****NEWS Type of Breast Implants: Natural Breast Implants

According to an article by FOX NEWS (and others), silicone breast implants may be replaced by a new ‘natural’ form of implant that uses tissue grown by a person’s own stem cells—immature cells with the ability to change into any type of body cells under the right conditions. I hear scientists have throughout years tried to increase breast size with, with no success (apparently). However, if they were to suceed women would greatly benefit from it.

First off, women would have the implants that would feel and look like natural breasts without the risk of neither deflation nor interference with mammographies. Second, since the natural implants require the surgeons to suck the fat from different parts of the body, particularly stomach, women would be having a ‘two in one’ type of deal. Also, scientists believe that adding stem cells into the body may actually encourage the growth of new blood vessels; in addition, there is no risk of rejection by the patient’s immune system.

‘Natural’ breast implants will certainly more desirable than artificial ones. I must emphasize how anxious I am for the completion of the studies.

Types of Breast Implant Texture

When choosing a breast implant, texture is an important consideration. There are two basic implant textures: smooth and textured. Smooth implants, the most commonly used texture, are able to move freely in the breast pocket for they have thinner shells; thus, making it soft.Textured implants on the other hand, do not. Smooth implants are also often placed under the muscle (subpectoral/submuscular placement) for it decreases the chances of the patient having capsular contracture, and it is believed that they may have less change of rupture.

Textured implants were designed as an attempt to reduce capsular contracture. However, whether or not they really prevent capsular contracture it’s still unknown. Texture implants have rough outer surface which allows them to create cohesion between the implant and the surrounding tissue, and to create traction rippling—that is, when the overlying tissue grabs the implant surface and begins to pull on it.
(http://www.justbreastimplants.com/implants/texture-shape.htm )

Breast Implant Shapes: Round and Anatomical

To determine what would be an appropriate shape for the implant, is an important factor when choosing breast implants. There are two shapes that a woman can choose from: round, which conforms to the natural shape of the breasts, and anatomical, which is often recommended for patients who underwent breast reconstruction.

Round breast implants the most popular type for breast augmentation. They are just that . . . round; however, there are certain types of round implants that enhance the forward projection of the breasts better than others. Round shaped implants not only present the fewest amount of complication, and provide the greastest amount of lift, fullness and cleavage; but it also provide less control over the upper portion of the breasts. Thus, they cost a little cheaper than anatomical shaped implant.

Anatomicals, also known as contoured shaped implants, are the ones shapes like teadrops. These type of implants generally have more volume at the bottom, which projects a conical fashion. Woman usually opt for this shape of implant because it gives them a more naturally teadrop shaped breasts. However, they can cost a lot more for the implant requires a textured surface to prevent rotation; otherwise it can become distorted—round shaped implant do not pose the risk of implant rotation because of its symmetrical shape.

Inframmary Incision

First thing I must say, ‘gross, gross, and gross.’ As TUBA, I also saw inframammary incision on Dr. 90210, and I’m still a little shaky. In this technique, the incision is made under the breast fold, and it seriously looked as if the surgeon was cutting the breast off. Patients who undergo this procedure generally have longer and more painfull recovery, in addition to a pretty visible scar (in a horizontal position).

Nevertheless, although I like this incision the least for it looked the worst, the incision is actually less noticeable as the nipple incision, and since the incision bypasses the milk ducks, women typically experience less difficulty breastfeeding. Plus, it allows for both subpectoral and submuscular placement of the implant. Yet another advantage can be found during revisions such as capsular contracture, when the surgeon uses the same incision rather than ‘cutting-out’ another part of the breast.

Transauxiliary Incision

The transauxiliary incision, also known as crease, is when the incision is made in one of the crease lines of the armpit. Once the armpit breast implant has been made, a channel, where the breast implant is inserted, is made. This approach is often used for skinny women who undergo a submuscular placement of the implant.

Women who have chosen the ‘armpit’ incision, report to be scarless after the procedure—which is probably because armpits normally remain concealed—even without proper healing of the incision. Also, according to surgeons, armpit incision tend to cause less future breast feeding complication that other incisions; and this particular incision allows them to place the implants above or below the muscle.

As all other incisions however, transauxiliary incision presents disadvantages as well. The first disadvantage is that approximately 22% of women with this incision will need to undergo another surgery in lesser amount of time as women with different breast augmentation incision. Another con is that if a patient ever needs revision, which happens within 4 to 5 years after the surgery, the original breast incision cannot be used; thus, requiring additional incision (plus scars).

No wonder transauxiliary incision is the least used.

Areola Incision

In this technique the incision is made around the edge of the areola (the darker skin around the edge of the nipple), and according to surgeons, this allows for precise placement of the implant since the incision is in the close proximity to the treatment area. In addition, areola incision allows for the placement of the implants in various position in reference to the chest muscle; and like TUBA, areola incisions also leaves a small scar and it tends to heal well.

Three major cons are associated with this time of incision though:

1. If scars don’t heal properly, they may be very noticeable.
2. When placing the implant the muscles and connective tissue must be separated; otherwise the patient may feel great discomfort.
3. Patient may suffer from mastitis (breast infection), galactocele (milk-filled tumor), or galactorrhea (sudden milk production by a woman who isn’t pregnant nor has given birth); thus, decreasing her chances of nursing.

Nevertheless, areola breast incision is now the most popular choice among breast implant incision sites.

TUBA (Trans-Umbilical Incision)

First time I ever heard and saw and a TUBA incision was on the TV show Dr. 90210. I try to be unbiased when writing these blogs; however, I must say that I’m amazed find to see how far women are willing to go for beauty. Anyways, the incision in this procedure is made along the rim of the patient’s navel. Then a small scope is tunneled to the breasts, and the implants are inserted through the incision and moved into the breast pockets. Once inside, the implants are filled with a pre-determined amount of implant solution.

The biggest advantage over the other incisions: TUBA procedure requires only one small incision for both breasts; thus, there will be only a single and smaller surgical scar once the procedure is completed. Moreover, TUBA involves a shorter recovery period and less postoperative discomfort that other types of breast implant incisions.
(http://docshop.com/education/cosmetic/breast/implats/navel-incision/ )

Submuscular and Subpectoral Position

Depending on how small the patients’ cup is and their amount of breast tissue, some opt to go with submuscular breast augmentation. This procedure involves positions the implant beneath the muscle, but not total behind the pectoral muscles. In most cases the pectoral muscle will cover about 2/3 of the implant; however, there are even some who choose to go for a complete submuscular placement--which can be achieved via the transaxillary, periareolar, or inframammary breast incision (I'll talk more about the types of incision on future entries).

http://www.implantinfo.com/inforesources/placement.htm

Image 1. Subpectoral Position
Image 2. Submuscular Position

Altough submuscular augmentation results in less cleavage, less natural breast movement, and longer recovery, I believe it’d still be the best breast positioning placement for I can live better with its cons.

Subglandular Implant Placements

Subglandular, also known as submammary or over-the-muscle breast position involves the placement of the breast implant under the breast tissue but above pectoral muscles. Since the muscles are left intact and only skin and fat are cut, subglandular implant positioning presents numerous advantages:

1. It leads to less complicated surgery and quicker recovery
2. It provides easier access to the implant in case of reoperation
3. It presents less postoperative pain and discomfort
4. Cleavage is more easily created
(http://www.docshop.com/education/cosmetic/breast/implants/subglandular-implant/ )

Generally subglandular placement does not provide good results in women with small amount of breast tissue for the implant is easily notice. Other big disadvantages of subglandular implant placements are the high likelihood to interfere with mammography during breast cancer screening; visible rippling for the implant is covered only by skin; and capsular contracture.

Also, I read somewhere that some surgeons believe that over-the-muscle may deflate more due to less protection by the muscle, and that they actually do drop a lot faster .

Single Lumen and Double Lumen Implants

Single lumen (shell) implant that is prefilled by the manufacturer with a set amount of silicone gel. There are no valves with this type of implant and the volume of silicone cannot be adjusted.

Double lumen implant that is composed of two shells. The inner lumen is prefilled by the manufacturer with a set amount of silicone gel. The outer lumen contains a valve that is filled with saline through a valve during surgery. Adjustments to the volume of saline in the outer shell cannot be made following completion of surgery.

Double lumen with an outer shell that is prefilled by the manufacturer with a set amount of silicone gel. The inner shell is filled with saline during surgery through a valve. This type of implant allows for adjustment of the amount of saline in the inner shell after surgery.

What to Know Before Undergoing the Surgery

I identify are four phases related to breast augmentation that a woman must be aware of:

1. Making the decision: consists in making informed decision as to whether or not to undergo the procedure. That is, the woman must be aware of the choices of implants she has, as well as their potential risk factors (see previous entries).
2. Know the procedure: Go over important considerations such as implant placement, incision, and size.
3. Find a Doctor: Know everything there is to know about the surgeon: How many years has he/she performed breast augmentation? Is he/she board certified? What is the most common type of operation and reoperation he/she performs? Costs before and after the operation.
4. The surgery: What happens during the procedure? How long does it last?
5. Recovery: How long is recovery after the operation? What will be the degree of discomfort?

Also, remember, breast augmentation procedures are not ‘100%-satisfaction- guarantee.’ You may not be fully content with the results, and this often means undergoing another surgery.

More Factors to Consider

Breast implants may also affect the women’s ability to breast feed. They impel the women’s to produce milk, and in addition they also cause breast problems such as mastitis (breast infection), galactocele (milk-filled tumor), or galactorrhea (sudden milk production by a woman who isn’t pregnant nor has given birth). It’s true that nowadays babies are rarely breast fed; however, I personally would still like to have that option.

As I said before, breasts implants do not last forever and the implantations cannot be undone. Therefore, women must undergo additional surgeries over the course of their life for their breasts will never be the same.

Example 1: Removal without replacement

(http://www.fda.gov/cdrh/breastimplants/breast_implant_risks_brochure.html)

Factor to Consider # 2 : Suicide

Breast implants have often been related to the suicide rate among women. Based on several studies performed, women with breast enhancement surgery differ from women of similar age in the general population in many ways, which may triple the death rate from suicide. Such studies concluded that women with breast implants differ in lifestyle characteristics such as body mass, marital status, as well as medical characteristics. Nevertheless, in an attempt to provide epidemiologic evidence regarding suicide among women with breast implants, the International Epidemiology Institute supported a study which began by identifying women who underwent breast surgery in either private clinics or public hospitals. The conductors of the study followed up for dearth from the day of first breast implant surgery, to the date of emigration, date of death, or end of follow up. The number of deaths observed during the follow up period was then compared to the expected number of deaths; thus giving the standardized mortality ratio. 88 cohort members died, and 15 of them were victims of suicide.

Factor to Consider # 1 : Cancer

There had always been controversies related to breast implants and breast cancer. According to a Dennis Deapen and some his colleagues, breast implants do not cause cancer, neither interfere with cancer’s detection during mammography. In order to corroborate this hyphotesis, the scientists monitored cancer incident in 3182 women who had breast implant. Previous to that, they estimated the cumulative survival rates by using both the product limit method, as well as Greenwood’s formula for the standard error. As a result, 37 women were diagnosed with breast cancer, and six of them died within a 2 to 10 year interval—minding that the deaths in this study were not related to a later cancer diagnosis (http://gateway.ut.ovid.com/gwl/ovidweb.cgi ).

Conflicting with this result, however, is the study conducted by Dr. Le Gem and others. They referred study relied on the participation of 4968 women younger than 65 years with breast implants and/or breast cancer. These patients were subjected to survival analyses and at the end of the experiment, 28% of all patients who did not have complete follow-up died, and about 2/3 of these deaths were caused by breast cancer (http://breast-cancer-research.com/content/7/2/R184 ). Moreover, there is also the Journal of Women’s Health study that reported 66 cases that involved interference with mammography by breast implants.

Both studies did prove that breast implants DO NOT cause cancer; however, whether or not they interfere with its early detention remains controversial. Carefully analyze this before putting yourself through a knife.

Infections

According to studies, one of the driving forces in the pathogenesis of capsular contracture is the biofilm, Staphylococcus Epidermidis, which penetrates the breast implants during the procedure (http://gateway.ut.ovid.com/gwl/ovidweb.cgi ). In addition to S. Epidermidis, however, breast implants, particularly saline implants are also infected by other bacteria as well as fungi organisms. These organisms have not only the potential to survive inside implants, but they may also agglutinate in the body. The question I ask myself now lies on whether they can cause any additional damage besides capsular contracture.