Background: Breast augmentation continues to be a very popular body contouring procedure for women. Whether it is to improve a natural underdevelopment or the effects of pregnancy and gravity, increasing volume is one of the key components of breast enhancement. The majority of breast implants are placed in women under the age of 45, particularly in the age range of 21 to 35. Because of this understandably age-skewed patient population and the amount of press and publicity that younger women get for undergoing the procedure, many older women wonder if they too can have the procedure.

I have had many older women (age 50 or older) in my Indianapolis plastic surgery practice ask if it is ‘safe’ for them to have breast augmentation. This concern about safety in ‘older’ patients relates to what the recovery would be like and are implants more prone to cause breast problems in older tissues.

Recovery after breast augmentation, due to the most common positioning of the implant under the pectoralis muscle, relates to a muscle injury recovery. While an older patient may take a little longer to recover from a pulled muscle than a younger one, that difference is relatively small. (if it exists at all) I have not noted that older breast augmentation patients report a more difficult or protracted recovery process nor are their complaints about immediate postsurgical pain any more significant.

Because breast cancer occurs more commonly in middle-aged and older women than younger ones, it is a legitimate question to ask if implants interfere with its diagnosis. There is no question that there is mild interference with radiologic imaging of the breast from implants, but this is overcome by taking additional mammographic views. When it comes to MRI detection, there is no imaging difficulty.

The one issue that older women pose that many younger women do not is breast sagging or ptosis. The incidence of the need for breast lifts with implant placement is much higher in the older patient as the effects of gravity and aging have taken a greater toll.

Case Study: This 56 year-old female wanted to improve the shape of her sagging breasts. She had had four children and her breasts had lost both volume and sagged. She was currently a small C cup and wanted to at least be a D cup. She choose saline implants because they could be placed in a ‘scarless’ method (no incision on the breast) and their lower cost.

Under general anesthesia, saline implants were placed through a transaxillary (armpit) incision in a submuscular position. The implants were 500cc in volume and were filled to 550ccs on each side. (Mentor, moderate plus profile) Her armpit incisions were closed with small dissolveable sutures. She went home as an outpatient and was placed on arm stretching exercises that began that very night after surgery.

Her recovery was quite rapid and within ten days left for a beach vacation. She had a much improved looking result with good fill of her breast skin and some degree of a lifting effect as seen in her side view. Her breasts were rejuvenated with a much better look in clothes with the resultant upper pole breast fullness caused by the implants.

It usually takes about three to four weeks after surgery until breast implants settle into their final position. This is particularly true in using the transaxillary approach as the release of the lower breast tissues is done more effectively by an open inframammary crease approach.

Case Highlights:

1) Breast augmentation is just as safe and effective in older women as it is in younger women.

2) In the aging breast, the higher incidence of breast sagging may require the consideration of some form of a breast lift or the acceptance of less than ideal breast shape and nipple position.

3) Recovery after breast augmentation in older women is no more severe or prolonged than that of younger patients.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

Background: The immediate and long-term success of breast augmentation is totally dependent on the use of an implant. Most of the risks of this surgery are implant-related, with infection being the most significant in the short-term and implant rupture in the long-term issue. While both can happen despite the best surgical efforts, the technique of handling the implant during surgery can influence the likelihood of their occurrence.

The traditional insertion of a silicone gel breast implant depends on substantial manual manipulation. The implant is removed from its sterile packaging, often soaking in an antibiotic solution first, and then placed into the breast. Inserting an implant into a breast pocket requires that it pass through an incision. In every primary breast augmentation, the length of the incision is almost always less than the diameter of the implant. Fortunately, silicone gel implants are very malleable and able to be deformed and distorted to fit through a hole that is smaller than it is.

Depending upon the size of the incision and the breast implant, this passage into the patient may go easily or with a lot of difficulty. Easily is defined by having minimal distortion of the implant as it passes into the patient. Difficulty is defined by the implant being severely distorted as it is pushed and poked through a disproportionately small incision. While there is no documented evidence that these insertion maneuvers influence the long-term risk of shell rupture, it would seem logical that it does.

Case Study: This 21 year-old female had long desired breast enhancement since she had been a small B cup since her mid-teen years. As she was about to start her first job after college graduation, she rewarded herself with a long desired breast implant procedure. She desired to be a full C cup.

Under general anesthesia, her breast pockets were developed in the submuscular place through an inframammary or lower breast crease incision. The length of the incision was 3.5 cms. The size of the breast pocket was developed with sizers. The implant packages were opened and an antibiotic solution poured over the implants and into the half-shell plastic container. Then using a Funnel device, it was opened and an antibiotic solution poured into the funnel to wet its inner lining.

The breast implants were then dumped into the Funnel without touching them. The back end of the Funnel device was wrapped around the implant pushing it towards the smaller opening.

The smaller Funnel opening was inserted through the incision and into the breast pocket. Squeezing of the back end of the Funnel propelled the breast implant through the smaller end into the breast pocket. The incision was then closed.

The Funnel device allows a breast implant to be inserted in the most sterile fashion from the package to the patient. No human hands ever touch the implant. This would help reduce the risk of infection. But the best feature of the Funnel is that it allows smaller incisions to be used without severe distortion forces placed on the implant’s outer shell. While the implant still does have to be distorted to pass through a narrow opening, the Funnel device allows those forces to be more evenly distributed across the shell of the implant. This would seem to lessen the risk of weakening through point areas of fatigue and subsequent early implant rupture.

Case Highlights:

1) Breast augmentation using the Funnel device offers a ‘no-touch’ technique for implant insertion.

2) The benefits of a ‘no-touch’ breast augmentation technique is a potentially lower risk of infection and less handling of the implant.

3) The Funnel breast augmentation technique exposes the implant to less shearing and distortion forces which likely increases the longevity of the implant before it eventually ruptures.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

Breast augmentation is a popular body contouring procedure, not only because it is successful, but also due to its instantaneous result. Unlike many types of plastic surgery where the final result takes time to see, the enlargement of the breast by an implant is immediately apparent. While temporary swelling and some bruising accompany this change, the immediacy of the size change has all patients doing close scrutiny and checking their investment.

While breast size changes dramatically at the time of surgery, it takes much longer until the breasts really feel like natural breasts. Understanding the evolution of breast augmentation recovery will reduce one’s anxiety and allow time to pass before judging the final result.

While the instantaneous size change makes for a more satisfying breast size, it does so at the expense of the elastic properties of the skin. The implant makes for stretched skin that is very tight. When combined with swelling that takes up to two days after surgery to peak, the breast will become more than just firm, they can become as hard as a rock. Some women’s breasts get harder right after surgery than others based on how firm or loose their breast tissue and skin was prior to surgery.

This breast firmness will subside as the swelling goes away and the skin’s elastic fibers relax and adjust to the new volume. It is a process that will actually take months, gradually getting better each week. That is why if you look at many early breast augmentation results that are often posted online or on various websites, the breasts look too round and even high. Just because they look this way early does not mean they will look like that six months later. The skin has yet to relax and the breast mound settle. The true feel and look of the breast can not be judged for at least three months after surgery.

Many women are concerned that as the swelling goes down so will their breast size. Largely this is not true. As the swelling subsides over a few weeks, the breast changes little in size but because less tight. Any perception of size change over time is the result of the implant settling down and not having such a high or proud position.

Regardless of the incision location used for breast implants, the skin of the breasts will develop some numbness. I am not talking here about the nipple but the skin. This numbness is primarily located over the bottom or lower pole of the breast. While some of this numbness does go away, not all women will develop completely normal feeling in this area. Fortunately the skin of the breast does not have great two-point discrimination so this is never a long-term problem, just a temporary nuisance.

While the size of the breast after augmentation occurs quickly, the feel of the breast takes much longer to develop a natural softness and normal mobility on the chest wall.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Breast augmentation achieves it success because it uses an implanted device to do so. Similar to orthopedic joint replacements or cataract eye surgery, the implant is the key part of the operation. The surgeon may get a lot of the credit for the initial results of implant procedures but, in the end, the long-term success of the operation will depend on the longevity of the implant. What is unique about breast augmentation, contrary to many implant operations, is that they are largely placed in young patients who have long remaining lifetimes.

One of the very common misconceptions about breast augmentation, and is often not thought of before the surgery, is that the implant will not last forever. Many patients assume that a breast implant will last forever. Breast implants are man-made devices which means, by definition, that they will not last forever. They will come a time, which can not be accurately predicted, when the implant will fail and need to be replaced.

Implant failure is when the bag or shell that contains saline or silicone develops a hole or tear, allowing what is inside to leak out. With saline implants, this will be relatively immediate and the implant will go flat. In silicone implants, the breast doesn’t lose volume because the synthetic gel material can not be absorbed. But silicone implant ruptures may cause discomfort or some hardening of the breast as the body reacts to the material.

This is highlighted by a recent report from the FDA that states ‘women who get silicone breast implants are likely to need additional surgery within 10 years to address complications such as rupturing of the device’. “The key point is that breast implants are not lifetime devices,” said Jeff Shuren, director of the FDA’s Center for Devices and Radiological Health. “The longer you have the implant, the more likely you are to have complications.” “Most women reported high levels of satisfaction with their body image and the shape, feel and size of their implants,” the FDA report further added.

This FDA report is not revolutionary or offers new information in regards to breast implants. It is what most plastic surgeons probably preach or highlight to every breast augmentation consult. I make it a point when talking to potential breast enlargement patients that this will not be their last breast surgery. Depending upon their age when they are implanted, even in the best scenario, that they will be having at least one and maybe two more breast implant surgeries in their lifetime. This is the reality of a fluid-filled medical implant. While many patients seem to be surprised by that insight, it has never seemed to deter a single patient from going forward with the breast implant surgery.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis Indiana

When women are seen in consultation for breast augmentation, they are understandably enthusiastic about how the operation will change the appearance of their chest. Some will be surprised to learn, however, that they will need a breast lift with an implant to achieve the best result. Breast implants are perceived by some to have the ability to lift a sagging breast when, in some cases, they actually can create the need for it.

Conversely, a women may come in only requesting a lift for her breast sagging to discover that an implant will also be needed to get the best result. It is a misconception that a breast lift has the ability to make permanent upper pole fullness, one of the desired changes with a breast lift besides nipple repositioning.

This combination of a breast implant and a breast lift, technically called an augmentation mastopexy, can be a very challenging operation to do well. This is because both operations, albeit done together, are working against each other. The implant expands the breast mound while the lift raises and tightens the breast skin. Finding an acceptable balance between the two can be difficult and it does not help that there are two breasts side by side of which the expectations are near perfect symmetry. In the face of asymmetry which nearly every women with breast sagging has only adds to the complexity of the procedure.

For these reasons, I advise all women undergoing simultaneous breast implants and a lift that there is a high revision rate with this operation. It is not my goal to have to do a revision, nor is there any economic benefit for doing so, it is just a difficult operation There are many reasons that the need for a revision may be desired including implant asymmetry, differences in mound shape or residual looseness of breast tissue and skin over the implant (bottoming out of beast tissue over the lower pole of the implant), some wide or persistent redness of the lift scars, nipple-areolar asymmetry, and adjustment of implant size. Given that breast augmentation alone has a 20% to 30% revision rate in the first three years after placement (national statistics from the manufacturer) should indicate how the ante goes up when a lift is added to the breast reshaping procedure.

The number that I like to imprint on a woman’s mind during the consultation process is a 50% risk of the need for revision for a combination breast implant and lift procedure. For many patients given their breast issues, the risk may not be that high. And my own practice experience indicates that, on average, it is not that high. (probably closer to 33%) But when significant breast sagging exists, the risk of revision may well be 50% or higher. At the least, it is a number that captures the patient’s attention and makes it more than just an infrequent occurrence.

In breast augmentation lifting, there are numerous options based on how much sagging exists and what size of the breast a woman wants. It is a balance between how much breast scarring one can tolerate and how much upward movement of the nipple is acceptable in the face of the desired mound size. One other important consideration which exists in this combination breast operation is keeping the nipple alive. In either breast augmentation or breast lifting alone, this is virtually a non-issue. But when done together, maintaining a good blood supply to the nipple is , always a consideration. Too much skin tightening, too large of an implant, or too much breast tissue undermining can compromise the survival of the nipple. This is why in doing the procedure, if in doubt, I would rather ‘underlift’ the breast or place a smaller implant than risk having the nipple die. It is much easier to do a secondary breast reshaping/revision than it is to remake a nipple.

Without question, a simultaneous breast augmentation and breast lift combination is the most difficult body plastic surgery procedure to perform from an aesthetic perspective For this reason, some plastic surgeons prefer to separate the procedures into two stages in order to reduce the risks. This is a very acceptable approach although it does expose the patient to a 100% risk of a second surgery. (and maybe even a third) When done together, the risk of a second surgery (revision) is about half that of when it is staged.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Background:  The satisfaction after breast augmentation depends upon many factors including the size and symmetrical placement of the implants. The location of the nipple on the newly created breast mound, however, plays an equally important role in the final appearance of the breasts.

 Ideally centered on the midportion of the breast mound as an isolated structure, it naturally draws one’s eye to it immediately. Its location, and the symmetry between the two paired nipple locations, impacts one’s perception of the symmetry of the breast augmentation result. I have seen more than one patient who felt their implants were asymmetric when it was the nipples, not the implants, that had asymmetric positions.

For this reason, it is very important in the breast augmentation consultation that the nipple positions are assessed and the horizontal levels between them checked. This is the time to identify any significant nipple asymmetries. Few women have perfectly level nipple positions. But when the differences are more than a ½ or 1 cm, it is likely that the breast augmentation procedure will make that difference even greater. Whether one should have a comcomitant nipple lift (superior crescent mastopoexy) on the lower positioned nipple during the breast augmentation should be considered.

Case Study:  A 26 year-old female came in for breast augmentation. She did have some breast tissue with fairly large nipple-areolar complexes. Her left breast hung slightly lower with a 1 cm difference (lower) in the upper edge of the nipple. This was pointed out and a nipple lift discussed. She preferred to wait and see how it looked after surgery and would do a nipple lift in the office under local anesthesia if needed.

Under general anesthesia, saline breast implants were placed through a transaxillary (armpit) incision. A pair of 375cc Mentor moderate plus implants were used and inflated equally to 425ccs. It did not appear that the nipple positions were worsened as the breast mounds got bigger.

In seeing her three weeks after surgery, the implants appeared symmetric and the nipple positions have actually improved. They were nearly level and certainly better than before surgery. Whether they will stay the same as the breast tissues settle and relax remains to be seen.

Pre-existing nipple asymmetry will often be made worse after breast augmentation. In some cases, as in this one, it may actually make it better but this is unusual. If horizontal nipple asymmetry is greater than one centimeter, a nipple lift should be done at the time of breast implants to improve the symmetry of the result. The fine line scar at the top of the nipple heals well and does not pose an aesthetic distraction.

Case Highlights:

1)      One of the most important preoperative predictors of asymmetry after breast augmentation is the horizontal level between the two nipples. Consideration needs to be given to a nipple lift done at the same time as breast augmentation for the lower positioned nipple.

2)      Usually horizontal nipple asymmetry will become more pronounced, rather than better, after the placement of breast implants.

3)      When the nipple asymmetry is small or if it is uncertain whether it will get worse when breast implants are placed, a nipple lift can be deferred to after surgery. Otherwise, it should be done to the lower nipple at the time of breast augmentation.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

Breast augmentation historically and to the present day is an implant-driven operation. What is put in accounts for the way it appears on the outside. Despite its popularity, breast implants due have their problems including a limited lifespan. Contrary to what many patients believe, they are not lifelong devices and they will eventually fail and need to be replaced.

The lack of permanency of breast implants, amongst other issues, has led to the pursuit of a more natural solution. Since breasts are composed of a percentage of fat tissue, it is logical to attempt breast augmentation with one’s own fat. Fat grafting has come to be of real value in facial rejuvenation as a filler and volume restoration method. Putting fat into the breast, however, is fraught with many more issues than in the face. It requires a higher volume of injectate so the risk of fat absorption and cyst formation with necrosis makes it potentially unreliable. History has borne that out in the past.

Breast augmentation with fat injections, while being practiced by a few surgeons presently, is still in its infancy. The biggest problem is to be able to increase the size of the breast appreciably with consistent and reliable fat graft survival. Small breast augmentations with fat is being done but these results would not be acceptable to most women seeking breast augmentation in the U.S. In addition it may require multiple injections sessions which makes the cost greater than the use of a traditional implant.

Autologous Fat Breast Augmentation (AFBA) will continue to be developed and one recent study supports a method to improved its results. In the June issue of Plastic and Reconstructive Surgery, a study out of Philadelphia uses a technique known as ‘preoperative expansion’ with fat injections. In 25 women (46 breasts), an average of about 300cc of fat was injected into each breast after device-assisted breast tissue expansion. It should be noted that not all patients were pure breast augmentation, some were implant replacements and others were for correction of breast deformities. With this technique the authors have achieved up to a twofold increase in breast size with no complications. When evaluated after six months, the treated breasts approximately doubled in size and were both soft and natural in feel and appearance. MRI scan showed no cysts or areas of necrosis.

In preoperative expansion, the patient first undergoes several weeks of treatment with a bra-like device, known as Brava, that uses suction pressure to gradually expand and stimulate the breast tissue. The patient has to wear this device for several hours a day. It appears that the pulling on the breast tissue not only creates internal space but may make the breast tissues more conducive to fat graft survival. The patients also used the Brava device for several weeks after the fat injections to help promote healing as well.

This study is significant as it is the first to report large volume fat injection survival in the breast. While it is cumbersome for the patient to undergo this expansion protocol, both before and after surgery, the results may be worth it. While this is not for every patient (probably less than 1% of breast augmentations currently), it lays the foundation for further refinement that one day may make it an option for a greater number of patients.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Background: Breast augmentation remains as one of the most popular and commonly performed of all body contouring procedures. Because breast augmentation involves two breasts, the symmetry of the result is very important. But few women have perfect asymmetry between their breasts and many have quite significant differences.

Breast asymmetry involves either the size of shape of the mound and/or the size and position of the nipples. Mound differences can almost always be improved by the size of the breast implant, whether it in volume or projection. Nipple differences, particularly those in the horizontal dimension, will be worsened by breast augmentation. When the nipples are at two different levels horizontally, they will become more so as the mound size increases. What looks a little cock-eyed when the breast is small will become more so as the breast becomes bigger.

Observing these nipple differences before surgery is important so the patient is aware of this aesthetic concern and maneuvers to address this problem are discussed. One nipple adjusting procedure is the superior crescent mastopexy or nipple lift. By removing a crescent or half-moon of skin above the nipple, it can be moved upward 1 to 1.5 cms at the time of breast augmentation surgery. This can lift up a nipple that is lower on one side or both sides can be done if there is a minor degree of breast ptosis or sagging of both breasts.

Case Study: This 35 year-old female came in for breast augmentation. She had some breast tissue and was a C cup. However she had noticeable asymmetry with a smaller breast mound on her left side and a significantly lower nipple as well. This was pointed out to her and a nipple lift on her left side was discussed as an important procedure to do with her breast implants to avoid worsening breast asymmetry.

Under general anesthesia, she underwent silicone gel breast augmentation with 550cc high profile implants. They were placed through a lower breast crease incision and were submuscular in position. Once the implant incisions were closed, the left nipple lift was done. A crescent-shaped segment of skin was removed with 20mms removed at widest or middle part of the excision. This made the upper level of the left nipple even with the opposite right side.

After surgery she had not only larger breasts (D cup) but both the mounds and the nipples were more even. The upper nipple scar on the left breast will remain red for several months but will eventually fade to white and be nearly invisible.

Case Highlights:

1) Breast augmentation is frequently performed in women whose breasts are not symmetric either in mound or nipple position. Their postoperative expectation, however, is that their enlarged breasts will be more symmetric or have perfect symmetry.

2) The horizontal position of the nipple and its positional symmetry between the breasts is one of the most important markers to note before breast augmentation surgery.

3) Modest degrees of nipple asymmetry can be improved with superior crescent mastopexies or nipple lifts. This can be an important additive procedure that may need to be done with breast augmentation to reduce asymmetry.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

Indianapolis, Indiana

The Gummy Bear breast implant captures a lot of patient and press attention and may represent a valuable role in the future of breast augmentation. While under clinical trial investigations for years by the two U.S. breast implant manufacturers, it is rumored that they are the verge of being approved by the FDA for widespread clinical use sometime in 2011. Given their potential availability, I thought it a good time to discuss the facts from the myths about these type of breast implants.

The name, gummy bear, is very appropriate based on how the implant material looks. Rather than being like a thick Karo syrup or more congealed like a pudding, it is more form stable. It is closer to refrigerated Jell-O in appearance and form. If you cut these breast implants in half with a knife, the two pieces would just stay intact. Like gummy bear candy, the implant will stay solid although it does not feel as hard as the actual candy.

The gummy bear implant is not a name ascribed to it by any of the manufacturers or the FDA. It is really an urban term coined by a plastic surgeon. It has different names by various nmanufacturers such as the Mentor CPG and the Allergan 410. It is really a fifth generation silicone implant, generically known as a form-stable cohesive gel implant. These implants were invented over 15 years ago and have a theoretical basis of being a longer-lasting breast implant that keeps its shape. The gel is more cohesive and firm. The gummy bear implants that will be initially available will have a teardrop and not a round shape. The implant’s teardrop shape anatomically matches that of a natural breast which projects more at the bottom than at the top. As the implant is thinner at the top, it will more naturally blend into the upper chest without an upper bulge which creates a round-looking breast.

Plastic surgery investigators of these implants state that they have a lower capsular contracture (hardening) risk, fewer problems with implant wrinkling and folding and an improved appearance of the breasts. They also offer the psychological benefit that should the implant fail (shell disruption), the implant material would remain intact and not migrate from the original breast pocket.

One of the criticisms of a more form-stable implant is that they can not be put in through very small incisions. They don’t deform as easily as the less stable forms of silicone gels. Some investigators have stated that it is not a problem, going even through a periareolar or nipple incision. Others, however, felt that it is easier to go through a lower breast fold incision. The shaped implant also can suffer from turning or rotating of the implant causing a distortion in the shape of the breast.

The gummy bear implant may be most ideal for the primary breast augmentation woman. This is because its teardrop form is most likely to remain positionally stable with a fresh pocket. In those patients who has indwelling implants, who are unhappy with certain aspects of their implants or want to change the size of their implants, a teardrop-shaped implant is less ideal. This is because existing breast pockets are much more likely to allow the implant to shift around its smooth interior pocket lining. This concern will eventually be obviated when form-stable silicone gel breast implants which are round are introduced.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Beyond deciding that one wants a breast augmentation, the next big choice is whether it should be done with a saline or silicone gel breast implant. There are numerous advantages and disadvantages to either one and neither implant is perfect. Here is one implant choice consideration, implant failure, discussed in detail. One may initially think that how a device fails would not highly influence device selection, but it can.

All breast implants will eventually fail. No patient will live their entire lifetime and not have to replace one or both of their implants. Failure in breast implants refers to a disruption in the containment sac or the bag (shell) that contains the internal filling. This allows some or all of its contents to come out. Because saline is essentially water, any hole will result in near immediate loss of its contents, a term accurately described as deflation. In other words, your breast will almost immediately go flat and will be obvious.

Silicone implants do not fail in the same immediate way. Because silicone gel is a lot thicker and does not flow very well, little of the material comes out so there is no immediate loss of breast volume. Silicone implant failure is not known as deflation, rather it is called silent rupture. One can go for years and never know that their implant has failed because the breast volume does not change. Most of the silicone stays inside and can not be absorbed even if it does come out.

Because of the differences in how they fail, replacement of silicone ruptures can be done more electively than saline deflations. Saline implant failures are often viewed by patients as an ‘emergency’ although they can be done electively anytime after they deflate…even years later.

When saline breast implants deflate, many patients will replace both implants with silicone if it is financially affordable. Having had one breast implant deflation, they understandably worry about when the intact implant will similarly fail. When only the deflated implant is replaced, it is usually done because it is the lowest cost approach. I have yet to see a patient with an implant failure of any type that just wants both implants then removed.

Many patients wonder how saline breast implants fail and how the volume of saline placed in them may impact such failure. Implant sizes come with what is known as minimal volume fill. This means that a 350cc saline implant, for example, should be filled with at least 350cc. Underfilling is one of the known reasons for early saline implant deflation. It is generally accepted that overfilling a saline implant will improve their longevity, which is the opposite of underfilling. How much to overfill has never been shown to influence deflation prevention. The manufacturers recommend a maximum fill which is usually close to 10% of the minimum volume. (e.g., 350cc maximum fill is 400cc) Overfilling beyond the maximum range may have certain advantages but greater longevity is not one of them.

What causes silicone implant failure is not as clear. Since they come pre-filled and unadjustable, volume fill has no impact. One factor that I conjecture can lead to early silicone implant failure is how they are inserted. Pushing a silicone implant through a very small incision can place undetected stresses on its shell, creating weak points that eventually cause a fracture or tear months to years later. This theory can’t really be proven but the insertion stress on a silicone implant shell seems intuitive. One recent insertion device for silicone gel implants, the Keller Funnel, helps in reducing these stress point areas by distributing it more evenly over a greater surface area of the implant. It also avoids any human contact with the implant from the package to the internal breast pocket.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana