What's the Deal with Breast Implants?

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About 1 in 20 women on the planet have breast implants. Lest some future alien race think that we were customarily buried with silicone orbs, I’m compelled to clarify: what’s the deal with breast implants?
I place anywhere from 2 to 8 implants per week, almost always an even number, and almost always in patients with two "X" chromosomes (…but those are topics for a different post…) I'm a board certified plastic surgeon, so I'm an expert on the subject, but there are certainly plastic surgeons who place more implants than me. Regardless, breast implants have had a storied history filled with missteps and misconceptions. Let's get to the bottom (or shall we say, the top?) of things.

Breast implants come in two main varieties: saline (salt water) and silicone (an organic polymer of elemental silicon, Si). The first silicone implants were made by Dow Corning in the 1960s. Poorly executed pre-market research, misinformation, and horrible press led to a class action lawsuit against the company. Under mounting social pressures, the FDA removed silicone implants from the market in 1992, leaving saline as the only available option for breast enhancement. Saline implants work just fine to increase breast size (that’s really what breast implants do, in case that wasn’t clear) but they tend to ripple, are more firm to the touch, and are more easily palpable. After extensive research conclusively failed to demonstrate any connection between silicone implants and systemic disease (e.g. lupus, rheumatoid arthritis), gel implants are in full renaissance. After a 14 year hiatus ending in 2006, silicone has made a comeback.

The newest silicone implants are teardrop shaped, which create a more “natural” look, although many women still prefer round implants and the “augmented” look. The round implants also have a softer silicone than the shaped, “gummy bear” implants (so named for the more cohesive silicone gel…don’t think too hard about it, they just feel like gummy bears). The logic is that the more cohesive silicone implants are less likely to rupture and leak, which means a lower chance of capsular contracture. “CapCon” is really the most common potential complication with breast implants, and can result in a firm, and sometimes even painful breast. This occurs in about 10% of patients, but it’s much lower for some doctors (this depends on both the technique and arrogance level of your plastic surgeon.) The treatment? Remove the implant and capsule, place a new implant, and you’re good to go.

In terms of other risks, breast cancer is atop the list of concerns; but rest assured: Implants don't increase your risk for breast cancer. While special maneuvers are required to displace the implant in order to visualize the breast tissue during mammograms, this doesn’t change the disease prognosis or severity of cancer diagnosis if found.

Depending on the technique used to place the implants, breast augmentation actually can interfere with breastfeeding. If a breast lift is also performed (where the nipple is moved upward), or if the incision is made near the nipple (dividing the milk ducts) then breastfeeding might not be possible. I always use a crease incision to place my breast implants and I almost always place them under the muscle (actually I use a dual plane technique—both over and under—but that’s for yet another post.) These two maneuvers bring breastfeeding difficulties almost down to zero, and also decrease the risk of “CapCon” (don’t call me arrogant). One thing is certain, silicone does not enter the breast milk. This has been conclusively studied, and it just doesn’t happen.

Ironically, the future of breast augmentation may take a page from its past. The first literature report of breast enhancement was written by Vincenz Czerny a Viennese surgeon who in 1895 transplanted a lipoma (a benign fatty growth) from a patient's back to their breast in order to correct asymmetry from a breast tumor he had removed. Fast forward 100 years: fat grafting (also called fat transfer) is red hot. Liposuction is performed to remove unwanted fat from certain areas of the body and it's then injected into areas that could use a little more plumping: the cheeks, lips, buttock, hands, labia majora and, of course, the breasts. "Natural" breast enhancement with your own own fat is rapidly gaining in popularity. Who knows: maybe breast implants will be obsolete before that alien apocalypse after all.

Dr. Adam J. Oppenheimer, MD is a board certified plastic surgeon in Orlando, Florida. Follow me on Instagram: @OrlandoNipTuck
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Orlando Plastic Surgeon