With the cooler temperatures upon us it is that time of year again when many patients start thinking about breast augmentation – the winter months providing the ideal opportunity for recovery. Although there is a tremendous amount of information out there, especially on the Internet, being bombarded with too much information can cause even greater confusion and uncertainty.
What kinds of implants are available in NZ, how are they placed, sizing and what are the risks? Sharing a few thoughts and some philosophy about current topics with breast augmentation, Dr Howard Klein tells it like it is from a surgeon’s perspective.
1. Implant Types
In this part of the world for cosmetic breast augmentation textured anatomical implants have been popular for many years. I’m not so sure why this is and has been the case, but many surgeons use these devices and are quite happy with them.
Anatomical Implants Vs Round Implants
Surely it is possible to get an excellent result using these devices. Having said this, I have always been a proponent of a smooth round breast implant. In my experience I believe them to be softer, less prone to position problems and in most women provide the needed upper pole fullness.
While it is appealing intellectually that you might want a breast shaped implant to augment the breast, you are in fact putting in an implant with less volume in the upper pole when many women desire more volume in their upper pole.
Since my preferred implant is round we never encounter rotation problems with these implants as there is no upper pole to shift. For most women with normal shaped breasts, I believe a round implant is the shape of choice.
Textured Vs Smooth Implants
Texturing of the implant is another hot topic of debate amongst plastic surgeons. There have been many ways to texture breast implants in the hope that we could decrease the incidence of capsular contracture. In my experience capsular contracture is a problem that has dramatically decreased in the last several decades.
In our practice, it is reasonably unusual to see a patient with symptomatic capsular contracture after breast augmentation. In my opinion, there is not compelling evidence in the plastic surgery literature that clearly indicates textured breast implants offer a substantially decreased risk of capsular contracture as an isolated variable.
There are some circumstances where a textured implant may offer advantages especially in patients requiring breast implant reconstruction after mastectomy. In this case, the shape of the implant does indeed determine the shape of the breast, but for your average breast augmentation patient I continue to believe that a smooth round implant is generally the best option.
Just a brief word about saline implants, although saline implants may be appealing, they do have a significantly higher failure rate in terms of leaking the salt water than modern cohesive gel implants. Additionally, in my opinion saline implants don’t provide the same natural feel and softness that a silicone gel implant provides.
2. Implant Placement
There are two main choices to make in terms of determining placement of a breast implant. The implant may be placed below the pectoralis muscle or above the pectoralis muscle.
Although there are specific indications for doing one or the other, in my experience for most primary breast augmentations, a patient gets a softer more natural result with placement of an implant below the pectoralis muscle.
In our practice we have women who are professional athletes, yoga instructors and patients with serious physical and athletic pursuits that all have had their implants placed below the muscle. I believe there is a more natural take off from the upper chest and the margins of the implant are more easily hidden.
Very thin patients are another group in which sub muscular placement is highly recommended. During the consultation process your surgeon will talk about implant type and implant placement.
3. Implant Sizing
Sizing can be simple or complex. Generally speaking the sizing process is more complex in textured anatomical implants. Since we prefer smooth round implants much of our sizing decisions are based on a patient’s chest wall measurements.
Generally speaking if we match the diameter of the breast implant with the patient’s chest wall measurement, then the post-operative appearance is consistent with the patient’s body size.
Many patients experience some anxiety as to whether or not their new breasts may look out of proportion to their body stature. Harmonising implant width with a patient’s chest wall measurements is an excellent way of making the right size choice and getting the maximum result.
Additionally, within the base diameter of the implant we can make several decisions on how much projection the implant will provide, and patients wanting a more subtle look can have a low profile implant and patients wanting a fuller look a high profile or ultra-high profile implant.
4. Breast Implant Associated ALCL
Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA ALCL) is a rare form of cancer that has been identified in the last few years. It seems to be associated almost exclusively with textured breast implants. Treatment for ALCL mostly involves removing the implant and the scar tissue around the implant (the capsule) which is generally curative. In some unusual cases ALCL requires additional chemotherapy.
ALCL remains an extremely unusual problem considering the number of breast implants placed around the world, and there is a great deal of research going on currently trying to identify its exact nature.
There have only been a handful of BIA ALCL cases that have been associated with smooth implants. This has led some researchers to believe that perhaps the texturing process in some implants may influence some sort of process that causes these abnormal cells to form.
ALCL generally presents a long time after breast implants are placed. Any patient who presents with a sudden increase in fluid around long standing implants should be evaluated for ALCL. It’s my feeling that ALCL has probably been around for a long time, but not identified as a specific condition until recently.
This new emphasis on ALCL reinforces the idea that patients who have implants should always be followed up if anything about their implants change over a period of time. In our practice we have an information sheet regarding BIA ALCL and this is discussed with each patient.
Hopefully you have found the above thoughts from Dr Howard Klein useful regarding his personal philosophy around the common issues in breast augmentation. If you have specific questions regarding breast implants in New Zealand don’t hesitate to contact the professional team at Howard Klein Plastic Surgery.