Breast implants

Introduction

What are breast implants?

Breast implants are medical implants that are used in plastic surgery to specifically change the size and/or shape of the female breast. There are different types of breast implants, which differ in size, material, shape and surface texture. Depending on the reason and the desired result of the implantation, different implant variants are available.

Why are breast implants used?

Breast implants always aim to (subjectively) improve the visual appearance of the female breast and the desire to do so can arise for various reasons. In most cases, women who opt for breast implants feel that their breasts are too small and would like to enlarge them with implants and ideally give them a perfect shape. However, there are also women for whom breast implants are a way of compensating for existing deformities (e.g. tubular/tuberous breasts) or asymmetries. Breast implants are also used to reconstruct a breast, for example after a mastectomy due to cancer or after an accident.

Types / Material

Types of breast implants

There are numerous variants of breast implants that differ not only in size, but also in other features such as material, shape and surface texture.

Material

Breast implants either consist of a silicone gel filling or are filled with a sterile saline solution. Both types of implant have specific properties and advantages, as the comparison shows:

Silicone implants are filled with a cohesive gel and have an even, firm consistency and a soft texture. They are available in different shapes and sizes, look and feel very natural. Compared to saline implants, they are less prone to wrinkling and rippling. However, any damage cannot be detected immediately, but usually only by MRI, which increases the risk of capsular contracture.

One variant is the so-called B-Lite implants. Their core consists of a mixture of a special silicone gel and microscopically small spheres (microspheres). This mixture has the advantage that the weight of the implants is approx. 30 % lower without affecting their shape and strength. The lower weight reduces the risk of back problems or deformation of the breast in the long term.

Saline implants consist of a silicone implant shell filled with a sterile saline solution. These implants allow flexible size adjustment through individual variation of the filling quantity (often only after breast surgery). The subsequent filling means that smaller incisions are sufficient. However, they are more prone to wrinkles and ripples and therefore feel less natural compared to silicone implants. If damage does occur, it is immediately visible and less dangerous, as the body can absorb the leaking saline solution naturally.

Strength

Breast implants can be soft, medium-firm or firm. The following applies: the softer the implant, the more similar it is to natural breast tissue and the more natural it feels. However, the risk of shape changes is greater with a soft implant than with a firm implant. The latter retains its shape but does not feel as natural. Medium-firm breast implants offer a good balance between naturalness and shape retention. Which firmness is ideal for you depends on your body proportions, the positioning of the implant and the desired result.

Shapes

Shape

Breast implants are generally available in two shapes: round and teardrop-shaped.

Round breast implants are characterized by their uniformly round and symmetrical shape in all directions. They ensure a full appearance in the upper breast area (push-up effect), which does not change even with movement. They can be placed above and below the pectoral muscle and are suitable for women who want a significant breast augmentation.

Teardrop-shaped breast implants are modeled on the natural breast shape and offer more volume in the lower breast area. This is why this implant shape is often referred to as an “anatomical” shape. The appearance of the breast can change with movement / rotation. These implants are suitable for women who prefer a natural look to their breasts and are also suitable for compensating for asymmetries in the breast shape or for breast reconstruction (breast augmentation).

In addition, new ergonomic implants have recently become available (e.g. Perle from GC Aesthetics, Ergonomix from Motiva), which have a round shape but are made of a special soft gel that adapts to the body position during movement, making the implants look particularly natural.

Surface finish

The implant surface can be smooth or textured. Both variants have advantages:

Smooth-walled implants feel soft and are very easy to move. However, there is a higher risk of displacement or hardening with these implants.

Textured implants are more likely to remain in their intended position and hardening is less likely. This applies in particular to macro-textured implants with a comparatively rough surface, but also – albeit to a lesser extent – to nano-textured implants with a less pronounced structure.

Procedure

What is the procedure for inserting breast implants?

Breast implants can be inserted via various access routes. With all surgical techniques, however, an incision is made in an inconspicuous place so that the resulting scar is barely visible later on.

The incision in the underbust fold (inframammary fold) is the most popular, as the surgeon has the best view with this approach, enabling precise placement. It is suitable for all implant shapes and sizes and is associated with a low risk of infection. Breastfeeding problems are also very unlikely here.

Alternatively, the incision can be made at the edge of the areola (periareolar). This approach is suitable if a breast lift or other corrections are also to be performed.

Access via the armpit (transaxillary) is also possible, but is technically more challenging with anatomical implants as the view is restricted. However, the breast remains “scar-free”.

The implant is placed in the desired position above the pectoral muscle and/or behind the pectoral muscle via the respective incision. The incision is then closed and treated with a sterile wound dressing. In some cases, it may be advisable to insert a drainage tube to allow wound fluid to drain away.

Placement

Placement of the implants in the breast (implant position)

A breast implant can be placed in front of or behind the pectoral muscle. Both methods have their advantages:

In subglandular positioning, the implant is placed directly under the mammary gland tissue and over the pectoral muscle. This means that the pectoral muscle is not affected by the operation, which allows for faster recovery.

With submuscular positioning, on the other hand, the implant is placed behind the pectoral muscle. The pectoral muscle in front of the implant provides a more natural look and feel, but usually requires a longer recovery time.

Alternatively, a mixture of the variants mentioned is possible. In the so-called dual-plane method, the implant is placed partially above and below the muscle in order to achieve perfect aesthetics.

Another relatively new variant is the so-called subfascial implant position. Here, the implant is placed between the pectoral muscle and the pectoral fascia so that the muscle fascia holds the implant and the muscles remain undamaged. This method is particularly suitable for women who are active in sports.

Risks

What are the risks associated with breast implants?

Breast augmentation with implants is a routine procedure for experienced doctors like Dr. Nichlos. Nevertheless, as with any surgical procedure, there are certain risks associated with the operation. These include general surgical risks such as bleeding, wound healing disorders and infections, as well as problems with scarring.

On the other hand, there are specific risks such as (temporary) disorders of breast or nipple sensitivity (e.g. numbness) or so-called capsular fibrosis. Here, the tissue around the implant hardens and forms a kind of capsule, which can deform the breast and cause pain. It is also possible that the implant may rupture or leak, meaning that it has to be replaced.

Breast Implant Illness (BII) is also currently being discussed. This is a clinical picture with many different symptoms, ranging from chronic fatigue and headaches to skin rashes, which are associated with silicone implants. Despite some indications from experience reports, a direct causal link between these complaints and breast implants has not yet been proven beyond doubt. However, a number of studies are currently underway, the results of which will certainly shed light on this issue.