Breast implants are an enormously popular cosmetic enhancement for women aged 18 and up in the United States. In 2010 alone, almost 300,000 American women underwent breast augmentation. Women seek this procedure for a number of reasons. Here are some of the most common:
- Dissatisfaction with small breast size after puberty
- Desire to have a more classically balanced hourglass figure
- Feelings of self-consciousness about breast shape
- A wish to create more symmetry for breasts that are not the same size
- Celebration of a major life event (marriage, divorce, reaching a certain birthday milestone)
- Wanting to feel better about their post-baby body
Many women also request reconstruction with breast implants after mastectomy or lumpectomy. Some women do get breast implants in order to increase their potential for career advancement in the entertainment industry. However, most women who get breast implants do so for personal reasons rather than to please other people.
History of Breast Implants
Breast implants with a flexible silicone envelope filled with liquid saline or semi-liquid silicone were first developed in the 1960s. They were used for both breast reconstruction and for cosmetic enhancement. This medical technology got off to a rocky start with various devices pulled from the market due to unwanted side effects and potential health risks. However, by the late 1990s the most serious safety concerns had been investigated and addressed to the satisfaction of the FDA. There are now dozens of types of implants available to U.S. consumers.
Varieties of Breast Implants
In the United States, saline and silicone gel are the only two implant filler materials approved for use in non-experimental settings. Both types have an elastomer shell. Saline is very liquid while silicone comes in a variety of viscosities from fairly loose to very thick gel. Cohesive gel implants that are basically solid (like a gum drop) are under review in clinical trials and may be available in the U.S. soon. During the decade or so that saline and silicone have both been available at the same time, silicone appears to be the more popular material from an aesthetic standpoint.
Implant shapes can be round (flattened sphere) or teardrop (matches the natural breast contour). Anatomically shaped breast implants have only one correct orientation and do not look right if they rotate. So, all teardrop implants have a textured surface. This gives the overlying tissue something to attach to during healing. Round implants can have a smooth surface allowing them to rotate freely in the pocket of surrounding tissue.
Types of Breast Implant Procedures
Breast augmentation surgery procedures typically fall into two categories — subglandular and submuscular. Implants can be placed underneath the fatty and glandular tissue in women who have sufficient breast tissue. However, many cosmetic surgeons prefer the results achieved by placing the implant under the pectoral muscle. This placement conceals the implant so the edges don’t show and provides greater support for the weight of the device.
Saline implants are inserted empty and filled once they are in place. Silicone implants are prefilled prior to insertion. This affects where the surgeon can make an incision to create the subglandular or submuscular pocket to hold the implant. Since a silicone implant can’t be compressed to a very small size, it is usually inserted through an incision in the crease below the breast. Some surgeons also know how to place a silicone implant through an incision around the areola or in the armpit. Saline may be readily inserted through an of these access points. Occasionally the initial incision for saline implant placement is made in the abdomen or directly through belly button.
Recovering From Breast Implants
A breast augmentation procedure is done on an out-patient basis with patients returning home in the care of a friend or family member on the same day. Pain is managed over the first few days with oral medication as needed. Swelling, bruising and moderate discomfort is expected. Rest may be required for about a week, although some patients return to sedentary work earlier. Movements such as lifting, pushing and pulling are typically restricted during the first few weeks to avoid injury to the surgical site. Return to normal exercise that isn’t too strenuous usually occurs within a month.
Realistic Expectations for Breast Implants
Current generations of saline and silicone implants have a fairly similar failure rate at this time. However, saline rupture and leakage is much easier to detect because the implant will deflate. Silicone may seem fine and failure may go unnoticed without an MRI to detect leakage. At this time, all breast implants are recognized as being devices with a limited lifespan. The FDA advises that most women who have breast augmentation will need maintenance surgery at some point in the future. It is important for patients to understand that additional operations including implant replacement may be required to keep the results looking and feeling good.