Breast Augmentation Revisions, Part 3
Breast Augmentation Revisions
(Fixing Breast Implants)
The next complaint regarding a bad breast augmentation has to do with feel. Educating the patient on the differences prior to surgery is absolutely crucial. Let’s review what the options are to avoid “wrong feel”
Option #1 – Saline Implants
Saline breast implants are supplied as an empty silicone shell with a fill valve. During surgery, the implant is placed into the breast pocket, and is then filled to the appropriate size based on preoperative evaluation and implant dimension. This type of breast implant has advantages and disadvantages
1) Advantage #1 – Smaller incision size. Because the breast implant is supplied empty, the incision can be less than 3cm in size, and any sized implant can be placed through the same incision
2) Advantage #2 – Implant rupture detection. If a saline breast implant gets ruptured, you lose volume immediately, and over the course of hours to days, the diagnosis of a rupture becomes very evident. It is usually a simple operation to remove the ruptured implant and replace it.
3) Advantage #3 – Cost. This is the absolutely least important advantage. Breast augmentation is not an accessory. It is a lifestyle choice. If you are looking for the cheapest type, reconsider your reasons for having this done.
1) Disadvantage #1 – Rippling. Extremely common with saline breast implants. This is a design flaw in the implant, and absolutely nobody likes it.
2) Disadvantage #2 – Less natural feel. A saline implant is just that, an implant filled with saline solution. It will feel different than the feel of your breast. This is unavoidable.
3) Disadvantage #3 – Swimming. If you swim in cold water with a saline implant, the saline implant temperature will balance with the water temperature, while your body remains warm. This can lead to a “turkey is done” effect, which can be socially awkward on the beach or at the pool
Option #2 – Silicone Implants
1) Advantage #1 – Natural feel. No question about it. Silicone implants feel remarkably like the natural breast tissue. Because of this, I will see 1-2 patients a week with saline implants request a change to silicone. I have NEVER had anyone ask the to go from silicone to saline because they like the “fake feel” better.
2) Advantage #2 – Safety. Silicone breast implants have been scrutinized like absolutely no other surgical device or prosthetic on earth. The FDA recently completed a 10 year double-blinded clinical trial that CLEARLY demonstrated the safety and efficacy of silicone implants. The cohesive gel implants (i.e., Gummi Bears) are safe.
3) Advantage #3 – Swimming. Silicone mimics the body tissue. You get less of the “turkey is done” effect.
4) Advantage #4 – MINIMAL RIPPLING. Almost never see or hear of it. Very common with saline.
1) Disadvantage #1 – Rupture. If you have an implant rupture, your implant will not deflate. This is a good and a bad thing. Many silicone implant ruptures are asymptomatic because the new implants have solid state silicone, not liquid. So, you can have a ruptured implant for years without any problems whatsoever. However, if you have concerns over rupture, you can only diagnose it with an MRI scan.
2) Disadvantage #2 – Incision size. Silicone breast implants come prefilled. Because of this, it is common to use a slightly larger incision to place the implant. As well, you cannot have this type of implant placed through the belly button. Having said that, in almost a decade of using these implants, I have never had anyone complain about incision size via an armpit (transaxillary) or inframammary (below breast) incision. I commonly hear complaints about the periareolar incision (around the nipple).
3) Disadvantage #3 – Cost. Again, I shudder to mention this, because it is more of a difference than a disadvantage. A silicone breast implant is superior in quality, feel, and minimizes rippling. In the end, you are paying for a superior product.
A few words about fat grafting, or autologouos breast augmentation. I commonly employ fat grafting in facial cosmetic surgery, buttock augmentation, and breast reconstruction. I do not use it primarily for breast augmentation. Currently, mammography has a hard time distinguishing breast cancer from fat grafting. In other words, cosmetic fat grafts in the breast can appear to be a cancer to your mammographer. There is a great deal of clinical research on this topic right now. I am waiting to use fat grafting for breast augmentation until it becomes a little safer regarding breast cancer surveillance.
When evaluating other surgeon’s implants, the “wrong feel” category often comes up. The key again is good preoperative communication. I always meet with patients more than once regarding breast implants. The more everyone knows, the better everyone does.