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    Are Breast Implants Better In Front of or Behind the Chest?

    Tag Archives: saline breast implants

    In most cases, when I perform breast augmentation, I place the breast implant, whether it is a saline breast implant or a silicone breast implant, behind the chest wall muscle.  There are many reasons for this.  The first is that the chest wall muscle (pectoralis major), actually serves as camouflage for the breast implant.  Some of the visible rippling that can be seen, particularly with saline breast implants, tends to be obscured to some degree with coverage by the pectoralis major muscle.  The second reason to put the implant behind the muscle is that it interferes with screening mammography much less.  There is good data from the radiology medical literature that demonstrates that placement of breast implants in front of the chest wall muscle can obscure a substantial amount of the breast field on mammogram.  The third reason is that traditional data with silicone and saline implants shows that the rate of capsular contracture, or pathologic scar tissue formation, is much higher when the implants are put in front the chest wall muscle as compared to behind it.

    There are a few anatomic conditions in which aesthetic outcomes are improved when the implant is placed in front of the chest wall muscle.  Careful examination and discussion with my patients are important in these situations to determine what will be best.

    If you have any other questions regarding this or breast augmentation in Dallas and Plano, please do not hesitate to contact my office at 214-827-2814.

    Capsular contracture can be a relatively common complication after placement of silicone breast implants or saline breast implants. Scar tissue normally forms around breast implants in all circumstances. In some cases, over time, it can tighten and compress the implant, making it feel firm and painful, causing what is called a capsular contracture. Capsular contracture is more common following infection, hematoma, or seroma, and the chance of it happening may increase over time. It occurs more commonly in revision breast augmentation than in primary breast augmentation.

    Capsular contracture is also a risk factor for implant rupture, and is the most common reason for re-operation after breast implant placement. Symptoms of capsular contracture can range from just mild firmness and discomfort, to severe pain, distorted appearance of the breast, and the ability to feel the implant. It is classified into 4 levels, depending on its severity:

    Baker Grade I: The breast is soft, and looks natural.

    Baker Grade II: The breast is a little bit more firm, but looks normal.

    Baker Grade III: The breast is firm and looks abnormal.

    Baker Grade IV: The breast is hard, painful, and looks abnormal.

    The data for both silicone and saline breast implants says that about 1 in 6 women will develop a severe capsular contracture, either grade III or IV, through 7 years after breast implant placement. For women receiving revision breast augmentation, this risk increased to about 1 in 5. When pain and firmness or abnormal appearance is particularly severe, additional surgery may be required. This usually requires removal of the breast implant capsule and replacement of the breast implant.

    Should you be developing firmness, hardness, or distorted appearance after your breast implant placement, you may have a capsular contracture. To learn more about this condition, please contact Dr. Jejurikar at 214-827-2814, at the Dallas Plastic Surgery Institute.

    Patients are obviously interested in knowing the likelihood of their saline breast implants or silicone breast implants rupturing. Although breast implants can remain intact for decades, all mechanical devices will fail at some point. When saline breast implants rupture, they deflate rapidly; rupture is usually easily detectable clinically. Studies of Allergan (Natrelle) saline breast implants showed rupture/deflation rates of 3–5% at three years and 7–10% at 10 years.

    When silicone breast implants rupture they rarely deflate, and the silicone from the implant can leak out into the space around the implant over many years. It is often difficult to detect a rupture clinically. For that reason, the FDA recommends that patients undergo a screening MRI to look for rupture 3 years after placement of silicone breast implants, and then every 2 years thereafter. Rupture rates are thought to be similar between silicone and saline breast implants. It is reasonable to estimate the risk at approximately 1% per year.

    Should you have more questions regarding breast implants or breast augmentation, contact Dr. Jejurikar’s office at 214-827-2814.

    Many patients ask me if their breast implants have any type of warranty. The answer is yes. Here are the details of Allergan’s ConfidencePlus® breast implant warranty program:

    • Lifetime Product Replacement – regardless of the age of the implant, Allergan provides product replacement in the event of a deflation or rupture
    • 10 years of guaranteed financial assistance
    • Up to $1200 in out-of-pocket expenses for surgical fees, operating room and anesthesia expenses not covered by insurance
    • Silicone filled and saline filled breast implants covered

    If you’d like more information on breast augmentation in Dallas or Plano, or would like to schedule a consultation, please contact Dr. Jejurikar’s office at 214-827-2814.

    A commonly asked question during Dallas breast augmentation consultations is whether breast-feeding is affected by the placement of breast implants. The most definitive answer is…maybe….but probably not! The official position of the American Society of Plastic Surgeons is that breast-feeding is not affected by placing silicone breast implants or saline breast implants. There are countless women in the world who have successfully breast fed their babies after breast augmentation.

    There are some important facts to know, though. First, it’s well accepted that certain incisions are more prone to causing nipple and areola (the pigmented skin surrounding the nipple) numbness. The periareolar incision is the most likely to do this. It is reasonable to assume that nipple numbness, although not preventing breast-feeding can impede the mother’s ability to do so. Second, there is debate about whether silicone from implants can leak into breast milk, and if it does, whether it’s harmful to a baby. Despite repeated attempts to prove so, no large studies conclusively demonstrate higher levels of silicone in breast milk of mothers with silicone breast implants, nor do they show a higher incidence of autism, autoimmune disorders, swallowing dysfunction, or other disease.

    So, in a nutshell, it’s more than reasonable for mothers with breast implants to attempt breastfeeding and to feel comfortable that they are not negatively impacting the health of their babies. For more information, or to schedule a consultation, don’t hesitate to contact our office at 214-827-2814.

    Almost all patients have several questions about the meaning of breast implant profiles.  Patients have seen pictures on the Internet of patients with breast augmentation results they liked and wanted the same style implants as in the pictures.  These patients had a limited understanding as to what breast implant profile refers, prompting this blog entry.

    The naming for implant profiles predominantly refers to smooth, round implants, which are the most common type of implants used for cosmetic breast augmentation.  The profile of the implant has nothing to do with the fill of an implant, with the vast majority of implants placed these days being cohesive silicone gel implants, otherwise known as “gummy bear” implants. The two major breast implant manufactures have different names for their implants.  Allergan refers to its implants as low, low plus, moderate, full and high profile.  Sientra has similar names, but also has a moderate profile plus implant, which is between its moderate and high profile implants. Motiva sticks with the same principles, but gets fancier with its names, referring to the implant profiles in the United States as mini, demi and full. In Europe, they offer an additional profile, Corse, which is the equivalent of an extra high profile implant.

    The profile of an implant equates to the projection of that implant.  For a given volume, the higher the profile, the fatter and narrower an implant is.  As a result, higher profile implants tend to provide more fullness and a rounder appearance to the upper portions of the breast.  Higher profile implants tend to be really useful in women with relatively narrow breasts who want significant enlargement of the breasts; in these women, if a low or moderate profile implant were selected, to achieve the desired volume may entail the implant riding into the underarm region.  In contrast, a patient with a wider build or wider breasts may find that high profile implants may fail to adequately fill their entire breast; they often times benefit from implants with lesser projection.  Higher profile implants also tend to be useful in women who desire a small breast lift without the incisions associated with a formal lift.

    In recent years, there has been a notable shift in the preferences of patients seeking breast augmentation, with increasing interest in low-profile and low-profile-plus breast implants. These implants are characterized by a wider base diameter and less projection compared to high-profile implants. This design creates a more natural, subtle enhancement that aligns with the growing trend toward understated aesthetics. Many patients are prioritizing proportionate results that complement their natural body contours rather than opting for the more pronounced, rounder look traditionally associated with higher-profile implants.

    The appeal of low-profile implants is also influenced by their suitability for specific body types. Women with broader chest walls often find that low-profile implants provide a harmonious fit that enhances their shape without looking artificial or out of proportion. Additionally, these implants are often favored by patients who wish to restore volume after pregnancy or weight loss while maintaining a soft, natural slope to the breast. As societal beauty standards continue to evolve, the demand for implants that achieve balanced, subtle results is expected to grow, making low-profile and low-profile-plus implants a significant choice in modern breast augmentation procedures.

     

    Understanding the Risks Associated with Breast Implants

    Breast implants are a popular option for enhancing breast size and shape, but like any medical procedure, they come with risks. These risks can range from mild to severe, depending on individual circumstances, implant type, and surgical technique. Here, we break down the potential complications and discuss differences among textured and smooth implants as well as saline, silicone, and Motiva implants.

    Mild Risks

    1. Pain and Discomfort:
      • Some patients may experience mild pain or tightness in the chest following surgery. This usually subsides within a few weeks as the body adjusts. (Occurs in approximately 20-30% of patients)
    2. Swelling and Bruising:
      • Swelling and bruising around the surgical site are common and typically resolve over time. (Occurs in up to 50% of patients post-surgery)
    3. Changes in Sensation:
      • Temporary changes in nipple or breast sensation, such as numbness or heightened sensitivity, can occur. (Reported in 10-15% of patients)

    Moderate Risks

    1. Capsular Contracture:
      • This occurs when scar tissue around the implant tightens, causing the breast to feel firm or appear distorted. It may require revision surgery. (Affects approximately 10-15% of patients)
    2. Rupture or Leakage:
      • Saline implants may deflate if ruptured, while silicone implants may require imaging to detect silent ruptures. (Rupture rates range from 1-5% over 10 years)
    3. Infection:
      • Infections around the implant site can occur, potentially requiring antibiotics or implant removal. (Occurs in 1-2% of cases)
    4. Seroma Formation:
      • Fluid accumulation around the implant may lead to swelling and discomfort. This may require drainage. (Reported in 2-5% of patients)

    Severe Risks

    1. Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL):
      • A rare but serious cancer of the immune system linked to textured implants. (Estimated at 1 in 2,200 to 1 in 86,000 for textured implants)
    2. Breast Implant Illness (BII):
      • A collection of systemic symptoms, such as fatigue, brain fog, and joint pain, reported by some patients. While not officially recognized as a medical condition, it has gained attention in recent years. (Prevalence unclear, but widely discussed in patient communities)
    3. Severe Implant Rupture Complications:
    • In rare cases, implant rupture can lead to significant pain and the need for immediate surgical intervention. (Rupture rates are low, with significant complications being exceedingly rare)

    Textured vs. Smooth Implants

    • Textured Implants:
      • Pros: Reduced risk of capsular contracture and better adherence to tissue, which helps them stay in place.
      • Cons: Higher association with BIA-ALCL and slightly rougher feel.
      • Risk of BIA-ALCL: Approximately 1 in 2,200 to 1 in 86,000, depending on the manufacturer and type.
    • Smooth Implants:
      • Pros: More natural feel and lower risk of BIA-ALCL.
      • Cons: Higher likelihood of shifting position over time and potentially increased capsular contracture risk.

    Saline vs. Silicone vs. Motiva Implants

    • Saline Implants:
      • Pros: Filled with sterile saltwater, easily detectable leaks, and lower surgical costs.
      • Cons: Firmer feel and higher likelihood of rippling. (Rippling reported in up to 10-15% of cases)
    • Silicone Implants:
      • Pros: More natural feel and appearance. Silicone gel maintains shape better in case of rupture.
      • Cons: Requires regular monitoring (e.g., MRI) to detect silent ruptures and higher initial cost. (Silent rupture rates estimated at 1-2% per year)
    • Motiva Implants:
      • Pros: Advanced technology with a natural feel, lower capsular contracture risk, and innovative safety features like microchip tracking.
      • Cons: Limited availability and higher cost compared to traditional silicone and saline implants. (Capsular contracture rates as low as 1-2%)

    Conclusion

    Understanding the risks associated with breast implants and the differences among implant types is crucial for making an informed decision. Patients should discuss their goals, medical history, and concerns with their surgeon to determine the best option for their needs. While risks exist, choosing an experienced surgeon and following post-operative care instructions can significantly improve outcomes and minimize complications.

    The Differences Between Silicone and Saline Implants: Understanding Your Options

    When considering breast augmentation, choosing the right type of implant is one of the most important decisions you’ll make. While saline and silicone implants have both been widely used for decades, advances in silicone implant technology have made them the more popular choice among patients and surgeons today. In this blog, we’ll explore the differences between saline and silicone implants, discuss the decline in popularity of saline implants, and highlight the innovations in silicone implants, including gummy bear implants and the latest Motiva implants.

    Silicone vs. Saline Implants: What’s the Difference?

    Breast implants are classified based on their filling material: silicone gel or sterile saline (saltwater). Here’s how they differ:

    Silicone Implants

    • Composition: Filled with cohesive silicone gel that mimics the feel of natural breast tissue.
    • Look and Feel: Silicone implants are often preferred for their more natural appearance and softer texture.
    • Durability: Modern silicone implants are highly durable and designed to hold their shape even if the outer shell is compromised.
    • Detection of Ruptures: Silicone implant ruptures are considered “silent,” as the gel typically remains within the implant shell or surrounding tissue. Routine imaging (e.g., MRI or ultrasound) is recommended to detect issues.

    Saline Implants

    • Composition: Filled with sterile saltwater after being inserted into the breast pocket.
    • Look and Feel: Saline implants tend to feel firmer and may create a less natural look, especially in patients with thinner breast tissue.
    • Detection of Ruptures: If a saline implant ruptures, the saltwater is harmlessly absorbed by the body, and the deflation is immediately noticeable.
    • Customization: Saline implants allow for adjustments in size during surgery since they’re filled after placement.

    Why Has Saline Lost Popularity?

    Although saline implants were once the go-to choice for breast augmentation, their popularity has significantly declined for several reasons:

    1. Less Natural Appearance and Feel: Saline implants are more prone to visible rippling and tend to feel firmer, which can detract from a natural look, particularly in patients with less natural breast tissue.
    2. Advances in Silicone Technology: Modern silicone implants, particularly gummy bear implants, provide superior aesthetics and a more lifelike feel, making them the preferred option for most patients and surgeons.
    3. Higher Capsular Contracture Rates: Capsular contracture, a condition where scar tissue tightens around the implant, is more common with saline implants. Studies estimate capsular contracture rates for saline implants at approximately 10–15% within the first few years after surgery.

    The Evolution of Silicone Implants: Gummy Bear and Motiva Implants

    The latest advancements in silicone implant technology have revolutionized breast augmentation, offering options that are safer, more durable, and more natural-looking than ever before.

    Gummy Bear Implants (Including Allergan Soft Touch)

    • What Are They? Gummy bear implants are made with a highly cohesive silicone gel that maintains its shape, even if the implant shell is compromised. Allergan Soft Touch implants are a popular option within this category.
    • Capsular Contracture Rates: Allergan Soft Touch implants have shown capsular contracture rates of approximately 5–8%, significantly lower than saline implants.
    • Benefits: These implants provide a natural teardrop shape, softer feel, and reduced risk of complications such as rippling or leakage.

    Motiva Implants

    • What Are They? Motiva implants represent the next generation of silicone implants, offering state-of-the-art technology for enhanced safety, aesthetics, and patient satisfaction.
    • Capsular Contracture Rates: Motiva implants boast some of the lowest capsular contracture rates in the industry, with studies reporting rates of 1–2% in primary augmentations.
    • Key Features:
      • ProgressiveGel: Provides a soft yet stable feel for a natural look and texture.
      • SilkSurface™ NanoTexture: Reduces the risk of complications like capsular contracture while maintaining implant integrity.
      • Ergonomix™ Shape: These implants adjust naturally to body movement, mimicking the look and feel of natural breast tissue.
      • Smart Technology: Some Motiva implants include an integrated microchip for non-invasive identification and tracking, providing peace of mind for both patients and surgeons.

    Which Implant Is Right for You?

    Choosing between saline and silicone implants—or even selecting among the various types of silicone implants—depends on your unique anatomy, aesthetic goals, and lifestyle. During your consultation, your surgeon will evaluate factors such as:

    • Your natural breast tissue and body type.
    • Desired breast size and shape.
    • Long-term maintenance and imaging preferences.
    • Concerns about implant texture, durability, and safety.

    Final Thoughts

    The advancements in silicone implants, such as gummy bear and Motiva implants, have made them the leading choice for patients seeking natural-looking, long-lasting results. While saline implants are still an option, their diminished popularity reflects the growing demand for the superior aesthetics and feel that modern silicone implants provide.

    If you’re considering breast augmentation, consult with Dallas’ best plastic surgeon, Dr. Jejurikar, to explore your options and find the implant that best suits your needs. With extensive experience and access to the latest innovations in breast surgery, Dr. Jejurikar can help you achieve your ideal results.

    Schedule your consultation today to take the first step toward the look you’ve always wanted!

    What Do People Value Most About Beauty? Insights for 2024

    Beauty is a personal and evolving concept, with different features holding more importance as we age. A recent survey from Beauty for Life, a collaboration between leading plastic surgery organizations, sheds light on what individuals value most about themselves and others, as well as their primary concerns about their appearance.

    What People Find Most Appealing

    When asked about the most appealing aspects of beauty in others, responses varied by age:

    • In their 20s, 30s, and 40s, individuals tended to prioritize a fit, well-proportioned body.
    • For those in their 50s and 60s, youthful skin became the most valued feature.

    When reflecting on their own concerns, however, respondents showed different priorities. For example, in their 30s, many individuals focused on their abdomen and hips, while in other decades, concerns about the face took precedence.

    Body Concerns Through the Decades

    When it came to personal concerns, the focus on specific areas of the body also changed with age:

    • 30s: Abdomen and hips were the most commonly cited areas of concern.
    • 40s: Abdomen and hips remained the top concern, but the percentage shifted slightly.
    • 50s and 60s: While concerns about the abdomen and hips persisted, these areas consistently outpaced concerns about the breasts or chest.

    These results suggest that priorities shift over time, but the abdomen and hips often remain areas of focus for those seeking aesthetic improvements.

    Motivations for Maintaining Appearance

    When asked why maintaining physical appearance was important, self-confidence was the leading motivator across all age groups. Other reasons, however, changed with life stages:

    • Younger respondents often prioritized attractiveness to potential partners.
    • In their 30s and 40s, individuals increasingly viewed appearance as a factor in professional opportunities.
    • Later in life, social factors like forming friendships became more significant.

    These insights highlight how personal and professional contexts influence our approach to beauty and self-care over time.

    Factors Contributing to Beauty

    When it comes to maintaining beauty, respondents emphasized the importance of a well-rounded approach:

    • Healthy habits like regular exercise, a balanced diet, and good skincare were consistently valued.
    • In later decades, many respondents also recognized the role of cosmetic medical procedures in maintaining a youthful appearance, with these treatments becoming increasingly important as part of an overall beauty routine.

    Understanding Evolving Priorities

    These survey results underscore that beauty concerns and priorities evolve throughout life. For younger individuals, the focus may be on certain physical attributes or relationship goals, while older adults may place greater importance on maintaining a youthful appearance for social and professional reasons.

    Recognizing these shifts is important for anyone considering aesthetic treatments, helping individuals make choices that align with their personal goals and values at every stage of life.

    If you’re interested in exploring options for enhancing your appearance, it’s helpful to consult with a board certified plastic surgeon like Dr. Jejurikar who can guide you through the best approaches to meet your needs and priorities.

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