Study Shows the Benefits of Reconstructive Breast Augmentation to Cancer Survivors

When breast augmentation is mentioned, the first thing that comes to mind is a cosmetic procedure to improve one’s figure.  While it is true that a significant number of patients seek this to increase their bust size, the surgery is also a way to reconstruct the breasts of cancer survivors who had mastectomy.

In 2010, approximately 93,000 breast reconstructive surgeries were performed in the country.  Most of the patients were cancer survivors who wanted to regain their normal appearance.

According to the American Cancer Society, female patients who have undergone breast reconstruction via breast implants, tissue-based method, or combination of both procedures, have experienced dramatic improvement in their social and sexual wellbeing after their traumatic experience with cancer and disfiguring surgical treatment.

A recent study, which is conducted by researchers from Memorial Sloan Kettering Cancer Center and The University of Toronto, examined the wellbeing of post-cancer patients who had DIEP flap breast reconstruction, a procedure in which their own abdominal tissue was used to create new breast mound.

Before and after breast reconstruction, the respondents were required to answer questionnaires that would determine the status of their wellbeing and self-esteem.  According to the findings, majority had experienced significant improvements in terms of their emotional health just three weeks after the reconstructive plastic surgery.

But as with any tissue-based breast reconstruction in which the patients will likely experience muscle weakness in the donor site, most patients had reported weakened abdominal wall three months after surgery.  However, the symptom is usually tolerated well by many.

While muscle weakness is one of the tradeoffs of breast reconstruction via tissue-based technique, plastic surgeons can prevent this by placing surgical mesh or support over the donor site.

Apart from using a person’s own tissue, plastic surgeons also use breast implants, either filled with silicone gel or saline solution.  But in case that there is little tissue left after mastectomy, they will first insert temporary implants that is inflated with saline solution every two weeks; once there is enough room, they remove the tissue expander and replace this with a permanent implant.

The appropriate breast reconstruction technique largely depends on the amount of tissue left—or the lack of it.  And in general, patients who had invasive cancer surgery will likely need tissue-based surgeries.

On the other hand, women who are left with more amounts of glandular tissue and skin after their cancer surgery will often have the opportunity to choose breast implant surgery, which is less invasive and results to less scarring than the tissue-based reconstruction.

French Implant Manufacturer Warned by US 10 Years Before the Scandal Broke

It has been estimated that 300,000 women have the defective breast implants manufactured by the now bankrupt French company Poly Implant Prothese (PIP).  According to reports, the devices are extremely prone to rupture as they lack a protective coating that prevents silicone gel from migrating to other parts of the body.

Fortunately, the defective silicone implants were not approved and sold in the United States.  In fact, the US Food and Drug Administration has warned PIP in 2000—10 years before the scandal broke—about its failure to follow “good manufacturing practices.”

However, reports show that 80 percent of PIP breast implants were exported to other countries including UK, Chile, Germany, Venezuela, Spain, Argentina, Colombia, and Brazil.

According to the FDA warning sent to PIP founder Jean-Claude Mas, the company’s plant in La Seyne-sur-Mer in the south France has 11 deviations from “good manufacturing practices.” 

The organization also warned him about the “adulterated” saline breast implants, and cited his company’s failure to investigate the deflation of its products in addition to failure to report 120 complaints in France and other countries.  Currently, there is global manhunt for the 72-year-old company founder who is a former butcher.

With the FDA warnings, consumer groups in France ask why their authorities did not conduct an investigation on the safety of PIP’s breast implants.

The US is one of the countries that require very strict guidelines when it comes to implants and devices used in cosmetic plastic surgery.  In fact, Mentor and Allergan Natrelle are the only two companies allowed to manufacture and sell breast implants in the country.

To allay the concern of patients in the US who had breast augmentation surgery, the American Society of Plastic Surgeons (ASPS) has released a statement saying that the defective implants did not reach the country.  The organization added that only those who had the procedure outside the US should be concerned with the defective product.

Because of the fiasco, the French government has promised it will pay for the implant removal surgery of women affected by the defective products.  It has been estimated that 30,000 patients in the country had the PIP silicone-filled implants.

Reports show that PIP’s cheap silicone implants were filled with an industrial silicone gel designed for mattress rather than for human.

On the other hand, the British government still insists that there is no need to require all women with PIP’s silicone implants to undergo implant removal surgery although they are advised to immediately consult their doctor to determine if there is a leak.

Breast Implants with Lift for saggy boobs

Even small breasts can sag due to the natural effects of aging, weight fluctuations, and previous pregnancies.  Fortunately, plastic surgeons have come up with a new technique which combines the benefits of mastopexy (or breast lift) and breast augmentation in one operation.

The sagging of the breasts primarily happens when the amount of tissue decreases and the skin becomes lax.  Contrary to popular belief, breast augmentation surgery alone is less likely to provide a lifting effect especially if there is a severe case of ptosis (drooping).

Mastopexy with breasti mplants starts by making incisions to remove a small amount of skin, which in turn corrects the sagging appearance.  With this technique, less tissue is excised than if breast lift is performed alone; for this reason, patients will enjoy less scarring on their chest.

Because less skin is removed, plastic surgeons need shorter incisions to perform mastopexy-augmentation surgery.  In most cases, they use the crescent-shaped incision around the areola complex, although patients with severe breast ptosis may need the lollipop incision in which the surgical cut is made around the areola and vertically down the breast crease.

The good thing with mastopexy-augmentation is that most patients can get more cleavage, although they should bear in mind that the final result also depends on their chest width and rib cage.  For example, women with a concave chest are likely to enjoy more medial cleavage and upper pole fullness as the implants tend to settle toward the center.

On the other hand, patients with convex chest will achieve less cleavage because their implants will likely settle opposite with each other.  However, there is a solution to the problem: use breast implants that offer more projection off the chest wall.

While some surgeons prefer simultaneously performing breast augmentation and mastopexy, others would rather wait for three months before another surgery (augmentation) is conducted.

Some doctors argue that breast augmentation with mastopexy—if performed on the same day—can lead to higher risk of asymmetrical breasts and complications since the skin is being removed and tightened while at the same time the implants stretch it even further.  Another concern is the tension on the incision site can adversely affect the blood supply.

They also argue that it is challenging to position the nipple and breast crease if mastopexy and breast augmentation are performed simultaneously.

Regardless if breast augmentation is performed on the same day of mastopexy or at a later date, most plastic surgeons recommend placing the implants totally under the pec muscle which can provide good coverage and strong “support.”

Teardrop-Shaped or Anatomical Breast Implants

Anatomical breastimplants—also referred to as dimensional, teardrop, and contoured implants—were first used to reconstruct the breasts of post-cancer patients.  But in later years, some plastic surgeons have started using these devices in cosmetic breastaugmentation surgery.

Unlike round implants in which all the sides are symmetrical, anatomicalimplants have more volume at the bottom than on top, leading to a teardrop appearance.  But because of their shape, there is a risk of flipping over, which in turn leads to visible distortion of the breast contour.

To prevent the anatomical implants from flipping over, they always come in textured shell, which can prevent them from rotating.

The anatomical implants are available in different sizes and profiles (outward projection off the chest wall).  However, patients should bear in mind that these implants are only filled with saline or saltwater solution.

Anatomical implants filled with silicone gel are not available in the US because the “gooey” material cannot be molded into a teardrop shape.

However, there is a new type of breast implant called gummy bear implant (available in some European countries and Canada) which uses a gel more cohesive than the currently available silicone implant’s.  And with its form-stable characteristic, anatomical implants can now be filled with silicone.

It is important to know that gummy bear implants are not yet available in the US market, although some patients may have these new devices if their breast augmentation surgery is conducted by a surgeon involved in a nationwide, FDA-approved study.

While anatomical implants are used in cosmetic breastaugmentation, they are not as popular as the round implants because they are more expensive and can expose patients to higher risk of visible and palpable rippling (because they are always available in textured shell), particularly those with a limited amount of fats and tissue in their breasts.

Another consideration is that the anatomical implants can rotate inside the breast pocket, which in turn can disfigure the shape of the bust.  On the other hand, round implants can be subjected to gross movement and they will still not result to distorted appearance because all their sides are symmetrical.

Contrary to popular belief, there is really no significant difference between anatomical and round implants when it comes to the breast contour after surgery.  In fact, round implants will form a teardrop shape if these are held against the chest wall as the gravity works its wonder.

Patient Options in Breast Augmentation Surgery

The primary goal of breastaugmentation is not just about increasing the bust size but also making the result as natural as possible.  Fortunately, this is easier nowadays as breast implants come in different sizes, shapes, shell, filling, and projection, in addition to a wide range of surgical techniques used by plasticsurgeons.

Nowadays, three options in breast implant placement are available for patients: complete submuscular (under the muscle), partial submuscular (partially under the muscle), and subglandular (behind the tissue).  These surgical techniques have their own pros and cons which are carefully explained to women so they can decide for themselves.

The complete submuscular implant placement results to longer recovery and more pain during healing period because the pec muscles are stretched and pushed.  However, the technique provides countless of benefits such as more coverage to reduce the risk of implant wrinkling; more lifting effect; better mammogram reading; and lower risk of capsular contracture, which is a condition resulting to hardening of the scar tissue around the implants.

On the other hand, the subglandular implant placement results to shorter recovery because the pec muscle remains intact.  But since no muscle covers the implant shell, the technique is only ideal for patients with enough glandular tissue, fats, and skin.  Another consideration to make is that an ongoing ptosis (drooping) may be further aggravated because of the lack of strong “support.”

Meanwhile, the partial submuscular combines the benefits of subglandular and complete submuscular implant placements.

Aside from the implant placement, the type of implants can also have a significant impact on the final result.  For instance, women who want to achieve more cleavage are advised to choose round implant rather than the teardrop-shaped version, although the latter is more notable for simulating the natural contour of the breast.

Breast implants are either filled with saline or silicone gel.  For those who want to achieve a more natural “feel” and “look,” and women with a limited glandular tissue, the silicone implant is a better option; however, one downside is that the patients are required to undergo MRI screening every two years to detect any asymptomatic or “silent” leak.

On the other hand, women with saline implants are not required to have a regular MRI screening because a leak is easily manifested by deflated-looking breasts, making it possible to immediately seek revision breast augmentation.

Regardless if saline or siliconeimplants are used, their size should not only be based on one’s goal but also on her body-frame, amount of tissue and skin, and chest width.  It is important to note that a good plastic surgeon will not push the body’s limit by introducing implants that are too large for it.

Breast implants can be inserted via four incision sites: axillary (armpit), TUBA (navel), breast crease, and areola complex.  Patients should remember that the best surgical technique largely depends on their goals, acceptable risk level, and type and size of implants.

The axillary and TUBA incision sites require the use of an endoscope, which is a fiber optic camera attached to a large monitor.  Through this instrument, plastic surgeons can insert an empty saline shell inside the breast pocket and then fill this with a sterile saltwater solution.

But because the axillary and TUBA incisions work farther away from the bust area, there is a greater margin of error.  By contrast, the breast crease and areola incision sites provide surgeons with greater control over the final result of the surgery, making them a more popular choice.

Since there are many surgical options and type of implants available for women, breast augmentation typically involves lengthy consultation between patients and plastic surgeons.  In this way, doctors can also determine if the goals and expectations of a person with the surgery are plausible and achievable.