Breast Implants

IMPLANT SHAPE: - Breast implants can be anatomical (tear drop shaped) or round. With round implants the shape adopts a natural "tear-drop" shape when the implant sits upright (this can be seen on the photograph on this page which shows an anatomical implant on the left and a round implant on the right). So, in effect, anatomical shaped implants have an even more droopy shape than round implants. Anatomical implants carry the additional risk of rotation within the breast pocket. If this happens it can lead to an obvious abnormal shape to the breast. If round implants rotate they will not cause this problem. This is one reason why round implants are often preferable to anatomical ones. For certain patient though (particularly very thin patients) anatomical implants are preferable.

IMPLANT COMPOSITION: - All implants have a silicone shell. Within the implant the "filling" is composed of either saline or silicone. Modern implants contain a cohesive silicone gel within them. The gel feels soft and natural but maintains it's shape better than older implants. These implants are less likely to cause visible rippling through the skin (see below for more information on rippling under the complications section). Because modern silicone implants are "semi-solid" they won't be as likely to leak silicone if the implant ruptures or breaks. If you were to cut into a modern implant it would be like cutting into a gummy bear (see photo on this page). Some implants have a "Polyurethane" (foam) coating around the outside. There is some evidence to suggest that these implants may lead to a reduced risk of capsular contracture (again see below for more information on capsular contracture under the complications section). However this is debated in the scientific literature.

IMPLANT TEXTURE: - Some implants are textured. This can help to stop them rotating. Textured implants seem to be linked with the very rare condition ALCL (see more details on this below under the complications section). Anatomical implants are typically textured, to help reduce the risk of rotation. Round implants can be smooth instead of textured. Overall smooth round implants are probably the safest implant option, leading to excellent results in the majority of patients.

IMPLANT PLACEMENT: - Breast implants can either be positioned under the chest muscles (known as the pectorals major muscles, sometimes called "pecs") or can be placed directly underneath the breast tissue. In very thin patients it may be necessary to place the implant under the chest muscle to create additional "padding" over the implant. This extra padding means that the implant is less visible under the skin. However, placing the breast implants underneath the muscle can be more painful and may lead to "animation deformity". Animation deformity is when the breast can be seen to move when the muscle contracts. (see more details on animation deformity under the complications section). It is interesting to note that photographs on websites will not be able to demonstrate animation deformity as this can only be seen on a video!

Anatomical (left) vs Round (right).

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Modern Implant cut in half

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RISKS ASSOCIATED WITH BREAST IMPLANTS

Capsular Contracture (this is the formation of hard scar tissue around the implant). This is unpredictable and does not occur in all patients and usually develops slowly over several years. A capsule is much more likely to occur if radiotherapy is given to the breast (which is sometimes required for patients who have breast cancer). Capsular contracture can lead to a hard and painful breast. The capsule tends to squeeze the soft implant and can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the capsule itself, or perhaps removal or replacement of the implant. However, having formed once, a new capsule may well form again in time.
Visible implant folds or ripples. These folds or ripples can sometimes be seen through the skin. When this occurs patients sometimes do not like the appearance. With modern cohesive gel implants rippling is less likely to occur but can still happen.
Infection. If infection occurs then the implant will usually need to be removed. It is important to wait for up to 6 months before then replacing it with a new implant. This is because if an new implant is placed sooner than this the risk of a new infection is much higher.
Change in Nipple Sensation. Some women find that their nipples become more or less sensitive after breast augmentation, or even completely numb. Sometimes small patches of numbness occur near the incisions as well. These symptoms usually disappear within time, but in some patients the change in sensation can be permanent.
Implant Rupture. Implants can rupture (or break) over time. Sometimes implant rupture can occur without any apparent symptoms or problems. If an implant rupture is detected (for example on a scan or because of a change in the shape or feel of the breast) then surgery is required to replace the broken implant with a new one. There is no evidence that a ruptured implant causes ill health.
Implant Rotation or Movement. This can lead to a mis-shapen breast and sometimes requires corrective surgery.
Silicone leak. Leak of silicone around the implant or up into the lymph nodes in the armpit can sometimes cause problems and the lymph nodes may swelling up or enlarge. This has the potential to affect the flow of fluid within the arm and may even lead to swelling of the arm.
Need for maintenance. Further surgery is sometimes required in the years to come e.g. implant replacement if the implant is broken or problematic. This will usually lead to additional cost.
Animation deformity. This refers to movement of the implant with muscle contraction. Implants placed underneath the muscles of the chest (pectoralis major muscles sometimes called "pecs") can been seen to move when the muscle contracts. Implants placed under the muscle can also sometimes be painful.
Anaplastic Large Cell Lymphoma (ALCL). This rare form of slow-growing cancer is currently reported to occur in 1:24,000 cases of breast implants although the information available on this condition is changing as we learn more about it. This is a type of low grade (slow growing) cancer that tends to present several years after implant placement with a swelling (seroma) within the breast. Most patients can be treated effectively with capsulectomy and implant exchange however there have been some deaths reported. For more information please visit the BAPRAS website.