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Are Breast Implants Better In Front of or Behind the Chest Wall Muscle? Dr. Sam Jejurikar of Dallas Plastic Surgery Institute discusses optimal placement of saline and silicone breast implants.

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.

In the past couple of weeks, I’ve had some patients engage me in conversations about breast implant profiles.  They had 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 two major breast implant manufactures have different names for their implants.  Allergan refers to its saline implants as low, moderate, and high profile and its silicone implants as moderate, midrange and high profile.  Mentor has similar names, but also has a moderate profile plus implant, which is between its moderate and high profile implants.

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.

Almost no patients choose low profile implants for aesthetic breast augmentation; the limited amount of projection provided with these implants does not coincide with their aesthetic goals.  Generally speaking, women looking to maximize their cleavage and perkiness often times opt for high profile implants.  Ultimately, though, the best implant profile for a patient can only be determined after a careful examination by a board certified plastic surgeon, taking into account the specifics of a patient’s breast anatomy, as well as their desired appearance.

Breast augmentation can give women with small or uneven breasts a fuller, better-proportioned look through the placement of saline breast implants or silicone breast implants, dramatically improving self-esteem and confidence. Any operation, though, including breast augmentation, poses some risks that can lead to complications or unfavorable results.

The most common complication is capsular contracture, or hard, firm scar that forms around the implant. Because the breast normally is soft, the development of scar tissue can make the breast feel and look hard, and in severe cases, can cause pain. With older silicone breast implants, capsular contracture was much more common. The frequency of capsular contracture has diminished with currently utilized silicone breast implants, so that the occurrence rate is now similar between silicone and saline breast implants. Mild capsular contracture is hardly perceptible, but severe contractures can be painful and unattractive. Treatment consists of surgery to remove the entire capsule and placement of a new breast implant. Placement of the implant in a pocket below the chest wall muscle results in a lower risk of capsular contracture than placement over the muscle.

Infection, if it occurs, usually does so within a few weeks of surgery. Infection occurs very rarely, but if an infection occurs it often requires antibiotics and the removal of the involved implant for several months.

Some women report that their nipples become oversensitive, undersensitive, or even completely numb. Some women also report small patches of numbness near their incisions. These symptoms usually disappear within time, but may be permanent in up to 15% of patients. If the possibility of having numb nipples is unacceptable to a patient, she should not have breast augmentation, as no plastic surgeon can predict which patients will develop this complication.

There is no evidence to indicate that breast implants will affect fertility, pregnancy, or the ability to breastfeed. If, however, a patient has nursed a baby within a year before breast augmentation, she may produce milk for a few days after surgery. This may cause some discomfort, which usually resolves within a few days. For women who get pregnant after having breast implants placed, in most cases, breast implants will not affect the fate of the breasts. After the breast tissue shrinks after pregnancy and breastfeeding, the breast skin may or may not shrink. If the skin does not shrink, the breasts will likely droop. Whether or not the skin shrinks is controlled by factors other than the presence or absence of breast implants.

Breast implants may break or leak. Most often, breast implant rupture is the result of normal wear and tear on the breast implant shell. If a saline-filled implant breaks, the implant will deflate within a few days and the salt water will be harmlessly absorbed by the body. To restore volume, another implant needs to be placed. If a break occurs in a silicone breast implant, silicone gel may move into surrounding tissue, provoking an inflammatory reaction which can lead to a severe capsular contracture. There may be a change in the shape of the breast, and the breast may become hard and painful. This will require a second operation to remove the breast implant shell and to replace the leaking implant.

No data exists suggesting that breast implants cause breast cancer. Silicone and saline breast implants, however, can alter surveillance for breast cancer. Breast implants can alter the amount of breast tissue visualized on a mammogram. When placed below the chest wall muscle, greater than 90% of breast tissue can be seen well on mammogram. When placed above the muscle, only about 75% can be visualized. Breast implants do not interfere with the ability to detect masses with self breast examination, regardless of position relative to the chest wall muscle. Self exam is the most successful way to discover new breast masses. Implants also do not interfere with ultrasound or MRI scans, which are helpful in the evaluation of breast masses.

Breast implants can move out of position anytime after breast augmentation surgery. If they move a lot, surgery may be needed them back into position. The larger the implant, the more likely it will displace downward.

Rippling or wrinkling of the implant is much more common with saline breast implants compared to silicone breast implants and in thin patients. The visualized wrinkles are the folds of the breast implant shell. Ripples can be particularly disconcerting if they occur on the upper pole of the breasts.

Because breast implants are manmade, mechanical devices, they are prone to problems over time. All women who undergo breast augmentation surgery should assume that, at some point in their lives, they will require a secondary procedure, whether it’s for capsular contracture, rupture, displacement, etc. Some women may never have problems, but it’s impossible to predict which patients will fall into this category.

Many patients want to know, “What’s better – silicone or saline?”  The answer is that it depends.  Both silicone and saline implants have pros and cons.  It’s important that the educated patient understands these differences before making an informed decision.  Before delving into these differences, though, it’s important to state unequivocally that currently utilized silicone breast implants are safe.  Over the past 15 years, many large and rigorous studies have been performed investigating whether silicone breast implants are associated with autoimmune diseases or any types of cancer.  All studies performed reached the same conclusion; there is no conclusive data supporting any link between silicone implants and these diseases.  Only after carefully considering these scientific studies did the U.S. Food and Drug Administration approve the use of silicone breast implants in all women for breast reconstruction and in women over the age of 22 years for cosmetic breast augmentation.

Some good things about silicone breast implants; breast implants filled with silicone gel look and feel more like natural breast tissue.  Also, particularly in thin patients, silicone breast implants tend to have fewer problems with visible rippling than saline breast implants.

Some bad things about silicone breast implants; breast implants filled with silicone are more expensive.  Silicone breast implants are approximately twice the cost of saline breast implants, which is factored into the price of surgery.  Also, a breast implant rupture is easy to detect when the implant is filled with saline; the breast tends to deflate rapidly, in the span of a few days.  A silicone breast implant ruptures is much more subtle to detect.  For that reason, the Food and Drug Administration recommends an MRI to monitor for rupture, the first one 3 years after surgery, and then every 2 years thereafter.  This test is expensive and most likely will not be covered by third-party insurers.  Lastly, capsular contracture rates, or pathologic scarring around the implant, traditionally were much higher with the older generation of silicone breast implants.  This does not seem to be the case with the newer generation of silicone breast implants used, which is largely attributable to a thicker implant shell and thicker, more viscous silicone gel within the implant.

So, what’s better?  To repeat, silicone breast implants look and feel much more natural, but it comes at a higher financial cost, the recommendation for MRI monitoring to detect for rupture, and a larger incision.  Despite this, with each passing year, more and more patients are opting for silicone breast implants.

This is taken directly from a press release from the American Society for Aesthetic Plastic Surgery

New York, NY and Arlington Heights, IL – What people find beautiful about themselves may be different than what they find appealing in another person. That’s just one finding from a recent consumer survey conducted on the BeautyforLife website (a joint venture of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery.) Visitors were asked “What aspect of physical beauty do you find most appealing in another person?” In their 20s, 30s, and 40s, respondents look for a fit, well proportioned body; youthful skin ranked at the top for respondents in the 50s and 60s. When considering “Which part of your body are you most concerned about?” respondents ranked their abdomen/hips number one in their 30s. But surprisingly, respondents listed the face, not their body, as the most popular choice in the 20s, 40s, 50s and 60s.

“It is always important to understand what our patients are most concerned about at different stages of their lives. We want to be equipped to help our patients make the right decisions to maintain their beauty at every age—no matter which type of cosmetic medical procedure they are interested in.” said ASAPS President Renato Saltz, MD.

Additional results were revealed when answering “Which part of your body are you most concerned about?” While respondents primarily chose their face, significantly more respondents are concerned about their abdomen/hips than their breasts (chest)—with the disparity increasing throughout the decades:

  1. 30s – 37% chose abdomen/hips as their top concern while only 18% chose breasts
  2. 40s – 32% selected abdomen/hips and only 10% breast
  3. 50s – 25% chose abdomen/hips compared to 7% breast
  4. 60s – 23% indicated concern about their abdomen/hips, while only 7% selected breast

Community members were also asked to consider “The most important reason to maintain your physical appearance.” “To boost self-confidence” was the top choice across all decades, with “To attract potential partners” a close second for the 20s. In the 30s and 40s, the second-most popular choice shifted to “To increase professional opportunities,” which remained the number two choice in the 50s, but by a much smaller percentage. In the 60s, increasing professional opportunities fell to third behind “To help make friends.”

“The survey on the BeautyforLife website has provided interesting data about patients’ attitudes, motivation and perception. Our goal is to provide useful tools for prospective patients to help them first decide if a cosmetic medicine procedure is right for them and then to provide information on how to choose an appropriate provider,” said Dr. Richard D’Amico, past president of ASPS.

Another question asked members to contemplate “The most important factor in maintaining beauty.” While adherence to a healthy diet, regular exercise and skin care were popular choices, approximately one in five members felt that a cosmetic medical procedure was most important in the 50s and 60s.

This survey was conducted by The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, via their Beauty for Life program—a series of patient education tools.

About ASPS
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 6,700 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. For more information, please visit the ASPS website at www.plasticsurgery.org.

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9101 N. Central Expwy.
Suite 600, Dallas, TX 75231
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