Breast Implants 101: Pump up the volume!!

About half million women in the USA have breast augmentation done for cosmetic reasons and winter/spring is the most popular time because of the forthcoming summer bathing suit season. The overwhelming majority of women who come in for breast augmentation have already firmly decided to proceed with surgery, but they are looking for guidance from the surgeon on the best options for their individual case to get the best results. According to Richard Bailey MD, cosmetic surgeon serving Mohave County AZ and Henderson, NV, "these are the 5 basic important decisions that each patient has to make for breast implant surgery".
1. Size and Shape.
Most women present requesting a certain cup size which has no clinical correlation to actual volume requested and needed to approached the desired look. As all women are aware cup size varies among manufacturer and circumference of chest, which is a B cup for one clothing line, is equivalent to C cup for another clothing line. Therefore, there have been numerous systems put forward to help the patient and the surgeon decide on what volume of breast augmentation is desired. There are systems such patients providing pictures of the look the woman is trying to achieve to wearable breast sizing systems (Purtz system www.lwgatz.com) to morphing computer programs estimating the volume change. There is no one system that is extremely accurate because there are variables such as the woman's tissue pliability that are not taken into account to achieve scientific reproducible measurements. The best method is to have the patient communicate as best she can using the system the surgeon routinely uses to approximate the desired augmented breast size. Regarding shape of the breast, this has been predetermined before any surgery and little can be done to change this except in special extreme cases such as Poland syndrome (genetic deformity of the breast and chest). The implants are available in different widths and heights for identical volumes which can impact shape of breast slightly. Most women request fuller breast with prominent projection with an attractive cleavage. An important surgical point is that a deep, aesthetic cleavage is formed by an uplifting brassiere not surgery.
2. Silicone vs. Saline implant.
The design of Silicone breast implants have been greatly improved since their reintroduction/approval by the FDA however, the long term benefits and risks are still under close surveillance by the FDA and medical community, which will go on for many years to ensure continued safety. Silicone implants have a silicone gel center which doesn't spill into the tissues like the liquid silicone implants of old which caused lifetime local tissue complications. If the silicone implant fractures the patient is usually unaware because there is no change in size nor shape, which explains the FDA mandate that all women with silicone implants should have a breast MRI 3 years after implantation and every 2 years thereafter.
A Saline implant contains sterile saline (salt water) and is heavier and more firm compared to a silicone implant of the same volume. Saline provides the same aesthetic augmentation result as silicone but, is much cheaper in initial cost of implantation and there is no need for post-implantation series of MRI's further reducing the long term cost. When a saline implant fractures the breast deflates in a matter of days to weeks depending on speed of leak and can be easily replaced as an in-office surgical procedure under local anesthesia with relaxation medication.
3. Incision Location.
The incisional site options are around the nipple (periareolar), in the breast fold (inframammary fold), in the armpit (transaxillary) and through the belly button (transumbilical). Each has its benefits and limitations and there are numerous variables taken into account in determining the best option. The complete discussion of this issue is beyond the scope of this article, but the best option is that decided between each woman and her surgeon after reviewing the entire clinical picture. The bottom-line is that the length of the incision to implant saline implants is less than half that for silicone implants.
4. Implant Location.
The 2 most common locations of implants regardless of type is either above or below the chest muscle called the pectoralis major muscle. Underneath the muscle is the most common location now because it provides more tissue coverage for the implant which has a number of advantages such as less visible rippling and less interference with mammograms. Capsular contraction which is scar tissue that normally forms around the implant can become too firm and adversely affect the feel and aesthetic look of the implant. The incidence of adverse capsular contraction is lessened with submuscular placement.
5. Implant Warranty.
The most notable implant companies Allergan and Mentor each warranty all their implants for 10 years and provide financial assistance for surgical fees for replacement in case of premature rupture. Additional superior benefits are available for $100 and well worth the expense because it provides financial assistance for replacement both implants even if only one fractures.