Implant Surgery

What is Breast Implant Surgery?

Breast implant surgery, also known as breast augmentation, is a cosmetic procedure designed to enhance the size and shape of a person's breasts. The surgery involves placing implants under the breast tissue or the chest muscles. These implants can be made from silicone, saline, or alternative composite materials, each designed to mimic the feel of natural breast tissue while improving the breasts' appearance.

Who is Suitable for Implant Surgery?

Breast implant surgery is suitable for individuals who meet the following criteria:

Physical Health: Individuals should be physically healthy without active infections or untreated cancers.
Age: According to FDA regulations, patients must be at least 18 years old for saline implants and 22 years old for silicone implants.
Realistic Expectations: Candidates need to have realistic expectations about the outcomes of the surgery.
Lifestyle Considerations: Non-smokers or those who can stop smoking for a period before and after the surgery are ideal candidates, as smoking can hinder the healing process.

This surgery is often sought by individuals looking to enhance their body image, reconstruct the breast following a mastectomy, or correct congenital deformities.

Benefits of Implant Surgery

Enhanced Appearance: Implants can improve the size and shape of the breasts, leading to a more proportionate and aesthetically pleasing figure.
Improved Self-Esteem: Many patients report increased self-confidence following their surgery.
Reconstruction: Breast implants can be used for reconstructive purposes for those who have undergone mastectomy or have congenital breast deformities.
Longevity of Results: While not permanent, breast implants can last many years without needing replacement.

Types of Breast Implant Surgery

There are several types of breast implant surgeries, based on the kind of implants used and the specific surgical techniques:

Saline Implants: These are filled with sterile salt water during surgery, allowing for minor size adjustments.
Silicone Gel Implants: These are pre-filled with silicone gel, which feels more like natural breast tissue than saline.
Cohesive Gel Silicone Implants: Also known as "gummy bear" implants, these retain their shape even if the implant shell breaks due to the thicker consistency of the silicone gel.
Placement Techniques: Implants can be placed either submuscular (under the pectoral muscle) or sub-glandular (over the pectoral muscle and under the breast tissue), depending on the desired outcome and the patient’s anatomy.
Incision Sites: Common incision sites include under the breast (inframammary), around the nipple (periareolar), in the armpit (transaxillary), and even through the belly button (transumbilical, though less common).

Preparation Before Implant Surgery

Medical Evaluation: You should undergo a full medical evaluation to ensure you are healthy for surgery. This may include blood tests and a baseline mammogram.
Medication Review: Discuss any medications you are taking with your surgeon, as some may need to be adjusted or stopped before surgery, especially those that can increase bleeding risk, such as aspirin or certain anti-inflammatory drugs.
Quit Smoking: Smoking can significantly impair your ability to heal. Quitting smoking several weeks before the procedure is generally advised.
Arrange for Help: Plan for someone to drive you to and from surgery and to stay with you for at least the first night after the operation.
Avoid Certain Foods and Medications: Follow your surgeon's advice on avoiding certain foods, supplements, and medications that might interfere with anaesthesia or recovery.

Breast Implant Surgery Procedure

Anaesthesia: You will be given general anaesthesia, which means you will be asleep and pain-free during the procedure.
Incisions: The surgeon will make incisions in predetermined locations (under the breast, around the nipple, under the arm, or in the belly button) based on the type of implant, degree of enlargement, and your particular anatomy.
Inserting and Placing the Implant: The breast implant is inserted into a pocket either:
Under the pectoral muscle (a submuscular placement) or
Directly behind the breast tissue, over the pectoral muscle (a sub-glandular placement).
Closing the Incisions: Incisions are closed with layered sutures in the breast tissue and with sutures, skin adhesive, or surgical tape to close the skin.

Breast Implant Surgery Recovery Plan

First Week: Rest is crucial. Follow your surgeon's instructions on how to care for your breasts following surgery, including medications to apply or take orally to aid healing and reduce the risk of infection.
Two to Six Weeks: Gradually return to daily activities as comfort allows. Continue to avoid heavy lifting or vigorous exercise until cleared by your surgeon.
Long-term Care: Attend follow-up appointments to monitor your implants. Healing continues for several weeks as swelling decreases and incision lines improve.

Implant Surgery Prognosis

Most individuals achieve the aesthetic or reconstructive goals they set out for, with improved body image and self-esteem. Advances in surgical techniques and implant technology have also helped enhance the safety and outcomes of the procedure. However, it's important to have realistic expectations and understand that results can vary based on individual factors like health, body type, and adherence to post-surgical care.

Implant Surgery Risks

Like any surgical procedure, breast implant surgery carries potential risks and complications, which include:

Infection
Capsular Contracture
Implant Leakage or Rupture
Changes in Sensation
Breastfeeding Difficulties
Cosmetic Issues

What if Implant Surgery is Delayed?

If the surgery is delayed for personal reasons, such as needing more time to consider the decision or prepare physically and mentally, there are generally no negative consequences. It’s important to be fully prepared and confident in your decision.

Suppose the delay is due to medical reasons, like controlling high blood pressure or quitting smoking to enhance surgical safety and recovery. In that case, this delay can lead to a better outcome by reducing the risk of complications.

Implant Reconstruction

Breast implant reconstruction is a type of surgery performed to rebuild the shape and look of a breast, typically after mastectomy (breast removal) due to breast cancer. This procedure can improve many women's psychological well-being and quality of life.

Types of Implant-Based Reconstruction

Immediate Reconstruction: This occurs at the same time as the mastectomy. The surgeon begins the reconstruction process by placing a breast implant after removing the breast tissue.
Delayed Reconstruction: This is done months or years after mastectomy. It often starts with the placement of a tissue expander to stretch the skin and create room for a future implant.

Phases of Implant Reconstruction

Tissue Expander Placement: Often, the first step involves inserting a tissue expander beneath the skin and chest muscle. The expander is gradually filled with saline over several weeks or months to stretch the area.
Exchange Surgery: Once the skin over the breast area has stretched sufficiently, another surgery replaces the expander with a permanent implant.

Types of Implants Used

Saline Implants: These are filled with sterile salt water. They are generally filled after placement, allowing the surgeon to adjust the volume.
Silicone Implants: These are pre-filled with silicone gel, which feels more similar to natural breast tissue than saline.
Cohesive Gel Silicone Implants: Known as "gummy bear" implants, these maintain their shape better than traditional silicone implants because they contain a thicker, more cohesive gel.

Advantages of Implant Reconstruction

Aesthetic Control: Implants provide volume and shape, offering a symmetrical and aesthetically pleasing result.
Shorter Recovery: Compared to a flap reconstruction, which uses a patient’s tissue, implant surgery typically involves a shorter and less painful recovery period.
Less Invasive: No additional surgery sites other than the breast area are involved, unlike autologous reconstruction, which requires tissue transfer from another body part.

Risks and Considerations

Capsular Contracture: The formation of tight scar tissue around the implant can cause the breast to feel firm and can be painful, requiring further surgery.
Implant Failure: Implants can rupture or leak over time, necessitating replacement.
Limited Longevity: Implants do not last a lifetime and may require replacement after several years.

Implant Removal

Breast implant removal, also known as explant surgery, is a procedure to take out previously placed breast implants.

Reasons for Implant Removal

Capsular Contracture: This is one of the most common complications where the scar tissue that forms around the implant hardens and may cause pain and discomfort.
Implant Rupture or Leakage: Saline implants deflate when broken, and the body absorbs the saline. Silicone implant ruptures are less noticeable and may require imaging tests to detect.
Cosmetic Concerns: Some individuals may be dissatisfied with their implants' size, shape, or appearance and choose to have them removed or replaced.
Health Concerns: A small number of people develop symptoms they feel are linked to their implants, often referred to as breast implant illness (BII), which might prompt them to decide on removal.
Ageing Implants: Breast implants are not lifetime devices; replacement or removal may be needed as the implants age.

Procedures for Implant Removal

Simple Removal: The surgeon removes the implant and, if necessary, some of the surrounding scar tissue.
Capsulectomy: This procedure involves removing the scar tissue capsule surrounding the implant. Depending on the situation, this can be either partial or total.
En Bloc Removal: If possible, the surgeon removes the implant and the surrounding capsule as one unit without breaking the capsule. Patients often request this technique because they are concerned about exposure to silicone from a ruptured implant.

Recovery and Aftercare for Implant Removal

Recovery from breast implant removal surgery generally involves:

Rest and Limited Activity: Patients typically need to rest and limit physical activities to allow the surgical site to heal properly.
Pain Management: Some discomfort, swelling, and bruising are normal, and pain can usually be managed with prescribed or over-the-counter pain relievers.
Support Garments: Wearing a supportive bra or compression garment may be recommended to help reduce swelling and support the breast tissue.

Outcomes and Considerations for Implant Removal

Cosmetic Changes: After implant removal, breasts may not revert to their pre-implant appearance. They may appear deflated, saggy, or irregular in shape, depending on the duration the implants were in place, the size of the implants, and skin elasticity.
Additional Procedures: Some individuals may opt for further procedures at implant removal, such as a breast lift (mastopexy), to address changes in the breast tissue and skin.
Emotional Adjustments: The change in body image post-surgery may require an emotional adjustment. It’s important to have realistic expectations and, if needed, seek support during this transition.

Breast Implant Exchange

Breast implant exchange, also known as implant replacement, is a surgical procedure where old breast implants are removed and replaced with new ones.

Reasons for Implant Exchange

Cosmetic Changes: Individuals may change the size, shape, or type of their implants to better suit their aesthetic preferences or changes in body image over time.
Implant Complications: Issues like capsular contracture, implant rupture, or leakage can necessitate an exchange.
Implant Lifespan: Breast implants are not lifetime devices. Over time, the risk of complications increases, and many choose to replace their implants preemptively after 10-15 years.
Desire for Newer Technology: As implant technology advances, some may replace older implants with newer, more advanced models for better aesthetics or feel.

Breast Implant Exchange Procedure

Incision: To minimise additional scarring, the procedure often uses the same incision sites as the original implant surgery. These could be under the breast (inframammary), around the nipple (periareolar), in the armpit (transaxillary), or the belly button (transumbilical).
Removal and Replacement: The old implants are carefully removed. If there is significant scar tissue (capsule), the surgeon may perform a capsulectomy, removing some or all of the capsule. New implants are then placed, which might be of the same type or different, depending on the patient’s choice and clinical recommendations.
Closure: The incisions are closed with sutures; in some cases, drains might be placed to help remove excess fluid.

Implant Exchange Recovery

Recovery from an implant exchange surgery can be similar to the initial breast augmentation, but many report it to be quicker and less painful since the muscles and skin have already been stretched. Typical recovery includes:

Downtime: Most patients can return to work and light activities within a week, although complete recovery and return to full activities may take a few weeks.
Pain and Discomfort: Generally managed with prescribed or over-the-counter pain relievers.
Care for Incisions: Following the surgeon’s instructions for incision care is crucial for preventing infection and promoting healing.

Considerations and Outcomes for Implant Exchange

Expectations: It’s important to have realistic expectations about the results of an implant exchange. Discussing potential outcomes with your surgeon can help align expectations with likely results.
Aesthetic Results: Implant exchange can often improve the appearance of the breasts by updating the size or type of implants, correcting any previous issues, and adjusting to changes in body shape or size over the years.
Health Considerations: For those experiencing complications from old implants, such as pain or systemic symptoms suspected to be related to the implants (a condition sometimes referred to as breast implant illness, though not officially recognised), implant exchange or removal can potentially alleviate these symptoms.

Individuals considering an implant exchange should thoroughly discuss their goals, expectations, and any potential risks with a board-certified plastic surgeon who has experience in breast implant surgeries. This ensures a clear understanding and helps achieve the most satisfactory results.