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Breast Augmentation

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About Breast Implants in New York

Basic Facts on Breast Implants

It is important to understand that the outer shell or envelope of all breast implants is made of silicone. However, the actual filling substance can differ giving rise to various types of breast implants including saline (salt water), pure silicone gel which is divided into simple or cohesive gel (Silicone implants are widely used in Europe and will most like return to the U.S. market by 2004)

Silicone gel implants are currently the most common type used throughout the World. In Europe current sales figures show a distribution of 70% silicone, 15% saline, and 15% for alternative fillers such as Hydrogel and Soya oils. As modern silicone gel implants have been available since 1963, surgeons therefore have over 35 years of experience with these types of breast implants. This is more than any other type in use. Evolution has brought changes and improvements over the years with the introduction of textured surface envelopes made of newer formulations designed to minimize the "bleed" or diffusion of what is usually tiny amounts of the silicone oil fraction of the gel contents.

Importantly the standard silicone gel by most accounts, arguably "feels" the most natural of all breast implants. This is probably as a result of the inherent smoothness of the silicone gel content.

A Few Facts on Silicone.

Many women considering this type of surgery will no doubt have heard of frightening stories about silicone toxicity or autoimmune/connective tissue disease, due to gel "bleed" or migration. As a result, breast augmentation has, in the last 8 years, received much unfavorable publicity mainly through the irresponsible actions of the media whereby, regardless of the facts, claims have been made with respect to silicone safety. Undoubtedly, most of these stories began to attract attention after the American Food and Drug Administration (FDA) in January 1992 imposed a ban on the use of silicone gel breast implants. The FDA concluded, "there was no evidence that silicone gel filled breast implants are unsafe, but there was insufficient evidence to prove safety". All the above was a result of pending law suits against the manufacturers of breast implants from women who had implants and were now allegedly suffering from a whole host of symptoms from a disease process arbitrarily termed "silicone related autoimmune disease". In fact a search of court records in America has revealed that no less than 216 separate complaints or symptoms have been filed in association with gel filled devices (a number unheard of with any other disease process or condition!).

Since this time there has been much activity and debate within the medical community to try to ascertain whether silicone gel breast implants are safe. To this end there have been many numerous statements issued and conclusions deduced. In summary some of these are:

  1. In January 1992 the Chief Medical Officer informed surgeons and doctors that the Department of Health felt no reason existed to withdraw implants from use based on scares in the USA.
  2. In April 1994 a Specialist Committee set up by the Department of Health, concluded that no scientific evidence existed which connected silicone implants with either connective tissue or autoimmune disease.
  3. There have been claims that silicone causes a totally new syndrome. These have been based on anecdotal reports and therefore no studies exist to substantiate this. In response to these the American College of Rheumatology (ACR) issued a statement in October 1995 based on research studies involving over 87,000 women. This read "silicone implants expose patients to no demonstrable additional risk for connective tissue or rheumatic disease" and " there is no reason to discourage women from considering breast implant surgery on the basis of acquiring or worsening a connective tissue disorder.
  4. At least 22 studies have been published from all over the world in the last few years, encompassing over 500,000 women in these studies, and none could find a relationship between so called "silicone autoimmune disease" and breast implants.
  5. The finding of silicone in bodily fluids should be viewed in perspective; silicone is found abundantly in our environment and indeed probably in most people. Our contact with silicone is extensive throughout all of our lives and it is used widely in medicine. Silicone is used as a lubricant in every disposable needle, syringe and intravenous tubing. Silicones are used in lipstick, suntan lotions, food processing, skin creams, hair spray, and cosmetics. Over 1000 medical products use silicone as a component or in the manufacturing process including artificial heart valves, joints, and pacemakers.
  6. In July 1998, the Department of Health published its findings and conclusions following a committee review set up to investigate the safety of silicone implants. The committee which comprised mainly of scientists and academics concluded that it found no scientific evidence linking silicone implants with disease( the full 36 page report can be obtained from Silicone Gel breast Implants Independent Review Group on 0207 972 8000 or it can be downloaded on the internet on http://www.silicone-review.gov.uk)

In conclusion to these statements, it would be fair to accept that some women who have had breast augmentation surgery, may have subsequently developed at some point in their lives a connective tissue or autoimmune disorder. However as these disorders arise fairly commonly in individuals in the general population anyway, regardless of whether they have had breast implant surgery or not, is it not possible that they may have become ill anyway? This type of question can only be answered by careful statistical analysis and examining groups of individuals who have had silicone implants and then comparing them to similar numbers and types of individuals without breast implants. If it then appears that the group of women with silicone implants suffers a higher number of individuals with autoimmune diseases then a causal link can be established. However, at the moment, after examination of all the relevant data, it seems safe to say that there is no conclusive scientific evidence that silicone materials in breast implants increases the risk of connective tissue diseases or for that matter breast cancer.

What are the alternatives to Silicone Gel?

Saline Implants are the mainstay of breast augmentation in the United States. (This may very well change once silicone is re-introduced for aesthetic breast surgery by the FDA in the upcoming year. Although the shell are still the made from silicone the filler is sterile saline, and if leaking were to occur the net effect would be the bodies absorption of salt water. Dr. Klapper will discuss at the time of your consult the pros and cons of Saline breast augmentation.

Are there different shapes and consistencies of breast implants?

There are different shapes and types of breast implants; both silicone and saline. Traditionally, all implants have been round. The majority of all implants currently used are still round with use of anatomic implants as deemed necessary to meet the individual patients goals.

How do I choose which size of breast implant is the best for me?

Implants come in a wide variety of sizes and it is possible for any woman to comfortably carry a variety of sizes on her chest. Most women have a rough idea as to how big they may want to be in terms of bra sizes. The objective during the examination is to determine which size of breast implant will give the desired appearance. As you can imagine different size implants in different framed women gives different results. The secret is to choose a size that will give you a more balanced, proportionate look overall and more inline with your desires. At the time of your consultation Dr. Klapper will take specific measurements of your breast and chest in order to try and determine which size would be suitable for you. In addition to these measurements he will take into consideration your vision of your ideal breast size.

It is important to understand however that ultimately, the limiting factor in choosing implant size is the space available beneath your breast. Its important to remember that as the volume of any breast implant increases, then so does its width. Therefore if you choose an implant that is excessively large, the edge of the implant may then extend around beyond the breast and potentially even under the armpit. This would be undesirable for most people. In addition the potential for rippling (see below) and other long-term adverse problems increases.
The vast majority of women however have a realistic outlook of what they wish to look like, and therefore it is not often that a surgeon cannot deliver the desired expectations to his patient.

How long do breast implants last?

Like all man-made products, breast implants do not last forever. Despite being very robust and resistant to even extreme pressures, they are susceptible to daily wear and tear over time. What this means in simple terms is that the outer shell or coating of the implant eventually wears thin and ultimately disappears. If this happens then the contents of the implant leak out. This is usually termed disintegration, leakage or rupture of the implant. Clinically however this may be difficult to spot. Occasionally one may detect a slight flattening of the breast or an alteration of the shape, but this may only be very slight and hardly noticeable. Capsule formation (see above) is the main reason that ruptures of an implant can sometimes be tricky to detect. As previously stated, a capsule forms a type of "biological bag" encompassing any breast implant. Should leakage of the implant therefore occur, the contents will still be contained in the same location by the body's own bag or capsule. Despite being difficult to detect clinically however, thankfully an ultrasound scan will most times be able to accurately assess the condition of any implant when necessary.

There are many quoted figures as to how long ultimately any implant lasts before disintegrating. An average figure is probably in the order of 20 years. There are however variations in the wear and tear amongst different individuals. A women therefore who subjects herself to extreme physical exercise for many hours a day on a regular basis with resultant excessive movements of her breasts (i.e. aerobics instructor, marathon runner, regular horse riding etc.) will naturally subject her implants to more wear and tear over a given period of time, than someone who does very little exercise. In the first situation it would be reasonable to assume that the implants may disintegrate sooner than in the latter case.

In order therefore to have a proper assessment of the state of your implants it is best advised to have your implants examined by a specialist on a regular basis from about 10-15 years after your operation and an ultrasound performed as necessary.