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In the 2007, The Food and Drug Administration (FDA) approved the use of silicone breast implants for any and all patients. Prior to that time, only saline filled breast implants were allowed for cosmetic reasons.
The number of women undergoing cosmetic breast implant surgery has increased dramatically in the past few years. It is now the second most common elective cosmetic surgery procedure, second only to liposuction. The reasons women seek breast implant surgery are wide and varied, but most cosmetic surgeons agree there is a link with body image and self-esteem.
Silicone breast implants consist of an envelope or sac of silicone elastomer (rubber). Within this sac is a special type of silicone gel. The implants are surgically implanted either under or above the chest wall muscles.
These implants come in a variety of shapes, sizes, and surface textures. The shape is usually round or teardrop, and maybe of a low, moderate, or high-profile variety. Implants also come with either a smooth or a textured surface. The size and type of implant is determined both by the patient’s wishes, but also the patient’s needs, as determined by a competent Cosmetic Surgeon.
Silicone breast implants are either placed under the chest wall muscles or on top of the muscle and under the breast tissue. This depends upon many factors including the stature of the woman, the size and shape of her existing breast, and the thickness and texture of her breast skin.
There are three common incision sites: within the breast fold (infra-mammary), around the nipple (peri-areolar) or within the armpit (axillary). In certain patients, it is also possible to place certain types of implants through the umbilicus or belly button.
Surgery is usually performed on an outpatient basis, either in a hospital surgery center or the doctor’s office surgery center. Anesthesia can be general or twilight anesthesia. Surgery usually takes between one and two hours to complete.
The incision is made in the desired location, and a pocket is formed to accept the implant. The implant is placed within the pocket and appropriately positioned. The opening is closed with sutures that will either dissolve by themselves or need to be removed at a future date.
Recovery time varies according to the patient and whether she might experience any complications after her surgery. Patients usually feel tired and sore for a few days and her breasts may remain swollen for a few weeks. Increased sensitivity is typical but rapidly resolves. Most patients returned to their pre-surgery activities within a few days to a few weeks after their operation.
As with any surgery, there can be risks or complications associated with it. The following, although rare, are the most common risks associated with breast implant surgery.
Scar tissue always forms around any breast implant. When this normal scar tissue tightens and squeezes the implant, a capsular contraction is said to have occurred. The cause for this is unknown but may be more common following a low-grade infection or excessive bleeding during or after the surgery.
Treatment for symptomatic capsular contraction, usually consists of a second corrective surgery. In this surgery, the implant is removed, the thick capsule is surgically excised, and the implant is replaced. If the patient’s implant was initially on top of the muscle, the surgeon may recommend that the implant now be placed underneath the muscle.
With the newer implants capsular contraction is much less common, but it is estimated that up to 9% of women suffer some form of capsular contraction. It must be remembered that all patients form a capsule around their implants, but only a small percentage of patients experience any symptoms from this.
Patients must understand that breast implants were not meant to last a lifetime. Some can rupture after a few months of being implanted while others can remain intact for many years. In the past there was some concern about leakage and rupture from silicone implants. The new FDA approved implants, however, have what is called “memory gel”, which means that the gel remains in place if the outer bag should rupture.
Deflated or ruptured implants always require surgery to replace the defective implant. The American made implants that we use, however come with a warranty that allows the patient to receive a new implant at no cost. While the deflation of an implant is not common one study has shown that 10% of women followed for an average of six years had at least one implant that deflated.
Any surgery carries the risk of infection. Although extremely rare, breast implants may become infected. This problem may be evident from a few days to a few weeks after the surgery. Antibiotics are always required, and in extreme cases, the implant may have to be removed and replaced at a later date.
So, silicone breast implants are here to stay. They are another option besides the old but tried-and-true saline implants. In certain instances, the silicone implants may be a better choice for a particular patient. The patient should make every effort to communicate her desires and needs with a competent Cosmetic Surgeon.
Richard A. Joseph, MD
Midwest Surgical Arts
1250 North Mill St. Ste 103
Naperville, IL 60563
(630) 717-8200 | MyCosmeticSurgeon.com
Dr. Richard A. Joseph selected this article for publication based on its relevance to modern cosmetic breast surgery. By outlining the evolution of silicone implants, surgical techniques, and associated risks, the article emphasizes the importance of personalized consultations and careful implant selection. This guidance offers valuable support for individuals considering breast enhancement and reflects the ongoing commitment of aesthetic medicine to safe, natural outcomes.