Cosmetic Surgery & Beauty #73

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Implant fill
There are two types of implant filling – silicone gel and
saline solution – and both are encased within an outer shall
of silicone.
Silicone gel implants are touted to have a more natural
feel than their saline-filled counterparts, and the gel’s
cohesive consistency helps retain implant shape following
insertion. In comparison, saline-filled implants are firmer to
touch, and have a greater chance of rippling after insertion.
If implant rupture occurs with saline-filled implants,
the saline solution will be absorbed into the body and the
rupture will be immediately noticeable to the patient. When
using silicone gel-filled implants, rupture is less noticeable
and can remain undetected for longer periods of time,
which is cause for concern to some doctors and patients.
Implant shape
Implants come in round, teardrop (anatomical) and conical
shapes. The round and teardrop options are the most
popular in modern-day breast surgery.
Round implants come in smooth and textured shells, and
will usually lend more upper pole fullness than anatomically
shaped implants. When the patient is upright, a round
implant can assume a defined, round shape or a teardroplike
contour, depending on its fill.
Anatomical (teardrop) implants have a fuller lower pole,
and the shape more closely resembles that of the natural
breast. Their design gives them greater projection in relation
to the size of the base, making them particularly suitable
for women with little breast tissue. A precise degree of
accuracy is needed when positioning anatomical implants,
because if they shift after surgery the shape of the breast
may be noticeably distorted. To reduce this risk, anatomical
implants will always have a textured surface to enable
adherence to surrounding tissue.
Implant texture
The surface of breast implants can either be smooth or
textured. Smooth-shelled implants are acclaimed for their
natural movement and feel, they are relatively easy to
insert during surgery and have a thinner shell than textured
implants. There is a downside to smooth implants, however,
as they have a greater chance of capsular contracture
(hardening of the breast), which is a common reason for
revision surgery.
In comparison, textured implants – usually coated
with polyurethane foam – exhibit greater adherence to
surrounding tissue, meaning there is less friction between
the implant and breast pocket. This reduces the change
of capsular contracture and protects against implant
movement following surgery.
Implant placement
Breast implants can be placed either above or below the
pectoral muscle and, in some cases, a dual plane approach
means the implant is partially placed in both fields.
Subglandular placement is when the implant is positioned
above the pectoral muscle, beneath the glandular breast
tissue. This implant positioning is best suited to patients
who have adequate existing breast tissue, as this tissue
will cover the implant’s edges after insertion. Subglandular
implant placement often causes a pronounced “roundness”
to the breasts, and the implant moves relatively naturally in
this position following surgery.
In patients with less soft tissue in the breast area,
implants placed underneath the pectoral muscle –
called submuscular implant positioning – are often less
conspicuous. This placement helps camouflage the implant
edges and can create a more natural-looking contour at the
top of the breasts.
In dual plane placement, the implant is placed partially
beneath the pectoral muscle in the upper pole, while the
lower half of the implant falls in the subglandular plane. This
placement will camouflage upper implant edges and provide
full projection in the lower pole, suited to women with a high
degree of sag or an accentuated breast fold. It will reduce
the defined ‘roundness’ usually associated with subglandular
implants and will offer a natural breast contour.
The incision site
The incision site will determine the visibility of scars and is
generally decided based upon the personal preferences of
the patient and surgeon. There are surgical advantages and
drawbacks for each site.
The inframammary incision is the most common incision
site for breast implant placement and it is made in the
inframammary fold, or the crease under the breast. The
periareolar incision is made on the border of the areolar - the
area of darker skin surrounding the nipple. A transaxillary
incision is made in the armpit fold, and a channel is created
to deliver the implant to the breast pocket. And, finally the
transumbilical incision, which not so commonly used, is
made on the rim of the navel and an endoscope is used to
tunnel to the breast.
Ultimately, a thorough understanding of the implants,
their shapes, fills and placement will help ensure a
satisfactory outcome. csbm
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