What is Breast Implants?
Breast implants have come a long way since the 1990s and are one of the most common cosmetic procedures today. The options have expanded to include cohesive gel implants, highly cohesive gel (or ‘gummy bear’) implants, saline implants, and structured saline implants that come in varying shapes and surfaces. These diverse choices even include the recently approved structured saline implants.
The history of breast enhancement dates back to 1895 when attempts were made at fat transfers. Subsequent techniques included injecting paraffin and using glass balls and ivory. In the 1950s, sponge implants started to be produced commercially, but they often led to the breasts hardening, infections, and the implants wearing away over time. Due to these issues, breast enhancement surgery didn’t gain popularity until the 1960s when silicone gel implants were introduced.
The use of silicone in augmentation started in the 1940s and grew in popularity after World War II. Silicone was even used in medical devices in the 1950s. There are stories about silicone being injected into women’s breasts during WWII, which often led to complications like pain and loss of the breast because the silicone would often move from where it was injected. In 1962, Dr. Thomas Cronin created a shell to contain the silicone gel and collaborated with the Dow Corning Corporation a year later to produce the type of breast implant we’re familiar with today. Saline implants became available too once shells were used but had more consistency issues and had a higher failure rate, with it estimated to be more than 75%.
The designs and styles of implants have seen many changes in response to problems faced by patients. From external patches and polyurethane-coated shells to softer gel fills, to shells designed to prevent silicone oil from leaking out. The gel inside the implants was also made more cohesive, meaning it sticks together rather than breaking off into small pieces that could spread to nearby tissues.
In 1992, the FDA temporarily banned gel implants, making saline implants temporarily the only type available in the United States as they were considered safer. At that time, there were textured anatomic, textured round, and smooth round implants available. They could be filled with a range of volumes, which could help correct small asymmetries. Smooth round implants ended up becoming the favored choice once studies showed that they take on the same shape as other shaped implants when viewed from the side in an upright position.
The mid-2000s saw the introduction and FDA approval of cohesive gel implants. Experiments were conducted with varying levels of cohesiveness, and we now have highly cohesive, form-stable implants in various designs, and round saline implants in textured or smooth surfaces. The structured (bi-lumen) Ideal implant is a recent addition available for use. All companies offer similar guarantees for rupture and capsular contracture.
When gel implants became available on the market again, the FDA limited their use to women over the age of 22 unless they were being used for reconstruction. Gel implants can be used in patients under 22, but surgeons must warn their patients that their warranties might not be valid or honored by the manufacturer. It is hoped that the FDA will lift this age restriction in the future.
What Causes Breast Implants?
In the early 90s, there was a lot of debate surrounding breast implants. This was largely due to a TV show hosted by Connie Chung, which suggested that implants could cause autoimmune illnesses. These fears came about from stories people told linking gel implants to serious diseases like connective tissue disorders and even cancer. Because of these concerns and due to lack of research proving that they were safe, the FDA halted the use of gel implants.
This action led to a large lawsuit that was settled in 1994 and caused the company Dow Corning to file for bankruptcy. For a good while, saline implants were the only type available. Gel implants only became available again in the mid-2000s.
Risk Factors and Frequency for Breast Implants
In 2000, the Institute of Medicine released a report on the research conducted on implants. Their conclusions showed no proof that silicone implants cause any widespread diseases, and highlighted that implants are not designed to last forever. Attempts to contest these findings have so far been unsuccessful as no new contrary evidence has been discovered. However, in March 2017, the Food and Drug Administration (FDA) issued a warning about a possible link between textured implants and anaplastic large-cell lymphoma—now referred to as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The risk of this condition is estimated to be 1 in 30,000.
Signs and Symptoms of Breast Implants
When placing implants, it’s crucial to ensure a sterile environment. The implant should be dipped in an antibiotic solution before fully unpacking it. This helps to reduce the risk of foreign particles sticking to the implant. For saline implants, a ‘closed system’ method should be used when filling them. This means the saline liquid should never be exposed to the air, helping to avoid contamination. You can accomplish this by using intravenous (IV) tubing to transfer the saline from its source bag to the implant.
If you’re worried about the condition of an implant, simple exercises can usually reveal if it’s intact or not. For instance, using both hands to apply pressure on the augmented breast, trying to move the implant. If the implant is intact, it will push against your hand. However, if you can’t feel the implant at all, it might be compromised. This is especially true for gel implants. In the case of saline implants, a rupture would typically result in a smaller, more natural-looking breast mound with the lack of any discernible implant on examination.
Silicone implants could sometimes hide a rupture. This happens when the silicone stays trapped within the fibrous tissue capsule surrounding the implant, leading to what is called a ‘silent rupture’. There might be no obvious signs of a rupture in these cases. That’s why it’s recommended to have an MRI done every 2 years to evaluate the condition of the implant – though this isn’t strictly enforced and many patients do not follow this unless there are distinct issues or concerns. Sometimes, the capsule can become inflamed, causing pain, soreness, swelling, noticeable changes in breast shape or size, lumps, or hardening in the affected breast.
Testing for Breast Implants
If you’re worried about problems like bursting or movement of gel implants, you might need to have an ultrasound, mammogram, or MRI. With saline implants, it’s easier to tell when there’s an issue – one of the implant sites will get significantly smaller. In case you’re not sure, wearing a molded bra that doesn’t stretch and regularly checking your shape in it could help.
This way, if there’s any leak in the implant, you’ll notice an increase in space in your bra cup as the implant gets smaller—this points to a problem with a saline implant.
Treatment Options for Breast Implants
If a breast implant has ruptured, as seen on imaging tests or indicated by physical examination, surgery to replace the implant is usually advised. This is particularly the case if the person wants to keep the same size of their breasts. If not, the surgeon might simply remove the faulty implant. Sometimes breast lifting surgery, called mastopexy, may be needed to achieve the best appearance. If an implant filled with saline solution has deflated but is not causing any problems or symptoms, it might be left in place.
If the implant was originally placed underneath the pectoral muscle, the surgeon may need to repair the muscle to reduce or eliminate any unnatural movement of the breast that occurred as a result of this placement.
What else can Breast Implants be?
Doctors consider several possibilities when examining possible issues related to breast implants. These include:
- Breast cancer
- Capsular contracture (hardening of tissue around the implant)
- Cysts (fluid-filled sacs)
- Fat necrosis (damaged or dying fat tissues)
- Fibroadenoma (non-cancerous breast lumps)
- Fibrocystic disease (lumpy or rope-like breast tissue)
- Late hematoma (blood pooling around the implant, long after surgery)
- Late inflammatory or infectious process (inflammation or infection occurring some time after surgery)
- Papilloma (non-cancerous wart-like growths)
- Presence of seroma (fluid accumulation around the implant)
The goal is to identify any potential issues, with each possibility bearing its own set of complications that require different treatments.