Breast Augmentation

Breasts consist of milk ducts and glands that produce milk during pregnancy; enclosed in a thick layer of fatty tissue. The breasts overlie the muscles of the chest. Advancing age may cause the breasts to droop or sag. Loss of skin elasticity, gravity and other factors such as pregnancy and nursing can also cause the breasts to lose their natural shape and firmness.

Breast implants are artificial shells made of rubber filled with sterile saline or silicone gel which is surgically implanted below the breast tissue for cosmetic purposes to augment the shape and size of the breast or for breast reconstruction. Breast reconstruction may be performed after mastectomy or loss of breast tissue secondary to trauma or injury. In a few cases, it may also be performed to rectify a birth defect. Breast implants can be placed either under or over the chest muscles.

Eligibility Criteria

Breast implant can be considered in women with the following characteristics:

  • At least 18 years old for saline implants and at least 22 years old for silicone gel implants
  • Should not have any active infection
  • Should not be currently nursing or pregnant
  • Should not have an existing malignant or pre-malignant cancer of the breast

Choices in Implants

Choosing the right breast implants is based on the following characteristics of the implant:

  1. Size: Size of the breasts after surgery depends on the initial breast size before the surgery and the size of the implant chosen. Larger implant size is chosen for a larger cup size, which is measured in cubic centimeters. The plastic surgeon will help you in choosing the right sized implant.
  2. Shape: Breast implants are available in two shapes —
    1. Round Breast Implants: These breast implants are round.
    2. Shaped Breast Implants: These resemble the shape of a mature breast, gently sloping downwards. These breast implants are tear drop shaped.
  3. Profile: Profile refers to the outward projection of the implant. Breast implants are available in three profiles: low, moderate and high. Thus, high profile breast implants have maximum outward projection for a size and shape.
  4. Surface texture: Round shaped breast implants are available with both smooth and textured shell surfaces whereas shaped breast implants are available only with textured shell surface. Textured implants have a thicker shell and are firmer. They require a slightly larger incision, than the smooth implants, for implantation. Textured implants were initially developed to reduce the risk of capsular contracture, a rare complication after breast implantation. In capsular contracture, scar tissue forms around the breast implant causing severe pain which may also lead to distorted shape, palpability or displacement of the implant. However, the results of the various studies do not show any significant difference in the risk of capsular contracture with the use of either textured or smooth implants.
  5. Implant filler: The breast implants are either silicone gel filled or saline filled.
    1. Saline filled breast implants are safer in event of an implant rupture, only the filled saline is released into the tissue. The empty implant can then be removed or replaced. Moreover, saline filled implants are filled with saline only after surgical placement of the implant, thus they require a smaller incision for placement. Filling during the surgery also allows the surgeon to make minor adjustments to the volume. However, these implants look less natural as compared to silicone filled implants.
    2. Silicone gel filled implants have a more natural look and feel firmer and softer than the saline implants. Silicone gel filled implants are pre-filled and require a longer incision for implantation. Only women over 22 years of age are eligible for breast augmentation using silicone filled breast implants.

The newer silicone implants have a thicker shell and thicker silicone gel which significantly reduces the risks of gel bleed and release of silicone gel should the implant rupture. Moreover, extremely low levels of gel bleed are of no clinical significance.

Silicone gel filled implant ruptures are most often silent. Thus, MRI is recommended after 3 years of the implantation and then at an interval of every 2 years. In case of an implant rupture, both the implant and the gel are surgically removed. It may sometimes also be necessary to remove the tissue capsule after the rupture. Gel rupture and spread of the gel to the nearby tissue has a small risk of granuloma formation, lymphadenopathy and fibromyalgia.

Complications and risks

Breast implant surgery may be associated with complications specific to certain breast implants that include capsular contracture, pain, infection, calcium deposits in the tissue around the implant, hematoma, seroma, changes in nipple and breast sensation, necrosis around the implant, extrusion and deflation or rupture. Few patients may develop unpleasant cosmetic outcomes that include wrinkling, asymmetry, implant shifting, incorrect size, unanticipated shape, implant palpability, scar deformity, hypertrophic scarring and or sloshing. Careful surgical planning and newer techniques are aimed at minimizing these risks and complications. However, in a few patients’ additional surgery may be required to treat the associated complications.

Your plastic surgeon will help you decide the right implant depending on your preferences.