Saline Breast Implants—Pros and Cons

Saline breast implants are filled with a sterile saltwater, for this reason, a leak will not result to serious health problems although patients will need revision breast augmentation to correct the deflated-looking bust.

Saline implants are not superior to silicone version, and vice versa.  Patients should realize that the most ideal option largely depends on their anatomical features (e.g., amount of breast tissue) and goals and expectations.

Meanwhile, these are the advantages of saline breast implants:

*  Shorter scar.  In the US, only saline implants filled at the time of surgery are available (currently there is no pre-filled saline implant).  Once the shell is inside the breast pocket, plastic surgeons inject this with a sterile saltwater before closing the incisions.

Because an empty shell can fit in a small incision, patients who will use saline implants should not be concerned with visible scars.

* Lower cost.  Saline implants cost less than the silicone version (around $900 to $1300 cheaper).  The difference in price is due to the reason that the cost of production for these implants is lower.

* No risk of silent leak.  In case of rupture, patients will immediately know it right away.  By contrast, women with silicone implants have to undergo regular MRI screening to detect silent leak.

* Slightly lower risk of capsular contracture.  This complication happens when the scar tissue surrounding the breast implants becomes too thick that it squeezes the devices.  Some studies suggest that women with saline implants are at lower risk of having this problem than patients with silicone version.  While the difference is just 1 percent per year, it can be as high as 10 percent after a decade of having the silicone implants.

On the other hand, saline implants have their own disadvantages such as:

* Less favorable cosmetic result.  Because saline implants are filled with only saltwater, women with little amount of breast tissue cannot achieve a natural result.  However, this is usually not a concern of patients with a moderate to significant amount of tissue and fat.

For patients with little breast tissue, silicone implants are the best option.

* Prone to sloshing

Unlike the silicone implants which are notable for simulating the natural “feel” of tissue, the saline version is prone to sloshing because it is only filled with water.  For this reason, some plastic surgeons intentionally overfill the shell to make the implants firmer.

* Natural deflation

One study has suggested that saline implants have a natural deflation rate of 1 percent per year due to evaporation and other factors.  By contrast, silicone implants maintain their for volume for years except in the event of rupture

Preventing Breast Implant Rupture

While there is no guaranty that breast implants will last a lifetime, plastic surgeons have come up with different techniques to at least prolong the devices’ lifespan and lower the risk of implant rupture.

In the event of implant rupture, the only solution is a revision breast augmentation; this procedure may involve replacing the implants with new ones or removing them without any replacement.

Meanwhile, these are some of the basic rules which can help patients prevent or at least lower the risk of implant failure.

* Choosing silicone implants over the saline version

Currently available silicone breast implants are less likely to rupture than saline because they are not prone to sloshing and wrinkling which are known to affect the shell’s stability.  Another advantage is that the silicone gel does not evaporate (unlike the saline) which means the patients can maintain their breast volume unless in the event of rupture.

The latest version of silicone implants—which have a more cohesive silicone gel than the one currently used—is almost immune to implant failure.  However, these breast implants, called the gummy bear implants, are not yet approved in the US although these are already used in Europe and Canada.

* When using salinei mplants

Rippling, which can compromise the shell’s stability, can be prevented in saline implants by slightly overfilling them.  However, this should be carefully done because too much filler can cause abnormal pressure on the device.

On the other hand, underfilling saline implants only has negative results because it can cause creases, leading to weak areas in the shell.

* Avoiding high trauma to the breast

Modern breast implants are very strong although they are still subjected to the effects of physical force.  Impact from car collision, sports injuries, and accidental falls may compromise the shell’s stability or may even lead to rupture.

* Consider the implant placement

Some doctors say that submuscular implant placement (placing the device under the pec muscle) poses a slightly higher chance of shell damage than the subglandular technique (positioning the implants over the muscle).  A good compromise might be the subpectoral placement.

* Use of Keller Funnel technique

In this technique, plastic surgeons place the breastimplants in a cone-shaped device and then squeeze it so the implants are transferred into the breast pockets.  Doctors use less force in this method than if they push the devices using their fingers.

Breast Surgery—Combining Fat Grafting and Breast Implants

Breast reconstruction via implants for cancer patients who had undergone radiation therapy is often not an ideal procedure due to the high risk of complications for the reason that radiation has toxic effects on tissues, which can impede natural healing for many women.

Because breast implants are not ideal for cancer patients who had radiation therapy, tissue-based reconstruction is the only viable treatment in which their own tissue from buttocks, abdomen, or back is used to create a new breast mound.  However, the tradeoff is longer recovery and muscle weakness and scarring in the donor site.

Fortunately, doctors have found ways minimize the radiation-induced complications, making it possible to use breast implants for post-cancer patients who received radiation therapy.  The staged procedure involves injecting a person’s own fats to her breast so the area will receive a “bed of healthy tissue” in the chest wall.

A recent study published in the February issue of Plastic and Reconstructive Surgery medical journal has proven the promising advantage of combining fat grafting and implants for breast reconstruction.

The three-year study involved 16 patients who underwent the new breast reconstruction technique after receiving radiation therapy to fight off cancer cells.  Eleven respondents had mastectomy (partial or complete removal of breasts) while five had lumpectomy and other types of breast-conserving surgery.

Breast reconstruction began three to six months after the respondents received radiation therapy.

All patients have received two to three fat grafts to place healthy tissue in the chest wall, allowing it to accommodate the breast implants and to lower the risk of radiation-induced complications.

The collected fats from the donor site must be subjected to a purification method to separate biomaterials such as blood and connective tissue; in this way, the survival rate of the grafted fats will be high.

After the staged breast reconstruction, the results were highly encouraging in terms of aesthetic improvements, the researchers concluded.  Also, patient satisfaction was rated high to very high.

Meanwhile, an average follow-up of 15 months did not show any complications as all patients have experienced good healing in their tissue surrounding the breast implants.

Performing radiation therapy after breast cancer surgery significantly reduces the risk of recurrence, although the downside is that the treatment can affect the body’s healing because of its toxic effects.

While the new study revealed the promising benefits of fat grafting with breast implant for reconstruction surgery, the researchers said more comprehensive surveys and trials with longer follow-up are still needed to confirm their findings.

Traditional Breast Lift Surgery Vs Surgical Mesh

Traditional breastlift surgery is conducted by making incisions around the areola, across the breast crease, and vertically down from the nipple to the fold, thus allowing plastic surgeons to excise some of the loose skin and tighten the tissue.  However, one tradeoff a patient should remember is that while it can raise and reshape the bust for a period of time, it cannot stop the effects of gravity and skin laxity.

But recently, plastic surgeons from South Africa have developed a new technique called Internal Bra System which uses a “support” to prevent future sagging.  This method is now also used in Europe.

The new breast lift technique uses a mesh-like device called Breform which is similar to the one used in hernia repairs.  Meanwhile, plastic surgeons who developed the method said the material can take the strain off the scars and skin, preventing the breasts from sagging.

While Breform has not yet been approved in the US, experts believe that it will be introduced to the market within the next coming years.

Breform is a cone-shaped polyester mesh that is placed underneath the breast skin and is attached to the fascia using internal sutures.  The procedure is conducted under general anesthesia that puts a patient to sleep.

Plastic surgeons in Europe who are using Breform said the device is incorporated into the breasts over time, with the body naturally producing fibrous tissue holding the new structure in place.  With this technique, they believe the result is like a permanent support bra under the skin.

However, patients should remember that the new technique also involves the same incision sites used by the traditional breast lift surgery.  This means that the risk of scar and the length of recovery of these two methods are almost the same.

While Breform is approved in Europe, it has not been permitted by the US Food and Drug Administration, which is noted for its strict regulations on medical instruments.  And because the breast surgical mesh is quite new, there is no long-term study proving its effectiveness and safety.

Some US plastic surgeons are also concerned if the mesh-like device may affect the accuracy of screening tests for breast cancer or if it may lead to serious complications.

However, a four-year study involving 170 patients in Holland found no serious complications following the procedure.  The trial also revealed that breast X-ray examinations were still possible after the internal bra surgery.

Can Silicone Breast Implants Correct Mild Drooping?

Silicone breast implants are increasingly becoming popular these days as they provide a more natural result than saline implants.  This is not surprising because they are filled with a cohesive silicone gel designed to replicate the “feel” and move of glandular tissue and fats; another bonus is that the filling does not evaporate—unlike the saline solution—which means the patients can maintain their breast volume unless in the event of leak or rupture.

The good news is that breast implants—particularly the silicone-filled versions—can correct mild or pseudo ptosis (sagging) which is caused by breastfeeding.  It happens when the mammary glands put pressure on some glandular fats, but after the enlargement resolves, the breasts somewhat “deflate.”

On the other hand, true ptosis is caused by stretched and damaged suspensory ligaments in the breasts.  Oftentimes, the problems can only be addressed by mastopexy or more commonly referred to as breast lift; this can be performed as a standalone procedure or as a complementary to breast implantsurgery.

To correct mild or pseudo ptosis, it is highly recommend to use small implants (300 to 350 cubic centimeters would be the right range) because introducing large ones can aggravate the problem as the tissue is forced to carry the extra weight.  And over time, the stretched tissues will worsen.

By using large implants, there is a higher chance that the patients will need breast lift sooner rather than later.

It is important to note that even small implants can provide upper pole fullness in the breast, the area which is often affected by childbirth and breastfeeding.  But as mentioned earlier, silicone implants are better than the saline versions because they do not have a natural deflation rate.

By contrast, saline implants have been found to lose about 10 percent of their volume after a decade because of evaporation and other factors.  This simply means that patients with these devices are more likely to need revisions sooner than those who have silicone implants.

Meanwhile, there is still a debate whether the subglandular or submuscular implant placement provides more lift.

In the subglandular implant placement, the device is positioned above the muscle which is believed to provide a more lifting effect.  But one downside is that only the tissue and skin support the implant, something which may aggravate the ongoing ptosis.

On the other hand, the submuscular implant placement is said to prevent future ptosis because the device, which is positioned under the pec muscle, is being supported not only by the tissue and skin but also by a thick amount of muscle.

Too Young for Breast Augmentation?

In the US, the legal age requirement for breast implant surgery is 18—and that is if you are going to have saline implants which are filled with a sterile saline (saltwater solution).  But if you want to use the silicone implants, you should be at least 22 years old.

The main reason why silicone breast implants require a higher age limit is that they pose risk in the event of rupture or leak.  For this reason, you have to undergo regular MRI screening to detect any “silent leak.”

By contrast, the examination is not necessary if you will choose the saline implants because in the event of implant failure, your breasts will deflate within hours after the rupture, thus allowing you to seek revisions right away.

Generally speaking, female patients under the age of 18 cannot have breast augmentation surgery unless there is an issue of breast deformity.  The problem with younger people is that their body is still maturing and they may not yet fully understand the ramifications of cosmetic plasticsurgery.

It is important to note that even if you are flat-chested at the age of 15, there is still a chance that your breasts will enlarge as years pass by.  And with large implants and ongoing breast development, you may end up having oversized busts that look unnatural and asymmetric to the rest of your body.

Another concern is that patients below the age of 18 are not emotionally mature.  In fact, a study has suggested that teenagers see cosmetic surgery as a way to fit into their crowd.  By contrast, adults seek the procedure to stand out from the rest.

As mentioned earlier, your plastic surgeon may allow you to have breast augmentation at a younger age if you are suffering from certain types of deformity including tuberous breasts in which they appear too pointy because of the unusual structure of their base.

Breast augmentation performed at a younger age may also be necessary if you develop a very large breast on one side while the other is too small or even “absent.”  In general, age is not an issue in reconstructive plastic surgery.

While the US is quite strict when it comes to cosmetic breast augmentation, certain countries allow the procedure on patients as young as 16.  This lower age limit is not acceptable to many American surgeons who believe that the body should be allowed to mature first before any aesthetic or elective surgery is conducted.

Breast Implant Size and Things to Consider Before hand

The size of breast implants is measured via cubic centimeter or cc instead of “cup” since every bra manufacturer follows its own standard.  Meanwhile, it is important to note that the volume is not the only thing that affects the final results as there are other contributing factors such as implant profile, shape, and placement.

During the previous years, a significant number of women who asked for breast augmentation wanted larger implants even if it meant having a “heavy” top look.  However, plastic surgeons today see a shifting trend toward smaller sizes to achieve the natural look.

The growing trend can be seen on some Hollywood celebrities who replaced their breast implants with smaller ones.  For instance, Denise Richards and Pamela Anderson have been reported to have undergone revision plastic surgery to downsize their implants.

Another good example is Kate Hudson who has been reported to receive small breast implants in 2010.  And because of the subtle changes in her bust size, no one would even know that she had the procedure if not only for her previous photos and videos showing how flat-chested she was back then.

As a general rule, very large implants will obviously look “fake” in addition to higher risk of complications as the body, especially the back and upper torso, has to carry more extra weight.  For this reason, a good plastic surgeon will make every effort to convince his patient that inappropriate implant sizes can lead to many problems.

The problem with inordinately large implants is that they may lead to premature sagging and tissue thinning as the breasts are forced to carry more weight.  To correct such complications, a revision plastic surgery—which may involve implant replacement or permanent removal of the device—is the only effective solution.

For thin patients, particularly those with limited amounts of glandular fats and tissue, very large implants can significantly predispose them to visible and palpable rippling, or sometimes even traction wrinkling especially if they will receive the textured implants with large size “graininess.”

Another consideration to make is that large breast implants can upset the center of gravity of women, which can affect the way they move.  With this consideration, athletes and patients who live an active lifestyle are generally advised to choose smaller implants to maintain their performance and good posture.

Because of the risk of excessively large bust size, implant manufacturers in the US do not sell silicone breast implants that are over 800cc.