In these sections we
will present your various options in breast implants, including
the available shapes, sizes, fillers and surface variances.
We will also cover the available implant placements. It is
very important to educate yourself regarding your options so
that you are able to make a truly well-informed decision.
*It is very
important to mention that TUBA patients are offered
saline-filled breast implants only. For this very reason
we will not cover silicone gel-filled or cohesive silicone
implants as much as we will be discussing saline. If
you wish to have silicone gel-filled breast implants, you cannot
choose the transumbilical method. This would be like
trying to squeeze a grapefruit through a straw. It is
practically impossible. Your surgeon will usually insert a
silicone gel-filled breast implant through an incision in the
mammary fold or around the areola.
Status of Saline & Silicone-filled
Breast Implants - Breast
Saline-filled breast implants have been officially approved in the U.S.
since May of 2002. Only two companies, Inamed Corp. (formerly McGhan
Medical) and Mentor Corp. were given this approval. Although
breast implants were available before the official approval
date. I, myself, first got saline breast implants in 1998.
breast implants are not yet approved in the U.S. however one
manufacturer, Mentor Corp., received a pre-approval nod from the
F.D.A. panel on April 16, 2005. Inamed was not granted a recommendation
on April 13, 2005. Although
this very well may have been a deficiency in paperwork as both
implants are comparable. Interesting to note is that
Mentor's manufacturing process takes place within the United Sates,
Inamed's in Costa Rica, making it easier for inspections to take
place for Mentor.
Implant Types Available in
Transumbilical Breast Augmentation
Since you are opting for the transumbilical method, your
surgeon will use a saline-filled breast implant. Breast
implant shells are manufactured from a very strong
silicone elastomer which may be smooth or textured, depending,
upon the model. These implants are deflated of any air, rolled up and inserted
into the navel, up into the track and into the proper placement
under the breast mound or pectoral muscle. The implant is
then filled intra-operatively with a sterile
available shapes include
include round, and contoured styles, otherwise known as tear drop or
anatomical. These implants are now available in low
moderate, and high profile options. The two most commonly
used implants are round and smooth but come in moderate or high
profile. Please discuss with your surgeon at your
consultation if he, or she, chooses to offer his patients
different choices in projection.
Inamed's saline implants range in sizes of 120cc
(with a maximum fill volume of 150cc) to 800cc (with a maximum
fill volume of 850cc). The most commonly used saline
implant from McGhan is the McGhan Style 68 (smooth/round). Although
these implants are commonly overfilled to reach larger sizes and
to lessen the chances of rippling.
offers a similar smooth, round implant (Mentor Style 1600) in
sizes from 125cc (with a maximum volume of 150cc) to 700cc (with
a maximum fill volume of 775cc). These, too, are often
overfilled to reach larger sizes and to lessen the chances of
High and low profile
implants come in different sizes and have different optimum fill
volumes so please check with your surgeon about the
specifications that will suit your size frame and your desired
placement is an issue which defines the general appearance of
the breast. The amount of
pre-existing breast tissue is also a determining factor for
implant placement. The three placements are sub-glandular,
sub-pectoral and full sub-muscular.
implants can be placed above the muscle in a patient with
adequate breast tissue. This position is best when
utilized by patients with larger breasts, which may sag slightly
and also in patients who wish to have a more natural movement.
However, in breast implants which are overfilled to hinder the
possibility of rippling, the implant can be palpable. The
implant's edges may be seen and felt in some patients with this
placement. In the sub-glandular position the implant is
placed above the pectoralis major, yet beneath the natural
glands of the breast. This placement has a shorter
recovery time than the next two due to no dissection of the
patient's muscles. Some surgeons believe the sub-glandular
placement carries with it a higher incident of capsular
contracture, or a painful hardening of the fibrous capsule
around the implant.
placement is best for patients who wish to achieve a more
natural look or who have little or no breast tissue, and/or have
thin skin. The placement does create an unnatural
appearance when the pectoral muscles are utilized however, the
trade off is thought to be a fair one by many. The implant
is placed under the pectoralis major muscle which fans from the
arm and underneath the breast. The pectoralis major covers
approximately 2/3 of the breast implant to help hide the edges
of the prosthesis in smaller breasted women. This
placement unfortunately carries with it a longer recovery time
and possible implant displacement. It is thought my some
surgeons to help prohibit capsular contracture.
sub-muscular placement is not offered by many surgeons but is an
option. The implant is placed underneath the pectoralis
major muscle as with the sub-pectoral placement but also covered
with the use of the serratus muscles which reside at the side of
the ribs and under the muscle fascia of the rectus abdominus of
the abdomen. It can offer support and an increased healing
time, was well as an increased time for implant settling.
Some surgeons believe this placement has the least percentage of
Implant Fill/Overfill Volume
Implant fill volumes are determined by the implant
manufactures and are set as guidelines per implant size.
Let's say a McGhan smooth, round Style 68 comes in 480 cc size.
The implants lowest recommended fill amount would be 480 and
it's highest recommended fill amount being 510cc. These
are set guidelines by the implant manufactures. Many
surgeons will fill more than the recommended fill amounts for a
standard average about about a 30 to 50cc overfill.
This is thought to help prohibit rippling and assist in
lengthening the implant's lifespan by disallowing folding of the
prosthesis with each breath so that no weak areas are made via
the creasing associated with this folding action.
amounts vary with each surgeon and also on a case by case basis.
Please discuss this with your surgeon to determine if he or she
even practices overfilling the prosthesis.
Just as with your vehicles and DVD player having a warranty,
as do your breast implants. Both McGhan (Inamed) and
Mentor have 2 warranty options each. There are standard
warranties, and extended warranties. For more information,
please see our Breast Implant
Warranty Information Section.
As with any surgery, risks, contraindications and
complications are a possibility. Although choosing a
qualified and experienced surgeon can significantly reduce your
chances of a negative experience--problems can arise. TUBA
can have just as many, if not a few less, possible complications
than a standard incision breast augmentation surgery.
standard pre-operative blood tests and physical examinations can
be ordered, negative reactions to anesthesia are inherent.
Although the chances are small, patients may experience
allergic-type reactions which can range from getting a little
nauseated to a life-threatening emergency.
non-anesthesia related complications may include infection, loss
of nipple sensitivity (although with TUBA a .5% chance is
possible, numbness of the breast envelope, irregular scar
tissue, implant displacement, synmastia/symmastia, bottoming
out, galactorrhea (lactation), calcifications, implant
extrusion, implant deflation, future breastfeeding
complications, rippling (palpability of the scalloped edges of
the implant), thrombophlebitis (inflammation of an epigastric
vein of the thorax) and general dissatisfaction. Other
surgical complications may include hematoma (or a collection of
blood within the tissues), seroma (fluid collection within the
tissues) and thrombosis (clots lodged in a vessel).
made from collagen fibers naturally form around any
foreign object that is placed in our body, in this case the
foreign object is a silicone-shelled breast implant.
It is speculated that the capsule forms to shield the body from
the foreign object by creating a fibrous wall of tissue in
between the two. It is also speculated that the tissue
capsule prevents friction within the body cavity. The key
point here is that capsule formation is normal. The
tightening, or contraction, of this capsule, however, is
when problems begin to surface. This is called Capsular
Contracture and is often the bane of the breast augmentation
patient' existence. Please see our Capsular
Contracture Information Section for more on this
include women who are pregnant or nursing, those with terminal
illnesses, patients with diabetes or wound healing disorders,
and those who have allergies to silicone. Please discuss
the risks and complications with your surgeon for more
Perhaps you remember the silicone implant scare of the
1980's and early 1990's? Silicone is any of the
"various polymeric organic silicon compounds obtained as
oils, greases, or plastics and used especially for
water-resistant and heat-resistant lubricants, varnishes,
binders, and electric insulators" (Merriam-Webster) It
is also found in processed foods, cosmetics, medications and all
sorts of products that you are exposed to and ingest on a daily
basis. It is also used to lubricate medical devices such
as tubing, hypodermic needles and is found in the food industry
as being used to lubricate blenders, frozen drink machines,
piping, cooking utensils, and machines.
are synthetic polymers and are made by combining oxygen and
silicon and in high temperatures and pressures can produce
polydimethylsiloxane (PDMS). The fluids are made from
linear chains of PDMS whereas the gels are lightly crosslinked
to give it a thicker cohesive-ness. Although without a
container such as a highly cross-linked silicone elastomer
breast prosthesis the silicone gel takes on no shape of its own
and is very vulnerable to gravity and momentum, if applicable.
The elastomer implant shells contain very little free PDMS so
that it remains a solid. However "like can not hold
like" so the lower weighted molecular silicones leach
through the elastomer shells - even with the presence of
protective inner barriers. Silicone gel bleed can cause
local inflammation and granulomas.
said that, there is no conclusive evidence in any study by any
major, respected organization that can establish a direct or
indirect link of any connective tissue disease or cancer with
Although there is
not the same amount of maintenance related to breast
augmentation surgery as comparable to owning a vehicle, there is
a particular type of upkeep which must be carried out to keep
your breasts and general health in optimum order. Although
bacterial infections are most common within the first week or
two, it can occur even within the first year of implantation.
Some surgeons suggest that you take a few antibiotics in the
event you need dental work or experience excessive plaque or
dental carries which must be dealt with. Other incidents
such as blood borne- infections and other type of bacterial
intrusions can causes problems in the breasts around the mammary
prosthesis. Infections can cause extrusion and large
amounts of pus to form, necessitating a removal surgery and a
strict course of antibiotics such as Cipro or Levaquin. In
the event that a bacterial infection forms in the implant
pocket, after the implants are removed the patient must wait
several months before a replacement surgery. In
cases where an actual pocket bacterial infection is not present,
capsular contracture can form after a problematic bacterial
infection within the body.
massage is also a step which many breast augmentation patients
undertake every single day. Manual massage of the implant
and pocket keep the implant soft and mobile. Without
massage it is possible that your implants fibrous capsule may
begin to contract and become very hard and painful. Please
discuss massage with your surgeon as not every surgeon instructs
this type of exercise.
and Breast Self-examinations
Having a mammogram every year as you get older and consistently
examining your breasts every month at home are important steps
in making an early diagnoses and increasing your chances of a
full recovery, in the event of breast cancer or other
irregularities. Please see our section on Mammograms
and Breast Self-examinations for more information.
about the procedure
risks & complications
(Updated on 02/23/10)
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