Now Breast implant surgery has become one of the most common cosmetic surgery procedures. Every woman has different anatomy and a different desire for the breast volume and shape. A wide variety of different types of implants are currently available to match their needs
Medical science and device engineering has seen a lot advancement. So breast implant has become quite safe, Breast implant life is about 10to 12 years but one must remember that breast implant is not a life-long surgery. The patient usually needs second surgery down the line.
Breast implant design is based on only 4 Parameters:
Different size of the implants is available to match the patient’s desire and anatomy. The end volume of the breast is a total of patient breast native volume plus implant volume.
For long-lasting aesthetic breast shape, optimum volume 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.
Apart from the volume/size, there are only three design variables that describe each of these devices, i.e., shape, shell characteristics, and filling material. Understanding how these three variables mix and match allows the surgeon to choose best fit implant according to your desired breast shape and size..
The predominant shape incorporated into the design of a breast implant was classified as the round shape.
A “round” implant actually has a shaped aspect of its design. These implants are symmetrical in the horizontal and vertical dimensions; however, the projection tends to be less than the width or height of the device. The advantage is the height and width, which 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.
Anatomically Shaped Implants
What has been traditionally called an “anatomically shaped” implant is an implant shell being asymmetrically designed in the horizontal, vertical, and sagittal (projection) dimensions. It is also called as “tear drop implant”. 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. It corrects the ptosis of breast better compared to the round implant.
The original silicone gel implants were constructed with a smooth surface. It has some problem of capsular contracture means hardening and distortion of the breast.
It was discovered that coating an implant with a layer of polyurethane foam resulted in a dramatic reduction in the rate of capsular contracture. However, the late degradation of polyurethane resulted in capsular contracture and other complications.
So, 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 variation of texture like micro texture and Nano texture implant are also available.
Advantages of the textured implant include the following:
- The device becomes immobile, a feature that is particularly useful when using anatomically shaped devices that must maintain the proper orientation.
- It is believed that the textured surface reduces the rate of capsular contracture, which was reported later as it’s been somewhat controversial; the good surgical technique is equally important to reduce the capsular contracture.
NOTE: Recently textured implant has been associated with ALCL (ACUTE LARGE CELL LYMPHOMA). ALCL is a low-grade curable lymph cancer and not associated with breast cancer as it occurs rarely. But smooth implant association with ALCL is not found
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 has obvious advantages as follow:
- Readily available
- Entirely physiologic, and inert, which is safe because if a saline implant gets ruptured as the saline is simply absorbed without sequelae.
- The implant can fill the device during surgery, which is useful to manage asymmetries in a very controlled fashion.
The Disadvantage includes the following:
- 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 get deflated.
- B) Silicone gel has 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.
A greater degree of cross-linking of the silicone molecules give firmer consistency, which translates to better support for the anatomically constructed shell. Shape maintained during the upright position. It is called as form stable implant or gummy bear implant, less wrinkling at the upper pole and it has more sustainability.
Drawbacks include the following:
- 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.
- Taking the three design variables into consideration— shape, shell characteristics,
and filling material— (That are of various types)
- Implant designs are available in two basic groups of implants that are commonly used today, i.e., round or anatomically shaped.
- All-round implants have a horizontal and vertical dimension that is symmetrical, but it differs in the projection.
- Most manufacturers offer round implants with three different projections a low, mid, and 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.
Anatomic Implants: Design Variations
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 with the development of textured silicone surfaces.
This is an implant fixation method along with the anatomic concept for breast implants, and over the years, several different anatomic designs for both silicone and saline has been introduced.
TEXTURED short height anatomically shaped saline implants; textured, full-height anatomically shaped saline implant was developed for both augmentation and reconstruction. It was thought to be better suited for reconstruction because it could provide a better upper pole filler for the breast after the mastectomy.
The anatomically shaped textured cohesive silicone gel implant combined with a variable textured in order to provide an achievable outcome both in terms of 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.
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 as well as 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.