Breast implants: The 5 essential factors

Breast implants: 5 Essential factors

Thinking about a breast enlargement? Here are the 5 most crucial aspects of breast implant surgery you need to know.

1. Implant shape

Choosing the right shape of breast implants is vital to the success of your surgery. Indeed, your choice of round, teardrop or conical will help determine your final breast shape after surgery.

Choosing the right implant for you is dependent on your existing breast size, shape, symmetry and projection, body type, and your personal preferences.

There is no one breast implant shape that is best for everyone. Your surgeon is the best resource for determining what breast implant is best for you and your body type.

Round and teardrop implants are most commonly used, however conical implants are becoming more popular to help fill an ‘empty’ chest in certain cases.

Round implants

Round implants are circular with an even projection of volume. They are a good choice for those who want more fullness in the upper part of the breast and tend to give greater cleavage. Many surgeons agree round implants are typically the best choice for those patients with well-shaped natural breasts who desire a straightforward breast enhancement.

Teardrop implants

Teardrop, or anatomical, implants more closely resemble the natural shape of a breast, gradually sloping downwards to produce an attractive straight line from the collarbone to the nipple. Teardrop implants tend not to be as full as round implants but because they are fuller in the lower half they can also provide greater projection in proportion to the size of the base, making them particularly suitable for women with little natural breast tissue. Mild elevation of the breast and the nipple can also be achieved, making them particularly suitable for women who have mild droopy or tuberous breasts.

Conical implants

While not as well-known as round and teardrop shapes, the conical implant is gaining popularity for its ability to add volume to both the upper and lower poles of the breast while also creating a good elevation of the breast and nipple to counter ptosis or droopiness.

It is essential that the right amount of volume, or fill, is selected – otherwise there is a risk the breasts will end up with a pointy appearance. They are available in polyurethane surface only.

2. Implant size

Breast implant sizes are designated by their volume, which in Australia ranges from 90 to 900 cubic centimetres or millimetres (cc or mm), or by their weight. One gram of silicone is equivalent to slightly less than 1ml (1cc). The higher the number, the larger the implant.

They are also made with different diameter bases to suit different widths of chest wall and with low to high profiles (amount of forward projection). For this reason, each manufacturer produces a number of ‘styles’.

It’s important to take your natural breast width into consideration. Your surgeon will measure the base diameter of your chest to determine the ideal width of implant. If the implant is too wide for your chest, you may get ‘webbing’ between your breasts (symmastia) or too much ‘side boob’. If the implant is too narrow, it will not fill the chest appropriately and be difficult to create a shapely cleavage.

The choice of implant projection is to a large extent a personal one. A woman with adequate breast tissue and a shape she is happy with may opt for a low-profile implant that will simply increase the size of her breasts. Another patient seeking to create cleavage, or a patient with some degree of sag, may prefer a high-profile implant that can help achieve these results.

During your consultation, your surgeon will take into consideration the width of your chest and breast tissue and advise you on the most suitable implant size and style for your individual anatomy.

3. Implant material

This next crucial factor looks at the type of fill (saline or silicone) as well as the shell of the implant wall (smooth or textured).

Silicone vs saline

Saline and silicone breast implants both have an outer silicone shell, however they differ in material, consistency and techniques used for placement. Both types of implants have their own advantages and risks.

Silicone gel-filled implants are used more commonly in Australia. Silicone implants contain a cohesive gel, designed to mimic real breast tissue. It has a slightly firm, non-runny consistency, which can give a more natural feel. As the gel is not liquid, the risk of dispersal if the implant ruptures is minimised. It also typically maintains its shape better than a saline implant, especially in the upper part of the implant.

Saline-filled implants use a medical grade saltwater solution, which makes the implant feel like a water-bed. This can be controlled to an extent by the volume of fill in the implant. If implant rupture occurs, the saline is absorbed by the body. However, saline implants feel firmer than silicone implants and have a higher risk of visible folds and ripples.

Unlike silicone gel implants, saline implants can be filled through a valve during surgery. Because of this, the insertion of the implants generally requires a smaller incision than that associated with silicone gel implants. The amount of fill can also be adjusted after surgery, which is not possible with fixed silicone gel implants.

Smooth vs textured

Implant shells can be smooth or textured. Smooth-shelled implants are easy to insert and make the breast move and feel more natural than a textured shell. However, they have increased risk of capsular contracture (hardening of the breast), which is a common reason for re-operation.

Textured implants have a thicker shell and the very nature of their surface means they can grab onto and adhere to the surrounding tissue, causing less friction between the implant and breast pocket and therefore helping to reduce the risk of capsular contracture. Many surgeons also believe it offers them greater control over the ultimate shape of
the breast.

Round implants come in smooth and textured shells, but anatomical implants have textured surfaces only to allow for better integration with the surrounding breast tissue. The implant may still flip or move and distort the appearance of the breast, so the surgeon must be experienced with this type of implant.

The polyurethane foam coated breast implant gained approval for use in Australia in 2008. Used in South America and Europe since the 1970s, it was designed to significantly reduce rates of capsular contracture. With the foam coating, the collagen fibres that surround the implant are not lined up, but sit in a circular pattern around the foam structure. This means they are less likely to slide over one another and contract. There are differences in technique with this type of implant, such as the pocket size used to accommodate the breast implant needs to be typically bigger than usual.

Regardless of the type of implant women choose, the shape, texture and size can be customised to reflect her individual body type and aesthetic goals.

4. Incision site

There are four incision options: the inframammary crease (under the breast where it meets the chest), periareolar (around the nipple), transaxillary (inside the armpit) and transumbilical (through the navel).

Inframammary

The inframammary incision is the most common breast augmentation incision used today, made in the crease under the breast close to the inframammary fold. The surgeon creates a pocket for the breast implant, which is slid up through the incision, then positioned behind the nipple.

This incision offers the best exposure for visualisation and allows the implant to be placed over, partially under or completely under the chest wall muscle. The scar is hidden in the crease under the breast and is not normally visible when wearing a bikini top.

Periareolar

The periareolar incision is another widely used method for placing breast implants, particularly for those . An incision is made just beyond the areola, which is the darker area of skin surrounding the nipple. The incision should be made at the very edge of the areola where the dark tissue meets the lighter breast tissue, which makes the scar least visible.

Similar to the inframammary incision, the periareolar incision allows the surgeon to work close to the breast. It is possible for the surgeon to easily and precisely place the breast implants in various positions in relation to the chest muscle. However, this is the only incision that involves cutting through breast tissue and ducts, and sensitivity in the nipple may be reduced.

Transaxillary

The transaxillary incision is made in the natural crease of the armpit and a channel is created down to the breast. This may be performed with an endoscope (a small tube with a surgical light and camera in the end) to provide visibility. The implant is inserted and moved through the channel into a prepared pocket.

The greatest advantage of an underarm breast augmentation incision is that no scar is left on the breasts. The scar is virtually invisible in the armpit fold and lack of tension generally makes for straightforward healing.

The transaxillary site is relatively far from the breast, where the surgeon needs to create a pocket for the implant, so visibility is limited. There is also a higher incidence of the implant being positioned too high and a greater risk of breast asymmetry after surgery.

Transumbilical or navel (TUBA)

The TUBA incision is made on the rim of the navel. An endoscope can be used to create a tunnel and to provide visibility to the surgeon. After a pocket is created in the breast, the implant is inserted through the incision and moved up into the breast area and positioned in the pocket.

The resulting scar from the TUBA incision is typically virtually undetectable and does not appear on the breasts. Inserting breast implants through the navel requires only one incision (and scar) for both breasts, while other incision sites require separate incisions.

However, this incision can only be used for saline implants as the filling is added after the implants are placed. Also, the distance of the incision from the breast can reduce the surgeon’s ability to control bleeding and to position the implant correctly.

5. Implant placement

The placement of breast implants can have a significant impact on the final outcome of breast augmentation and therefore it requires individual consideration.

Experienced surgeons base their implant placement decisions on factors such as the individual patient’s quantity of breast tissue, natural breast size and symmetry, the dimension and shape of the chest wall, the amount of subcutaneous fat and the quality of breast skin.

Generally, there are three placement options: subglandular (in front of the muscle), submuscular (behind the muscle) and dual plane (partially under the muscle). There are pros and cons for each position.

Subglandular

The subglandular pocket is created between the breast tissue and the pectoral muscle. This position resembles the plane of normal breast tissue and the

implant is placed in front of the muscle. Sometimes the implant is covered by a thin membrane, the fascia, which lies on top of the muscle. This is called subfascial placement.

This position is suited to patients who have sufficient breast tissue to cover the top of the implant. This procedure is typically faster and may be more comfortable for the patient than submuscular placement. There is generally less post-operative pain and a shorter recovery period because the chest muscles have not been disturbed during surgery. The implant also tends to move more naturally in this position.

However, subglandular breast implants may be more visible, especially if the patient has little breast tissue, little body fat and thin skin. With subglandular implants, there tends to be more of a pronounced ‘roundness’ to the breasts, which may look less natural than those placed under the muscle, but this is a matter of personal preference.

Submuscular

The implant is placed under the pectoralis major muscle after some release of the inferior muscular attachments. Most of the implant is positioned under the muscle. This position can create a natural-looking contour at the top of the breast in thin patients and those with very little breast tissue. The implant is fully covered, which helps to camouflage the edges of the implant, as well as rippling. With this placement, there is less chance of capsular contracture occurring.

There may be more post-operative discomfort and a longer recovery period. The implants may appear high at first and take longer to ‘drop’.

Dual plane

The implant is placed partially beneath the pectoral muscle in the upper pole, where the implant edges tend to be most visible, while the lower half of the implant is in the subglandular plane. This placement is best suited to patients who have insufficient tissue to cover the implant at the top of the breast but who need the bottom of the implant to fully expand the lower half of the breast due to sag or a tight crease under the breast.

This position minimises the rippling and edge effect in thin patients while avoiding abnormal contours in the lower half of the breast. Generally, this placement is able to achieve a more natural shape to the upper portion of the breast instead of the ‘upper roundness’ that can be more common with subglandular implants. However, it involves more complex surgery, which if not performed correctly may result in visible deformities when the pectoral muscles are contracted.