CosBeauty Magazine #80

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Choosing the size and shape of your implant Choosing the right shape, size, projection and placement of breast implants is vital to the success of your surgery and your final breast shape. The perfect implant for you is dependent on your existing breast size, shape, symmetry and projection, body type, and your personal preferences. There is no one breast implant shape that is best for everyone. Your surgeon is the best resource for determining what breast implant is best for you and your body type. 1. Implant shape Round and teardrop implants are the most commonly used implant shapes. Round implants are circular with an even projection of volume. They are a good choice for those who want more fullness in the upper part of the breast and tend to give greater cleavage. Many surgeons agree round implants are typically the best choice for those patients with well-shaped natural breasts who desire a straightforward breast enhancement. Teardrop, or anatomical, implants more closely resemble the natural shape of a breast, gradually sloping downwards to produce an attractive straight line from the collarbone to the nipple. Teardrop implants tend not to be as full as round implants; but because they are fuller in the lower half they can also provide greater projection in proportion to the size of the base, making them particularly suitable for women with little natural breast tissue. Mild elevation of the breast and the nipple can also be achieved, making them particularly suitable for women who have mild droopy or tuberous breasts. 2. Implant size Breast implant sizes are designated by their volume, which in Australia ranges from 90 to 900 cubic centimetres (cc). The most common sizes range from 300 to 400cc. They are also made with different diameter bases to suit different widths of chest wall and with low to high profiles (amount of forward projection). For this reason, each manufacturer produces a number of ‘styles’. It’s important to take your natural breast width into consideration. Your surgeon will measure the base diameter of your chest to determine the ideal width of implant. If the implant is too wide for your chest, you may get ‘webbing’ between your breasts (symmastia) or too much ‘side boob’. If the implant is too narrow, it will not fill the chest appropriately and have difficulty creating a shapely cleavage. The choice of implant projection is to a large extent a personal one. A woman with adequate breast tissue and a shape she is happy with may opt for a low-profile implant that will simply increase the size of her breasts. Another patient seeking to create cleavage, or a patient with some degree of sag, may prefer a high-profile implant that can help achieve these results. During your consultation, your surgeon will take into consideration the width of your chest and breast tissue and advise you on the most suitable implant size and style for your individual anatomy. Feature 3. Implant fill: saline or silicone The type of fill used inside the implant is either silicone or saline. Both have an outer silicone shell; however they differ in material, consistency and techniques used for placement. Both types of implants have their own advantages and disadvantages. Silicone gel-filled implants are used more commonly in Australia. Silicone implants contain a cohesive gel, designed to mimic real breast tissue. It has a slightly firm, nonrunny consistency, which can give a more natural feel. As the gel is not liquid, the risk of dispersal if the implant ruptures is minimised. It also typically maintains its shape better than a saline implant, especially in the upper part of the implant. Saline-filled implants use a medical grade saltwater solution, which makes the implant feel like a water-bed. This can be controlled to an extent by the volume of fill in the implant. If implant rupture occurs, the saline is absorbed by the body. However, saline implants feel firmer than silicone implants and have a higher risk of visible folds and ripples. Unlike silicone gel implants, saline implants can be filled through a valve during surgery. Because of this, the insertion of the implants generally requires a smaller incision than that associated with silicone gel implants. The amount of fill can also be adjusted after surgery, which is not possible with fixed silicone gel implants. www.cosbeauty.com.au 69
4. Implant shell: smooth or textured Implant shells can be smooth or textured. Smooth-shelled implants are easy to insert and make the breast move and feel more natural than a textured shell. However, they have increased risk of capsular contracture (hardening of the breast), which is a common reason for re-operation. Textured implants have a thicker shell and the very nature of their surface means they can grab onto and adhere to the surrounding tissue, causing less friction between the implant and breast pocket and therefore helping to reduce the risk of capsular contracture. Many surgeons also believe it offers them greater control over the ultimate shape of the breast. Round implants come in smooth and textured shells; but anatomical implants have textured surfaces only, to allow for better integration with the surrounding breast tissue. 5. Incision site There are four incision options: the inframammary crease (under the breast where it meets the chest), periareolar (around the nipple), transaxillary (inside the armpit) and transumbilical (through the navel). The inframammary incision is the most common breast augmentation incision used today, made in the crease under the breast close to the inframammary fold. The surgeon creates a pocket for the breast implant, which is slid up through the incision, then positioned behind the nipple. This incision offers the best exposure for visualisation and allows the implant to be placed over, partially under or completely under the chest wall muscle. The scar is hidden in the crease under the breast and is not normally visible when wearing a bikini top. 6. Implant placement Experienced surgeons base their implant placement decisions on factors such as the patient’s quantity of breast tissue, natural breast size and symmetry, the dimension and shape of the chest wall, the amount of subcutaneous fat and the quality of breast skin. Generally, there are three placement options: subglandular (in front of the muscle), submuscular (behind the muscle) and dual plane (partially under the muscle). With subglandular placement, the pocket is created between the breast tissue and the pectoral muscle. This position resembles the plane of normal breast tissue and the implant is placed in front of the muscle. Sometimes the implant is covered by a thin membrane, the fascia, which lies on top of the muscle. This is called subfascial placement. This position is suited to patients who have sufficient breast tissue to cover the top of the implant. This procedure is typically faster and may be more comfortable for the patient than submuscular placement. There is generally less post-operative pain and a shorter recovery period because the chest muscles have not been disturbed during surgery. The implant also tends to move more naturally in this position. However, subglandular breast implants may be more visible, especially if the patient has little breast tissue, little body fat and thin skin. With subglandular implants, there tends to be more of a pronounced ‘roundness’ to the breasts, which may look less natural than those placed under the muscle; but this is a matter of personal preference. With submuscular placement, the implant is placed under the pectoralis major muscle after some release of the inferior muscular attachments. Most of the implant is positioned under the muscle. This position can create a natural-looking contour at the top of the breast in thin patients and those with very little breast tissue. The implant is fully covered, which helps camouflage the edges of the implant, as well as rippling. There may be more post-operative discomfort and a longer recovery period. The implants may appear high at first and take longer to ‘drop’. The dual plane method places the implant partially beneath the pectoral muscle in the upper pole, where the implant edges tend to be most visible, while the lower half of the implant is in the subglandular plane. This placement is best suited to patients who have insufficient tissue to cover the implant at the top of the breast, but who need the bottom of the implant to fully expand the lower half of the breast due to sag or a tight crease under the breast. This position minimises the rippling and edge effect in thin patients, while avoiding abnormal contours in the lower half of the breast. Generally, this placement is able to achieve a more natural shape to the upper portion of the breast, instead of the ‘upper roundness’ that can be more common with subglandular implants. However, it involves more complex surgery, which if not performed correctly may result in visible deformities when the pectoral muscles are contracted.
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