Silicone breast implants were created in the U.S.A by two American Plastic Surgeons, CRONIN and GEROW, in 1962. The modern times of breast implants had finally arrived. Aesthetic Plastic Surgery (augmentation mammaplasty, with an aesthetic objective) and Reconstructive Plastic Surgery (e.g. due to cancer and other diseases). Having Silicone Breast Implants is an important personal decision because it changes your physical appearance, selt-esteem and confidence and your general well being.
BREAST COMPOSITION
The breasts are formed with glandular tissues, connective and fatty tissue stroma with lactiferous ducts (to drain the milk to the nipple), arteries and veins, lymphatics and nerves, all of which are found underneath different qualities of skin that envelop the breast.
The breasts are situated over the Pectoralis Major and Minor Muscles. The implants can be placed in front of (subglandular) or behind (subpectoral) these Muscles. The proper implant position will depend on various factors, such as the width of the breast tissue and the quality of skin.
Subcutaneous fat and intraparenchymal fat produce the softness of the breast and influence the shape and contours of the breast. But the shape also depends on the elasticity of the skin. A young females breasts are made up of more glandular tissues than fatty tissues, therefore making the breasts firmer. Glandular tissue gradually gets replaced by fatty tissue as the years go by. Therefore breasts with more fatty tissue than glandular tissue are less firm.
Pregnancies, breast feeding, diets, getting older and other factors also affect the shape of the breast.
As well as these factors, gravity also affects the upper pole, leaving it emptier. BREASTS DO NOT HAVE MUSCLE. NO GYM ACTIVITY WILL INCREASE THE SIZE OF YOUR BREASTS.
WHAT ARE SILICONE BREAST IMPLANTS? IS SILICONE SAFE TO USE IN HUMANS? DOES SILICONE PRODUCE CANCER?
Silicone breast implants are devices made up of an outer layer or envelope of silicone elastomer that is in contact with the body tissues and are filled with silicone gel. This gel is what maintains the shape of the implant. There are other types of implants that are filled with normal saline solution, in which the volume can be altered after the implantation (expanders). There are also implants of silicone gel that are enveloped with polyurethane.
SINCE THE DISCOVERY OF SILICONE, SILICONE HAS HAD MANY APPLICATIONS IN EVERY DAY LIFE, MEDICAL APPLICATIONS, PHAMACEUTICAL APPLICATIONS AND ALIMENTATION DURING THE PAST 50 YEARS. For example: Artificial Joints, pumps, shunts, drains, ocular implants, pacemakers, breast implants, penile implants, testicular implants, tablets and capsules with silicone (anti-acids), lipstick, lotions, sunscreens, deodorants etc.
WE ARE CONSTANTLY EXPOSED TO SILICONE IN OUR EVERY DAY LIVES. UNTIL NOW, THERE IS NO SCIENTIFIC EVIDENCE THAT SILICONE PRODUCES CANCER. Different scientific investigations have been carried out by the U.S. National Cancer Institute, International Epidemiology Institute and Karolinska Institute of Sweden, Danish Cancer Registry, Fred Hutchinson Cancer Research Center, Institut Gustave Roussy in France, Alberta Canada Cancer Board, U.S. Centres for Disease Control and Prevention y University of Southern California School of Medicine).
THAT IS WHY YOU SHOULD NOT BE AFRAID.
IS THERE A SPECIAL RISK FOR WOMEN WHO WHO ALREADY HAVE SILICONE IMPLANTS THAT ARE ENVELOPED WITH POLYURETHANE?
Silicone implants enveloped with polyurethane, which was introduced at the beginning of the 70´s, have the advantage that capsular contractures are less frequent. But they have the disadvantage that the implant fixes itself strongly in place and therefore is difficult to remove. There are scientific studies that show that the polyurethane (the most external layer of the implant) can break away therefore become a conventional implant. Between the chemical elements of polyurethane, a substance called toluen diamina (TDA), that has produced cancer in laboratory animals. AT THIS POINT IT IS NOT CLEAR IF IT CAN BE PRODUCED IN HUMAN BEINGS. The Food Drugs and Administration of the U.S.A. show that it is very improbable that a women will produce cancer because of the use of this type of implant (probability of 1 in 1 000 000 throughout the whole life of the patient).
WILL IMPLANTS INTERFERE WITH MAMMOGRAMS?
Breast implants are radiopaque (meaning they are completely white), therefore can pose some breast imaging problems. That is why a woman with breast implants must tell the radiologist beforehand, so that a well defined and additional views can be taken.
A regular self check of the breasts and clinical examinations are fundamental.
CAN IMPLANTS CAUSE CONNECTIVE TISSUE OR AUTOIMMUNE DISEASE IN HEALTHY WOMEN?
Silicone, just like most other substances can produce an allergy. However allergies to Silicone are very uncommon. Some rare disorders such as lupus erythematosus, dermatomyositis, scleroderma, and rheumatoid arthritis. THERE IS NO EVIDENCE THAT IMPLANTS PRODUCE THESE DISORDERS.
Scientific investigations have been carried out by, Mayo Clinic, Harvard Medical School, University of Michigan School of Public Health, Emory University, University of Kansas Artritis Center, University of Washington Fred Hutchinson Cancer Research Center, University of Toronto, University of Maryland, University of Pittsburg, University of California, SanDiego y Johns Hopkins University Schools of Medicine).
WHY IS IT PROHIBITED TO USE LIQUID SILICONE ON ITS OWN?
Because liquid silicone migrates through the blood and the lymphatic vessels working its way to different organs, such as the liver, kidneys, brain and pancreas etc. SILICONE GEL (different to liquid silicone) IS NOT PROHIBITED.
CAN SILICONE FROM SILICONE BREAST IMPLANTS BE TRANSMITTED THROUGH BREAST MILK? CAN A MOTHER WITH BREAST IMPLANTS GIVE MILK?
YES, THERE IS NO SCIENTIFIC EVIDENCE THAT SILICONE IS PASSED THROUGH BREAST MILK AND THERE IS NO PROBLEM BREAST FEEDING.
The thing that can alter the lacteous level in the breast milk, is if the lactiferous ducts are damaged while undergoing the periareolar incision.
THE DIFFERENT TYPES OF IMPLANTS
DEPENDING ON THE SHAPE:
- Round
- Anatomic
THE SIZE:
- Variable
THE PROFILE:
- High and low
THE SURFACE:
- Smooth
- Textured
- Polyurethane
THE FILLING:
- Saline
- Silicone Gel
INDICATIONS:
Plastic Surgery can benefit the following conditions:
- Augmentation of the breasts for aesthetic reasons, for small breasts.
- Breasts that have reduced in volume after lactation.
- Breasts that have become less consistant.
- Unsymmetrical breasts, one being bigger than the other.
- Poland´s syndrome, augmentation and correction of the shape.
- Breast reconstruction after mastectomy (removal of cancer).
- Abnormalities of the breast and thorax wall.
- Replacement of implants for medical or aesthetic reasons.
CONTRAINDICATIONS:
We will not operate if we believe that your objective is not realistic. IT IS IMPOSSIBLE TO OPERATE ON PEOPLE WITH EXAGERATED OR FANTASY EXPECTATIONS.
I recommend you read the chapter “Psychological Aspects of Plastic Surgery” of this website.
- If you have poor health, above all cardiovascular and mental disorders we cannot operate.
- Those patients who smoke should stop completely at least one month before the operation because this operation may produce the loss of tissues.
- Patients who are addicted to drugs or alcohol.
- Patients who worry too much about small defects that in reality are very minute.
- Patients who will not accept the final scaring. ALL OF THESE OPERATIONS LEAVE SOME SCARING AND THE QUALITY OF THESE SCARS DEPENDS ON MANY UNKNOWN FACTORS.
- If you have FIBROCYSTIC CHANGE of the breasts.
- If you have local breast cancer or disseminated.
- Insufficient tissue, because of irradiated tissue or Radical Mastectomy.
- Previous allergies to substances or materials.
- Dissatisfaction with previous augmentation mammaplasties.
- If you have an infection in any part of the body.
- If you have a history of bad scaring.
SURGICAL OBJECTIVES:
- Increase the size of your breasts with implants, if you have an inadequate volume, to improve your self-esteem.
- The place of the implants, the incisions will be definded after medical consultations and undergoing a careful and detailed study.
- Achieve symmetry between the two breasts.
PLANNING THE SURGERY:
BEFORE THE OPERATION
First you must undergo a complete medical examination. Then we will be able to give you in writing, the modifications that are suitable for you. We always do a photo session as a fundamental part of evaluating your case.
WITHOUT PHOTOS WE DO NOT OPERATE. IT IS ALSO VERY IMPORTANT THAT YOU REMEMBER THAT ALL THE INFORMATION YOU RECEIVE IN WRITING, SHOW AN ESTIMATION OF THE FINAL RESULT.
Between you, the patient and me the Plastic Surgeon, we should agree on the results that we are able to achieve. We ask for blood tests regularly.
- We always ask for a mammograms.
- If you have the flu or are menstruating, please communicate 3 days beforehand.
- Do not drink alcohol at least 24 hours before operating.
- Do not take ASPIRIN 15 days before operating
- Organize your activities so that you are able to rest after the operation.
- Do not drive your car for at least 30 days after the operation.
- Only begin physical exercise gradually 2 months after the operation.
ANESTHESIA:
- The first choice is General anesthesia
PROCEDURES:
- The duration of the surgery is approximately 2 to 3 hours.
- INCISIONS AND POSITIONING; there are 3 different incisions.
1) Inframammary incision: it is an incision of about 4 to 5 cm below the breast. It is a good position but it leaves a visible scar.
2) Periareolar incision: it is a semi-circular incision around the areolar (border of the nipple). In many cases this incision is unnoticed, depending on the patient, but it can reduce the erogenous sensation of the nipple. It is not recommended for patients with small areolars (smaller than 3.5 cm).
3) Axilar incision: Under the armpit, can be covered by hair and hidden below the arm and does not leave a scar on the breast. But the visualization of the entire breast pocket is difficult but made possible with endoscopic surgery. With the endoscopic axillary approach, special care is necessary to create symmnetric pockets.
PLACEMENT OF THE IMPLANTS:
1) Subglandular or retrogladular: placement behind the breast tissue, only when the women has good coverage. This produces more natural results. Also for body builders or athletes who want to avoid muscle contractions. But if the patient is slim or the coverage is too thin, we opt for one of the following positions.
2) Submuscular: the placement in front of the chest wall and behind the pectoralis major and minor muscles and the serratus anterior muscle.
3) Subpectoral: In front of the chest wall and behind the pectoralis major and minor muscles and the lower part of the implant behind the breast. This position contributes to the long term success and appearance.
RECOVERY:
- It is an outpatient surgery.
- 24 hours of bed rest.
- After these first 24 hours you may be able to start to walk around.
- Eat well, food high in protein and lots of vitamin C.
- You must keep the sterile tapes in place for 24 hours.
DO NOT WORRY IF IN THE FIRST DAYS YOU HAVE:
- Bruising and swelling, which can be more prominent on the second day.
- Some discomfort when lifting your arms.
- Generally you do not need drainage if the muscle has not been sectioned. If the pectoral muscle was cut to put the implant behind it, we use a drain for around 48 hours after the operation.
- If you are in pain, take analgesics, BUT NEVER TAKE ASPIRIN, BECAUSE IT CAUSES BLEEDING. Generally placing the implant behind the pectoral muscle causes more discomfort or pain.
- We give antibiotics to prevent infection.
- Full showers can be taken from after 2 to 3 days.
- Stitches can be removed from 7 days after the operation.
- Sterile tapes and or bandages are to be changed every 3 days during a 2 week period.
- For 30 days a special elastic bra is to be used.
- From 2 weeks onwards we indicate 10 lymphatic drainage sessions to help the recovery process, eliminate toxins and improve the circulation.
- As the days go by you will begin to feel better and better but be careful, this does not mean you are ready for intense physical activity. Take extra care with the arms as you can easily make the stitching come undone.
- You should be able to return to everyday activities 2 weeks after the operation and drive a car 1 month after.
- Intense physical activities can be taken up again some 60 days after the operation.
- Full recuperation of your sensitivity can take place within a few months time.
- The scars will be hidden behind your bra o bikini top. Generally they get better throughout 1 and 2 years, but they are permanent. Inframammary scars can be seen. Periareolar scars are not as visible. Axillary scars are visible when you lift your arm. THERE ARE MANY UNFORESEEN AND INDIVIDUAL VARIATIONS (such as wide and hypertrophic scars, depending on many factors such as the genetics of the patient.
- Sun bathing should be avoided for at least 3 months.
- Any increase in fever or if the area becomes red, or if there are any other unusual signs, contact your doctor or plastic surgeon immediately.
- Naturally, because of ones anxiety to see the final result, the first couple of days one can be somewhat depressed. But this is temporary. BEING PATIENT IS FUNDAMENTAL.
- After 6 months you will be able to get a good idea of the final result. Nevertheless the scars maintain some coloring and continue getting better until 1 to 2 years after the operation.
FINAL RESULTS:
Generally the results obtained are similar to what was planned.
More than 95% of women are happy with the long term results. They feel a lot better with their new image, proportional breasts, better form and volume, self-esteem and happiness.
The breasts will have an increased volume, improving consistency and shape. Remember there is different size implants, we always look for the best harmony between the size of the breasts and the size of the chest.
AN OPERATED BREAST PASSES THROUGH VARIOUS STAGES:
1) IMMEDIATE PERIOD: From the first until 30 days. The breasts will be bigger and better but will still be far from reaching the planned results.
2) MIDDLE PERIOD: It is variable, between 4 and 6 months. During this period the breast begins to evolve towards the end result. There are different grades of swelling. The scaring is in transitional phase. In the next period the will become even better still.
3) FINAL PERIOD: Extending from 6 months until 2 years. Here the breasts will reach their final result, in aspects such as scaring, shape, consistency, volume and sensitivity. This is when we take the final photographs to compare with the before photographs. Any bikini top can be used.
POSSIBLE COMPLICATIONS:
They are rare, BUT REMEMBER, THERE IS NO PLASTIC SURGERY WITHOUT RISKS OR POSSIBLE COMPLICATIONS (even if they are minimum, they still exist). SMOKERS HAVE A HIGHER RISK FACTOR.
- · HEMATOMAS: Occurs between 0.5 – 3 %. If not reabsorbed, it shall be removed.
- · INFECTION: Occurs in 2.2% of patients. Generally due to Staphylococcus Epidermidis. We always give antibiotics during the operation and for 5 to 7 days afterwards. Local culture is recommended, followed by antibiotics, draining and occasional removal of the implant.
- · SEROMAS: The accumulation of Serous Liquids, just like the Hematoma, this can produce capsular contracture. Occasional draining is then used. The Seroma is not always acute. There are also late Seromas of unknown origin.
- · CAPSULAR CONTRACTURE: It is the most common problem encountered after breast implants. This phenomenon of unknown cause probably has a multi-factor cause. Different degrees of unilateral or bilateral capsular contracture produce asymmetry, distortion, firmness and discomfort. In this situation there are different treatments, such as removing the capsular and changing the placement of the implant. The manufactures advise against the external Capsulotomy procedure, which can cause the rupture of the implant.
- CALCIFICATIONS: Of unknown cause, this has been reported in tissue adjacent to those of the implantation at times calling for the removal of the implant.
- IMPLANT RUPTURE, HOLE OR CUT: Generally due to piercing instruments or accidents. Most cases happen during surgery. In this case the implant must be changed.
- · EXTRUSION: Unstable of compromised cover tissue, excessive stress or trauma occurring in the location of the implantation and/or interruption of the scaring process can lead to extrusion of the implant.
- · LOSS OF SENSIBILITY: Infrequent. It is almost always a process reversable with time.
- INTERFERENCE IN THE BREASTFEEDING: No study has shown that the silicone in the implant is transmitted by the maternal milk.
- INTERFERENCE WITH MAMMOGRAPHY: The patient shall be regularly submitted to mammography after surgery. The patient shall be advised to request the service of professionals who are familiar with mammography techniques with implants, and do not forget to show the PATIENT IMPLANT CARD to the radiologist. Ultrasounds can prove useful in conjunction with mammography and allow examinations to be made from any angle.
- DISPLACEMENT OF THE IMPLANT: This problem, associated with the operating technique, may cause discomfort to the patient and discomfort and distortion of the desired shape.
- FOLDS: Any fold can lead to medical complication, such as reduction of tissue thickness, abrasion and extrusion which may be mistaken for palpable tumors. Immediate investigation must be carried out whenever there is any doubt.
- ASYMMETRY: This may result from capsular contraction or rupture of the envelope, in the later case an assessment is required to decide whether or not there is the need to remove the implant.
- PAIN: Some patients may feel pain in the post operative period which should be investigated immediately.
- IMMUNOLOGICAL RESPONSE: Despite a number of studies there is no scientific proof of this cause and effect relation.
- CANCER: There is no scientific proof that implants produce cancer.
FINALLY WE WOULD LIKE TO ADD THAT THE IMPLANTS ARE NOT FOREVER. THEREFORE AT SOME TIME IN THE FUTURE THE REMOVAL OF THE IMPLANTS COULD BE INDICATED.
