, and requires a larger 2.5 inch incision for placement.
At our Minneapolis / St. Paul area cosmetic surgery center, breast implants containing both silicone and saline are available. At Minneapolis Plastic Surgery, Ltd., the newest type of silicone breast implants provide incredibly natural looking and feeling results, and also a high level of safety. The latest types of silicone gel breast implants presently used (as part of the more general FDA study since 1992) are softer but also cohesive. These implants do not leak if the shell is cut or punctured, and can be inserted via a 1.5 inch incision. Cutting one of this latest generation of breast implants is like cutting Jell-O. In other words, leakage does not occur and you get two solid intact parts.
With silicone gel or saline breast implants, microscopic silicone molecules can still enter a patient's body, just as liquid silicone does in the patient who has an injection with a needle lubricated with liquid silicone. No scientific study to date has provided credible evidence that silicone has any cause-and-effect relationship with autoimmune diseases or conditions such as rheumatoid arthritis, lupus, scleroderma, or so-called "human adjuvant illnesses." With these studies in mind, silicone gel breast implants were FDA-approved in November 2006 for elective first-time cosmetic breast enlargement in women over the age of 22. Our Minneapolis / St. Paul area providers of breast implants are proud to provide patients with the latest scientific data and the option to choose either saline or silicone implants.
The surface of breast implants can be smooth or textured, and the filler material silicone gel or saline. When silicone gel implants were used prior to the FDA restrictions of 1992, placement above the muscle was also the preferred implant position for many plastic surgeons. Texturing the surface of the silicone gel implant reduced the incidence of capsular contracture in this position (above the muscle and just below the breast tissue). However, after the FDA restriction on silicone gel implants and the switch to saline-filled implants, placement above the muscle led to unacceptable wrinkling that could sometimes be felt or seen. This led to most surgeons switching to placement of saline breast implants below the muscle to increase tissue coverage and reduce these concerns. Even placement of saline-filled implants below the muscle will not always eliminate implant wrinkles, particularly in thin patients and/or patients with very little overlying breast tissue. Now that silicone gel implants are again available, more patients will be able to avoid the "water-balloon" feel and rippling seen in some saline implant patients. Although each patient's circumstances are unique, our experienced Minnesota plastic surgeons frequently use silicone breast implants to provide the most natural looking results. Of course, at Minneapolis Plastic Surgery, Ltd., we will help you determine the appropriate size, shape, and filler material to meet your needs.
Based on the choice of saline or silicone, textured or smooth, and the patient's unique body type, appropriate surgical placement will be determined. Using textured breast implants below the muscle can cause unnatural adherence to the chest and restricted natural movement of the breast. In textured saline implants, the lack of gel to act as a lubricant inside the implant (saline is a poor lubricant) can allow flexing and creasing of the implant shell surface with each movement. This can ultimately lead to a higher risk of failure at one of the low spots in the textured surface, with leakage and deflation of the saline implant. The textured implant shell is also thicker and more palpable. Submuscular placement already reduces the incidence of capsular contracture, so smooth breast implants in this location are preferable to adherent textured-surface implants. The smooth-shell saline-filled implant placed below the muscle is soft, less palpable, and less likely to deflate (if properly filled), and has low rates of capsular contracture formation. It also moves with the patient's position and therefore more closely resembles natural breasts.
However, smooth-shell silicone-gel-filled implants are even more homogeneous with breast tissue and provide the softest, most breast-like, and most natural "feel" of any implant. Since the newest generation of silicone gel implants is also cohesive, they cannot leak or rupture. While the vast majority of patients are again choosing silicone implants for their breast enhancement surgery, we believe that the best and most experienced breast surgeons offer their patients a choice of either silicone or saline breast implants. This is why our board-certified plastic surgeons are happy to provide patients with information about all options.
Breast implants come in round or teardrop ("anatomic") shapes. While some plastic surgeons prefer the teardrop-shaped implants in some situations, the smooth round implants are generally the softest, most natural in appearance (upright and lying down), least likely to be felt externally, and (for saline implants) least likely to leak. When you are making your surgical decisions regarding breast implants, our plastic surgeons will, of course, help guide you throughout the process.
Textured surface implants have a thicker shell, are more likely to be felt externally, and have a somewhat higher leak rate (saline implants) because of the thinner or weaker areas in the tiny peaks and valleys of the shell surface. Since teardrop-shaped implants must have proper positioning and must stay in that position (sloped part up, rounded part down) to take advantage of their innate shape, by necessity they are textured so that the body's tissues can adhere to and maintain the proper position of the implants. Thus, the teardrop implants cannot and do not move as the patient changes from a standing to a reclining position. Also, the teardrop implant remains teardrop-shaped when the patient is lying down, whereas the natural breast flattens out and assumes a round appearance. Teardrop implants are also more costly than round smooth implants. The smooth round implant does just what a natural breast does: it is teardrop-shaped when the patient is upright, and flattens and drops slightly to the side when the patient reclines. Thus, the round implant is actually more "anatomic" than the teardrop or so-called anatomic implant.
Final breast size can be estimated in a number of ways; one of the best techniques for choosing the size of breast implants is for the patient to bring photographs of models with the desired final breast size to their consultation, or at the time of surgery at our Minneapolis / St. Paul accredited office surgical facility. The proper size implant to most closely achieve this appearance is then chosen in the operating room. (Since we stock all sizes and profiles of saline and silicone gel breast implants in our surgical center, we do not have to “order in advance” and can change based on your choices right up to the time of surgery). Photographic examples have proven to be much more accurate than the patient requesting a letter cup size, or trying to find a similar person who has had breast implants and whose anatomy and/or results approximate your goals. Trying on implants in a brassiere is another excellent way to provide some idea of desired final breast size and the implant volume needed to achieve that size; however, it is essential not to become overly attached to a specific bra cup size (B, C, D, etc.) or implant volume (400cc, etc.), since your own breast tissues and chest muscle will conceal an implant's impact on your appearance significantly more than a cotton stretch bra or lace brassiere. Typically, a woman who chooses a specific cc volume implant that she feels looks good in her bra will be too small after surgery if that exact volume implant is used in her body. A good general rule of thumb is to add 50 to 100cc to the implant volume you feel looks good if you choose to size in a brassiere. In other words, if you like how a 400cc implant looks in a bra, it will take a 450-500cc implant to look about the same size in your body.
Since what this surgery accomplishes is increased volume, your own skin brassiere (pre-surgery breast shape) will determine your final breast shape after implants increase your breast size. Size will also determine just how much breast mass extends to the side of the chest (armpit area), or into the cleavage region, since proper implant positioning is determined by the position of your nipple areola complex.
For instance, a woman with widely spaced nipples will need to have her breast implants positioned more laterally (towards the armpit area), since the implant pocket and final breast mound must be properly centered beneath the nipple areola complex. If the implants were simply placed close together in the center to give the full cleavage look, each nipple areola complex would then be positioned too far to the side, giving a "wall-eyed" appearance.
Similarly, a woman who has more medial nipple position would have a "cross-eyed" appearance if she requested lateral fullness and her implants were placed more to the side of the chest without taking into account the nipple position atop the new breast mound.
Our plastic surgeons will, of course, work with you to determine the size and position of your breast implants. Your own anatomy determines shape (unless you also need a breast lift, where incisions are made to lift or otherwise shape your breast skin, or reposition your nipple and areola).
Most women seeking breast implants at our Minneapolis / St. Paul practice emphasize that they do not wish to be "too large" after augmentation. There is a natural hesitancy to make a change that is so dramatic that "everyone will know" or that might embarrass you at the health club, swimming pool, relative's home, or church meeting. Most patients have these concerns, and many verbalize this. However, 6 to 12 months after surgery, when these concerns evaporate, and the social settings where "someone might notice" are successfully overcome, a surprisingly large number of patients admit they now wish they had chosen larger implants. Some undergo another operation to place new, larger implants. Fortunately, the surgical pocket for the implant is already healed, and recovery is quicker when size change is requested. Although the choice of size is entirely up to each individual patient (with some anatomic limitations), choosing just slightly larger than what you consider to be optimal preoperatively will help you to avoid re-operation for size change, including the cost of new implants, operating room, and anesthesia.
If you have been considering breast implants, the professionals at our Minneapolis / St. Paul area cosmetic surgery center can help you throughout the decision-making process. From if and when to have surgery, to the size and shape of your implants, we are here to help. We also provide free consultations. To schedule your consultation, contact Minneapolis Plastic Surgery, Ltd. today.
Please contact Minneapolis Plastic Surgery, LTD. if you have any questions about our procedures or would like to schedule a complimentary consultation with one of our plastic surgeons.
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Minneapolis Plastic Surgery, LTD.
4825 Olson Memorial Highway (Hwy 55) Suite 200
Minneapolis, Minnesota 55422
Phone: (763) 545-0443
Fax: (763) 545-2784