22 Jun Modernising Breast Implants
BY Dr Terrence Scamp
In the early 1990’s plastic surgery in America was thrown into upheaval by a Federal Government restriction on the use of silicone breast prostheses.
A number of patients had presented with rupture of their implants and in some cases, lumps had formed in the surrounding breast tissue as a reaction to the silicone.
Regrettably, the whole issue became politicized with special interest groups emerging from all directions to try and steer the controversy. There was a problem and that was undeniable, but what received little attention was that the implant manufacturers had recognized this in the mid-1980’s and already changed the design of their implants.
Silicone breast prostheses have been around since the sixties. The most common complication related to these has always been capsular contracture, where the scar tissue surrounding the prosthesis thickens and exerts pressure on the implant itself. This may make the implant sit in an abnormal position (usually too high), feel firm or have an unusual shape.
In the mid 70’s implant manufacturers tried to overcome this problem by making the implants softer. They did this by making the wall more flexible and the gel that filled the implant more watery in consistency.
Unfortunately at this time, one of the common ways to treat hardening around implants was closed capsulotomy, where the breast is grasped forcibly and pressure exerted to try and push the implant through the thickened scar tissue wall. When you combine a thinner-walled implant, a less viscous gel and this maneuver it’s easy to foresee that one has a recipe for disaster and many implants were ruptured in attempting this maneuver.
By the mid 1980’s the manufacturers had changed their design. Implants were now made with a thicker wall and the gel itself was more dense.
So although the controversy erupted in the early 90’s the problem had been recognized and addressed almost seven years beforehand.
The modern breast implant bears little resemblance to these older designs. The wall of the modern implant is much thicker and more durable than the previous styles and the silicone gel that fills them is now “cohesive”. This means that even if a hole is cut in the wall of the implant the gel will “stick together” and stay inside the implant itself. This has added enormously to the safety of these devices.
In addition, new styles of implants have emerged. The modern tear-drop shaped implant was developed with a very dense gel. It is described as resembling “Turkish Delight” in consistency and one can actually cut these implants in half and they will stay in two pieces with no leakage. These implants are called tear-drop shaped or anatomical or form-stable, the latter referring to the fact that they maintain their tear-drop shape within the body.
This has enabled manufacturers to create a range of different designs with different vertical dimensions and different degrees of projection for any given width of implant. This in turn has permitted modern Plastic Surgeons to “tailor” their implant selection to the patient’s breast size and shape and to their desires.
These tear-drop shaped implants are excellent for avoiding a “too round” look to the breast which may look unnatural, especially in women over 30. The implant creates a natural fullness in the upper breast, which can mask moderate degrees of breast sag, meaning that a pleasing breast shape can be achieved in many cases without resorting to the extra scarring of a breast repositioning procedure.
Only about 15% of women have breasts that are closely matching. These tear-drop shaped implants permit one to choose implants of different dimensions to achieve a much better match in projection and shape than was hitherto possible.
The tear-drop shaped implant has a tendency to be a little wide in its base dimension for many women who are seeking a larger size enhancement. Round implants are better suited to achieving this sort of larger size change as they can achieve greater projection with less width. In addition, the round implants have a softer feel to them and many women prefer this. Their softness allows them to be inserted through smaller incisions and even via a peri-areolar incision.
A further style of implant being used more commonly is the polyurethane coated implant. These implants have been around since the 80’s but fell into disuse in the USA and Australia when the silicone gel controversy erupted in the early 90’s. They were however continuously used in South America since this time and the available scientific evidence would suggest that they are the most effective at preventing hardening around breast prostheses.
For this reason, polyurethane-coated implants are often selected for patients undergoing revisional surgery for repeated hardening around the breast prostheses. These implants come in a round and tear-drop shape to suit the woman’s breast shape and her preferences.
Breast augmentation remains one of the most popular procedures in Plastic Surgery. It can be performed to undo much of the damage resulting from childbearing or to simply bring a smaller-breasted girl into better proportion to the rest of her body. They are also useful where one breast has failed to sufficiently develop. Naturally, with our outdoor lifestyle, our warm climate and our beach culture, the Gold Coast remains one of the centres for breast augmentation in Australia. Most breast enlargement surgery is performed as a day patient and return to normal activity is usually within days of the procedure.
Developments in enhanced implant safety by design and introduction of a wider range of implant shapes and styles enables the modern Plastic Surgeon to match the selection of breast implant to the woman’s physique, her breast shape, and her desires, resulting in a higher satisfaction rate with this popular procedure.