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Breast reconstruction plastic surgery
To get answers to the most frequent questions about breast reconstruction
plastic surgery and the types of breast implants, please select
one of the links below:
Are any other types of implants available?
At this time silicone gel implants are available for restricted,
investigational use. Trilucent breast implants which have a soybean
oil filling were withdrawn from sale in England in March 1999
by the British Government. On June 6, 2000 their Medical Devices
Agency recommended that women with these Trilucent implants should
have them removed.
Additional information is available at http://www.nhsdirect.nhs.uk
and from the manufacturer's site at http://www.trilucentinfo.com.
Who is not eligible for reconstruction with
breast implants?
Aside from women, who for various reasons, may be best served
by either reconstruction utilizing an autologous technique or
who should not undergo reconstruction at all, implants are contraindicated
for patients with cancer or precancerous conditions that have
not been treated adequately and patients with active infection
anywhere in the body.
How reliable are saline breast implants?
While the exact longevity of any breast implant cannot be predicted
with certainty, saline implants are quite reliable. Failure of
saline implants is primarily associated with either incompetence
of their valves or "fold-fatigue."
According to data recently submitted to the FDA, the one-year
risk of deflation is approximately 2%, and the three-year risk
is approximately 5%. While saline implants are largely reliable,
the odds of requiring implant replacement are significant.
Recent data presented to the FDA revealed that about 18% of implants
placed for reconstructive use would require removal for any reason
within three years. Additional surgery will be necessary within
three years in 33% of implants. The most common reasons for implant
removal were leakage/deflation (31%), capsular contracture (21%),
infection (10%), and patient request for a change of size or style
(23%).
How do I know if my saline breast implant is
leaking?
In most cases, when a saline implant ruptures, the harmless saltwater
solution spills into the surrounding tissues within a few days.
Slow leakage (partial deflation), which can occur over a long
time period, is extremely rare.
Can I be any size I want?
There is some opportunity for choice of ultimate breast size
although the size is most commonly chosen to provide the best
match for the opposite breast.
If a change in size of the opposite breast is planned, then this
anticipated change must be considered in the size choice for the
reconstructed breast.
What are "adjustable implants"?
Some saline implants have valves that allow them to be inflated
gradually following surgery.
One manufacturer makes an implant known as the "Becker implant"
that functions as both a tissue expander and as the permanent
implant. It enjoys some popularity among plastic surgeons today.
The Mentor Corporation manufacturers an implant called the "spectrum,"
utilizing a remote filling port, which allows for some adjustment
of size post-operatively. A final size must be chosen within six
weeks, at which time an in-office surgical procedure is needed
to remove the remote filling port.
Does the implant go above or below the muscle?
While cosmetic breast augmentation implants are commonly placed
above the pectoralis muscle as well as below, we feel it's important
to place all reconstructive implants behind the muscle because
the muscle provides important padding as it covers the implant.
The muscular coverage is especially beneficial in its upper pole
where the edge of the implant needs camouflage and adjacent to
the mastectomy scar where wound healing problems are avoided.
It is not as critical and may be less optimal to cover the lower
pole of the implant with muscle because of the need to obtain
more relaxed soft tissue in this area.
Do breast implants cause human disease?
A discussion of this issue could easily fill several volumes,
and significant medical-legal overtones have made this question
difficult to answer.
The FDA has
produced a well-written informational booklet addressing this
concern, and we highly recommend that patients who are considering
breast implants for either reconstructive or cosmetic purposes
review this document.
Silicone is widely used in a variety of consumer products including
foods, cosmetics and as lubricants in developed countries. Numerous
review groups have established the safety of silicone as a biomaterial
for human use. In 1998 an independent National Science Panel,
appointed by the judge for the Federal Breast Implant Multi-District
Litigation, found no evidence linking silicone breast implants
to systemic disease.
The Independent Review Group, organized in the United Kingdom,
concluded that, overall, silicones found in breast implants had
minimal toxicity and no adverse effect upon the body's immune
system.
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454-0044.
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