WHAT ARE BREAST IMPLANTS? HOW SAFE IS IT?

There are varieties of Breast implant types available based on only 4
Parameters:

• Size
• Shape
• Shell
• Filler

Based on these 4 parameters, wide variety of different types of breast implants
are currently available to match their needs.

A. Size
The breast implants are sized according to the volume of the filler in cubic
centimeters (cc).
The end volume of the breast is a total of patient breast native volume plus
implant volume. To match the patient’s desire and anatomy, various sizes of
implant available in small increment size of 20 to 50 ml to cater the need and desire of individual
patient.
Larger the implant larger the diameter and projection. Each company gives chart of size,
diameter and projection to select the best breast implant for a patient

For the given diameter breast implant comes in different height. Higher the
implant profile breast more is the projection and one can have more volume
with the same diameter of the implant.

For the given diameter breast implant comes in different height. Higher the
implant profile breast more is the projection and one can have more volume
with the same diameter of the implant.

Low
Medium
High
Very High

Limitations: One needs sufficient skin to accommodate the more projected breast implant.

• Shape

Breast implants are available in tear drop and round shapes

Round Implants

• A “round” implant is symmetrical in the horizontal and vertical dimensions; however, the projection tends to be less than the width or height of the device. 
• These provide a uniformly round shape to the breast.
•  This results in a shape that sticks out more from the body and which is fuller on the top part.

The advantage is the height and width remains the same if the implant rotates inside as the shape doesn’t change.

The disadvantage includes that if the upper pole convex is not covered by breast tissue properly, then the implant is felt from outside.

On an average height patient in India prefer round implants

Anatomically Shaped/ Tear drop Implants

An “anatomically shaped” or “tear drop implant”. Implant is an implant shell being asymmetrically designed in the horizontal, vertical, and sagittal (projection) dimensions. 

These are fuller at the bottom than at the top .The projection increases from the top of the device down to the lower third of the implant. 

Which is designed to mimic the contour of a normal breast in the upright position? 

Advantages:

• • Which many say that provides more natural look to the breast. 
  • These are also a bit softer to touch than the round breast implant
  • It corrects the ptosis of breast better compared to the round implant.
  • If one have more height or to short height tear drop implant are preferred.

Disadvantages:

• Tear drop implant are more costlier than round one
• Less forgiving-chance of rotation of implant and distortion of shape can take place

The original silicone gel implants were constructed with a smooth surface.

Advantages:

• Soft
• Smooth implants gravitate towards having a little lower rupture rate and are more durable.
• Safe- no ALCL

Disadvantages:

• Chances of capsular contracture, the good surgical technique are equally important to reduce the capsular contracture.

• Smooth implants have a greater possibility of moving inside the pocketcompared against textured implants.

Textured

Silicone texture was developed to reduce capsule formation. There are two basic textures are usedin the vast majority of silicone and saline implants: Biocell and Siltex.

Recently there are variations in texture like micro texture and Nano texture implant are also available.

Advantages 

• The device becomes immobile, a feature that is particularly useful when using anatomically shaped devices that must maintain the proper orientation.
• Reduces the rate of capsular contracture, 

Disadvantages

•  Difficulty in taking off the foam

Recently textured implant has been associated with ALCL (Anaplastic large cell lymphoma). ALCL is a low-grade curable lymph cancer and not associated with breast cancer as it occurs rarely. 

There are several filler materials are used in the breast implants, i.e., hydrocolloid gel and peanut. But, only two fillers stood with the time called Saline fillers & Silicone gel fillers.

Saline

Advantages: 

• Readily available
• Cheaper than silicone gel implants
• Small incision 
• Entirely physiologic, and inert, which is safe because if a saline implant gets ruptured as the saline is simply absorbed without problems?
• The implant can fill the device during surgery, which is useful to manage asymmetries in a very controlled fashion.

 Disadvantage:

• The low cohesiveness of saline results in a fluid-like water-balloon effect on the implant that can be seen and/or felt.
• Valve may fail and implant and get deflated

Silicone Gel

Silicone gel is much more inherent cohesive, producing a softer, more natural feel to the implant.

 If the gel is less extensively cross-linked, leading to a looser consistency to the gel (left). If the gel cross-linked to a greater degree to create a firmer gel that is used to support the shell in anatomically shaped implants.

Advantages

• A greater degree of cross-linking of the silicone molecules gives firmer consistency, which translates to better support for the anatomically constructed shell. 
• Mimics real breast tissue and more natural.
• Shape maintained during the upright position.

Drawbacks:

• It is less forgiving, so volume selection must be optimum because these implants come pre-filled and the volumes are limited to a defined schedule of choice.
• If the implant ruptures, the gel remains in the peri-implant space, and an operative procedure must be performed to remove the implant material.
• Less likely to cause a fluid-like water-balloon effect on the implant

Various breast implant type are available after taking the three design variables into consideration— shape, shell characteristics, and filling material— (That are of various types). Implants designs are available in two basic groups of implants that are commonly used today, i.e., round or anatomically shaped.

Round breast Implants

All-round implants have a horizontal and vertical dimension that is symmetrical, but it differs in the projection.

• Most manufacturers offer round implants with four different projections a low, mid, high and very high projection for a given volume.
• For each given volume, as the projection of the implant increases, the base width of the device decreases.
• For instance, a patient with a tight skin envelope a moderate profile implant isa better option because it will fit beneath the skin envelope without crowding the space, creating a more comfortable relationship between the implant and the soft tissue and a more aesthetic and natural result. The PT will not be able to tolerate a high projection or high profile implant without creating tension at the apex of the device, results in surrounded out of the periphery implant makes it more prominent in terms of a rounded contour.

• Conversely, with a patient having loose laxity of the skin envelope, the better choice would be a high profile implant because it would more evenly fill out the loose and redundant skin envelope.

Beyond the issues related to projection, what the implant is filled with can dramatically affect its performance. Because of their relatively low level of cohesively, saline-filled implants must be filled to a greater degree than silicone gel implants to perform safely;

One disadvantage of this overfill strategy, is the more rounded contour of the overfilled round device. In thinner patients, this rounded contour can distort the breast, creating an artificial, augmented appearance.

Filling the round implant with silicone gel is more easily tolerated by the round implant shell. Here an under fill strategy can be used because the wrinkles that form are much softer and place less stress on the implant shell. The wrinkles are also less likely to become visible through the skin envelope. This, together with the overall softer feel of silicone gel-filled implants, makes them a preferred choice among many surgeons.

Anatomically shaped breast Implants

The anatomically shaped implant has theoretical advantage in the context of creating an attractive breast contour. But if they rotate, then breast shape gets altered, Over the years, several different anatomic designs for both silicone and saline has been introduced.

Textured anatomically shaped saline implants of many different profiles developed for both augmentation and reconstruction. It was thought to be better suited for reconstruction because it could provide better upper pole filler for the breast after the mastectomy.

The anatomically shaped cohesive silicone gel implant combined with a variable textured are available for augmentation/implantation and reconstruction.

The cohesive gel-filled anatomically shaped implant holds its shape when placed upright, whereas the saline device collapses in the upper pole, leading to the possible formation of visible or palpable wrinkles.

Combination Implants

Manufacturers have developed a series of combination devices in an attempt to combine the advantage of saline volume adjust ability with the soft feel of silicone, 

Generally, the outer lumen is developed a silicone gel filling material AND inner lumen is filled with saline. The valve which passes through the outer gel component makes the access of the inner saline portion. This concept has also been explored in patients with volume adjust ability with the final desired size by adding saline as needed as post operatively, then eventually removing the remote port.

Although its use has limitations to a certain extent in daily aesthetic practice

Gummy bear or form stable implants maintain their natural shape even when its position is changed. They are filled with the filler material.

Advantages

• They hold their shape
•   Lasts longer.

Disadvantages

• Firmer than natural breast
• Less forgiving in shape

For long-lasting aesthetic breast shape, optimum volume breast implant to be selected. Optimum implant size is decided from the patient’s tissue characteristics like chest width, breast width, native breast volume, and skin characteristic.

Concept of optimum breast implant size have reduced complication and resurgence incidence drastically

The Breast Implants have evolved over the years in many parameters such as Saline implants, Silicone implants, Surface, Filler, Shell and Shape.

The first generation silicone implants

Invented in 1962 by Cronin and Gerow which was fabricated by Dow Corning Corporation

Advantages

• Made using thick, smooth silicone elastomer as a two-piece envelope joined together towards their ending.
• Decently viscous silicone gel used as filler.
• Had presence of draconian fixation patches on rear end of to hold the position of the implant.
• Shape of implant was teardrop

Disadvantages

• Mediocre shell quality
• High incidence of contracture
• Silicone gel showed absence of cohesiveness

Second generation of silicone implants

launched in 1970s so that the shortcomings of the first generation could be reduced

Advantages

• Thinner shell
• No draconian fixation patches
• Silicone gel had reduced viscosity
• Shape of implant changed to round

Disadvantages

• Leakage of silicone molecules into the periprosthetic intracapsular region reason being thinner shell and lessened permeability of shell coupled with thin shell wall.
• Leaked silicone left behind a adhesive, oily remnant around the capsule inside the periprosthetic intracapsular region

Third generation of silicone implants

They came in 1980s in order to overcome the drawbacks of the second generation

Advantages

• More Strength and Reduced Permeability
• Presence of multi-layered silicone elastomer
• Addition of a barrier layer along with denser shell
• Reduced device shell collapse chances

Disadvantages

• FDA banned these implants in 1992.

Fourth and fifth generation implants

Started to be researched post ban of third generation.

Advantages

• Manufactured as per stricter rules of American Society of Testing Methodology along with FDA accepted parameters for shell density and gel adhesiveness
• Enhanced quality control enforced
• Range of implants and shapes and surfaces available to choose from
• Initially polyurethane laminated foam was developed

Traditionally breast implants usually last for about 10 years.

Gummy Bear implants last a while more than other types

The breast implants does not hurt while they are implanted as surgery is performed under general anesthesia

The common risks associated with breast implants include

• Infection
• Rupture
• Capsular contracture
• Breast implant illness
• Breast implant associated anaplastic large cell lymphoma.

Yes you can safely and successfully breastfeed with your implants.

If the breast implants are larger than the ideal size then milk production during lactation may be reduced.

• As your breast tissue ages then sagging also occur simultaneously.
• The sagging is directly proportional to the size of your implants i.e. the more the size of your breast implants then faster is the sagging process.