Breast augmentation using breast implants is the tried and proven method to increase breast size. It does so by an outward displacement of the overlying breast tissue (parenchyma) and skin due to the push of the implant. Plastic surgeons have recognized for years that the push/pressure of the implant causes a reduction or loss in the amount of breast tissue that existed before surgery. This is easily observed in any breast implant replacement surgery where the removal of the old implant shows a near concave appearance of the breast in many women as the patient is in the horizontal position on the operating room table. While a well recognized phenomenon, such breast implant effects have not been quantitatively evaluated.
In the November/December 2015 issue of the Aesthetic Surgery Journal, an article appeared entitled ‘Evaluation of the Effects of Silicone Implants on the Breast Parenchyma’. In this clinical study the authors used volumetric magnetic resonance imaging at six and twelve months after the subglandular placement of silicone braesy implants. A total of thirty-four (34) women were studied with twenty-four (24) of them receiving the breast implants compared to a control of ten women. They found that at one year after surgery there was a 22% reduction in the amount of natural breast tissue that was initially present.
This is one of the few studies that provides quantitative evidence of the loss of breast tissue with implant placement. The parenchymal atrophy is a direct effect of mechanical compression. One theory is that such compression impinges on the tissue’s blood supply but it is equally likely that it is a direct effect on the cells themselves with pressure-induced apoptosis of the fat cells. But regardless of the mechanism the effect is real and is of considerable consequence when a patient considers implant removal (one does not return to their preoperative breast size and shape) or implant exchange. (this is why more implant volume may be needed later just to maintain the same breast size)
There are lots of problems with this clinical study including the location of the implant in the subglandular position and the use of textured polyurethane implants…two breast augmentation variables that are not done in the U.S.. Whether smooth saline or silicone implants placed in the partial submuscular position would create an exactly similar effect can only be speculated. There is also the highly variable impact of the size or volume of breast implants on how much breast tissue one has go start with and the tightness of the overlying breast skin. Large volume breast implants placed in breast mounds with lower amounts of breast tissue would be expected to cause considerable breast parenchymal loss over many years of implantation.
The main pertinent point of such a study like this to women considering breast augmentation is that it should be considered an aesthetically irreversible procedure. While breast implants can always be easily removed, one’s breasts will never return to their original size and shape. Fortunately only a minority of women ever progress to the point in their lifetime that they want their breast implants removed.
Dr. Barry Eppley
Indianapolis, Indiana