Breast Implants

[Yona]

What are the material options and design parameters in breast implants?

[Aruna]

@yona Design Features
Saline versus silicone gel
Saline implants have the advantage of decreased cost compared with silicone-filled products. Some products can also be filled from a distant port, which enables a surgeon to place them through a transumbilical approach. Moreover, if implant rupture occurs, this is usually more quickly recognizable. In patients with thin breast tissue, however, a higher chance exists that implant rippling will be visible on the surface of the augmented breast.

In contrast, silicone implants cost more but are widely believed to have a feel that is more natural, and rippling in thin-skinned augmentations is less noticeable. While placement of silicone implants through a transumbilical incision has been reported, the fact that they are pre-filled typically discourages such an approach, although they can still be implanted through periareolar, inframammary, or transaxillary incisions.

A literature review by Balk et al indicated that evidence for the long-term health effects of silicone gel breast implants is still inconclusive, with the evidence in many studies applying to breast implants in general and not specifically to the silicone gel type. However, a possible relationship was seen between silicone gel implants and a decreased risk for primary breast and endometrial cancers, as well as an increased risk for lung cancer, rheumatoid arthritis, Sjögren syndrome, and Raynaud syndrome.

Textured versus smooth
Textured versus smooth relates to the implant surface type and is a highly debated topic with regard to its effect on capsular contracture. In theory, textured surface implants may decrease capsular contracture. The mechanism is thought to be the byproduct of breast capsule growth onto the implant surface, which, because of its texture, encourages disorganization of capsular fibres and thus also the resultant force vectors of contracting fibers.

Round versus anatomical
Experience with anatomically shaped implants is evolving. Theoretically, these implants may provide a more natural shape to the augmented or reconstructed breast. Thus far, there does not appear to be a large cosmetic advantage to the use of teardrop-shaped implants in the breast reconstruction patient, but they might be more useful in certain cosmetic cases. The potential disadvantage to these implants is that they can rotate within the breast capsule and leave the patient with an inferior cosmetic outcome.

Adjustable implants
Mentor Spectrum implants come in smooth round, textured round, and textured teardrop shapes. Smooth, round devices are the most commonly used, as they ripple less than the textured variety. The novel advantage of these devices is that they permit the surgeons to adjust the implant size up to 12 months postoperatively. This is particularly helpful if a woman is unsure about what size breast she desires. Size change is accomplished via saline injection into a subcutaneous injection port or via an exteriorized injection port. The exteriorized port needs to be inserted via a long subcutaneous tunnel to prevent retrograde infection and should be removed within 1 week postoperatively.