Choosing the right implant, the position of the implant and where the incision
is placed are some of the most important decisions a woman can make when considering
breast implant surgery. When we see patients at the Plastic Surgery Clinic we
spend most of our time discussing these issues so every woman can make the right
choice for themselves.
The two major types of implants available for use in Canada today are Cohesive
Gel Silicone implants and saline implants. Saline implants have been available
for over 30 years. There is no other implant that has been more thoroughly
studied or has a longer track record than saline implants. Essentially these
implants are an empty bag that is filled with salt water or saline. The implant
is placed into the body, after creation of the pocket, by rolling the implant
up like a cigar and then filling it when it is in position. We use the same
solution to fill the implant that we give a patient when we start an Intravenous
or IV.
The advantage of saline is that it is safe, less expensive and leaves the
smallest incision and scar possible. Normal activities do not harm these implants.
We have patients with saline implants who work as female fire-fighters, police
officers, fighter pilots and personal trainers. Saline implants can occasionally
leak, usually due to a defect which develops around the valve. When this occurs
the saline is absorbed by the body and the implant goes flat. Replacing the
implant is a fairly simple operation where the incision is opened, the deflated
implant removed and a new implant inserted. The implant companies guarantee
the implants for life and so will provide your surgeon with a replacement for
free. You should check with your surgeon about possible surgical fees for implant
replacement. In my practice we replace implants without charging any surgical
fee. In fact we tell patients that if they develop a complication which can
be fixed, that we will do so at no additional cost.
The risk of implant deflation is 1% per year. That means that one out of a
hundred implants will deflate every year. So in 10 years a woman has a 10%
chance of developing a leak; in 20 years 20%, 30 years 30%. So in fact the
odds are that most women will live their entire lives without requiring a replacement.
There are some disadvantages with saline implants. These implants generally
look best when placed behind the muscle. Placing saline implants above the
muscle can lead to rippling and capsular contracture. Even when placed behind
the muscle some women may be able to feel the implant in the bra crease area.
This can give a ripply feel in the bra crease area. This problem is more likely
to occur in very thin patients. Most patients however do not experience this
problem.
Saline implants can be placed under the muscle through an incision in the
bra crease, around the bottom edge of the areola or in the armpit (axilla).
In my practice we perform the operation using any of these incisions and allow
patients to choose the incision which they feel is best for them.
Cohesive gel silicone implants are the newest form of implant available in
Canada. These implants have been used for breast augmentation since 2000 in
Canada and for over 15 years in Europe. These implants are filled with a solid
or cohesive silicone center. They are commonly called the “gummy bear” implant
because if they rupture, they don’t leak. You can stick a needle in these
implants, or even cut them in half, and nothing leaks out.
There are some advantages to cohesive implants. They are less likely to give
the problem of rippling or palpability of the lower edge in the bra crease
area. While they do not reduce the risk to zero, they do make these problems
less likely.