Silicone breast implant

There have been considerable technological advances in the design and construction of silicone breast implants since their early days. They are made with much thicker, stronger and durable outer shells that are filled with a very cohesive silicone gel – almost like taffy. The result is that they will withstand much more and last longer on average compared to previous versions.

But, they will not last forever?

Of course not!

The FDA in 2006 recommended (not mandated) that women who have silicone implants inserted for a breast augmentation in Scottsdale or breast reconstruction should have an MRI (magnetic resonance imaging) three years postoperatively then every other year afterwards. There was no specific data supporting their recommendation, however. Given the expense of an MRI which often may not be covered by a woman’s insurance plan, is this a prudent recommendation? Is it worth the money?

A retrospective study was performed at the University of Michigan and published in the March 2011 issue of the Plastic and Reconstructive Surgery® journal which examined 21 previous studies that had evaluated MRI’s and their ability to detect silicone implant rupture. The findings of the combined data were quite interesting and enlightening.

What was confirmed was that MRI’s were fairly accurate in detecting implant rupture but this wasn’t the whole story. In those women who presented with symptoms related to their implants, MRI’s were 14 times more likely to detect a rupture than in those who were asymptomatic. Looking at this from a different angle, the MRI’s were less helpful in women who had no symptoms.

Given that silicone gel implants on average last in excess of 10 years, can one justify the expense of repeated MRI’s as a screening tool for implant rupture (and breast evaluation) in otherwise asymptomatic women at least during this period of time compared to a routine screening mammogram for cancer?

With the present technology and the findings from this study, the answer is probably not. Mammograms and or ultrasounds (which are less accurate in the detection of implant rupture) should be performed for routine breast cancer screening. If there is evidence or a suspicion of an implant rupture, then an MRI can be considered or performed.

For more information on silicone gel breast implants, breast enlargement surgery in scottsdale, breast reconstruction or for any other plastic surgery procedure that I perform please feel free to call my office at 480-451-3000. A consultation can be scheduled at that time as well.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

What are these implants called and how are they different?

Even more important: Are they available to use here?

The silicone breast implants that I am referring to have been labeled “gummy bear” implants because in some ways they have characteristics of the candy after which they were nicknamed. I’m sure that this doesn’t include  taste though someone probably has already checked this aspect out. The major way that these silicone implants differ from earlier versions is that the gel is highly cohesive and form-stable which means that it resembles taffy rather than a viscous gel and maintains a stable shape.

These implants have been used in breast enlargements elsewhere since the early 1990’s. Extensive research on these implants has been performed both in this country and internationally but unfortunately they have not been cleared for broader usage here yet by the FDA (Federal Drug Administration) although their approval may be imminent. (Note: Plastic surgeons in the United States have been under the impression for the last several years that FDA approval was imminently forthcoming … but we are still waiting.)

There are a few advantages of these form-stable silicone implants (as well as some disadvantages) over the present day cohesive gel silicone implants. They will last longer in general and there will be virtually no potential of “gel” migrating elsewhere. The risk of developing capsular contracture appears to be lower, somewhere around 3% versus 5 – 10% or more with the standard silicone implants.

The cost for these implants are yet unknown though they are expected to be significantly more expensive than the present day silicone implants. This may affect their popularity and selection to some extent. Ultimately, several factors will play a role in deciding which type of silicone implant would be the best choice.

If you would like more information on silicone gel breast implants, breast augmentation surgery or for any other plastic surgery procedure that I perform or if you would like to schedule a consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

The following patient of mine is a 54 year old woman who had her original breast augmentation performed 32 years ago which was followed by three pregnancies and three children (photos A, C and E). For the last several years she has noted firmness of both breasts and irregularities of shape. Her desire was to have larger, softer and more attractive appearing breasts but not very ostentatious.

A.) Before breast revision surgery (frontal view)

B.) After breast revision surgery (frontal view)

C.) Before surgery (oblique view)

D.) After surgery (oblique view)

E.) Before surgery (side view)

F.) After surgery (side view)

Her breast revision surgery consisted of removal of the old silicone breast implants which were still intact, resection of the calcified scar tissue that surrounded them (capsulectomy), recontouring of the pockets in which the implants were situated and placement of smooth surfaced, high-profile silicone breast implants which were substantially larger than the ones that they replaced. Their volume was selected based on her desired overall general cup size and was tempered to keep her outcome more age appropriate (photos B, D and F).

She experience little discomfort postoperatively and was up and around her house the day of surgery. The size, shape and proportionality were exactly what she had desired which made her quite happy, satisfied and proud.

For more information on breast revision surgery, breast augmentation or on any other plastic surgery procedure that I perform or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Silicone breast implant

Virtually all of my patients ultimately select silicone implants for their procedure, whether it is for aesthetic or reconstructive reasons. The very few cosmetic patients who do choose saline implants do so because of the cost differential: they are around $1,000 less per pair. The aesthetic outcome and satisfaction of my patients from these procedures irrefutably supports the far greater superiority of silicone implants as compared to the saline ones and this is true for both cosmetic and reconstructive procedures.

This preference has been borne out in the medical literature including a multicenter study just published in the November issue of “Cancer”. This study carefully examined and analyzed the responses of 672 women who had undergone post-mastectomy breast reconstruction using either saline or silicone implants at one of three major institutions in this country. The findings were statistically significant in that the level of satisfaction was much greater in those women who selected silicone implants to be used in their reconstruction as compared to the saline ones.

If you would like additional information on silicone or saline breast implants, breast augmentation, breast reconstruction or for any other plastic surgery procedure that I perform, please call my office at 480-451-3000. We would also be happy to schedule a consultation for you if you desire.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

This is absolutely a “young” wives tale, an urban (suburban and rural) legend without any factual basis. There is no fixed period of time after a breast augmentation or mastopexy with implants at which point breast implants should be replaced. Some implants may last only 5 years or even less (rare) whereas others may remain intact for thirty years or more.

In general, I inform my patients who are considering breast enlargement surgery that breast implants, though quite durable, are not “permanent” devices that will never need to be exchanged or removed. Given enough time, probably all of them would eventually need to be replaced. It is my experience that the silicone implants do last considerably longer in comparison to saline implants. There are also differences in implant lifespan that are manufacturer dependent.

Let me repeat this again so that there can be no confusion:

There is no rule or evidence that breast implants need to be replaced every ten years.

If you want more information regarding breast implants, breast augmentation or any other plastic surgery procedure that I perform or if you would like to schedule a complimentary consultation with me, please contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

1. size change – usually to increase the implant volume and therefore the breast size; rarely to decrease
2. to modify the breast configuration such as to make them more projecting or less wide
3. to switch from saline to silicone implants; rarely, silicone to saline
4. replace a ruptured breast implant
5. in the course of treating one of a variety of aesthetic breast issues such as drooping or capsular contracture, replacing older implants with newer ones.

The most common reason for implant exchange is that a woman is unhappy with the selected size and wants to be significantly larger. It is fairly infrequent to desire a smaller size and this is often due either to the surgeon placing a far too large implant initially or the patient gaining a considerable amount of weight resulting in a marked enlargement of breast tissue.

In my practice, it is fairly rare for my patients to desire a change their breast implant size and if they do, it is usually years later. Why can I keep this rate extremely low? When evaluating my patients in consultation, I listen carefully to exactly what they want or think they want. I also measure and size them in the office, have them try on a variety of implants, and show them photos of other patients to provide them with a greater understanding and visualization. During surgery, this is fine tuned, as I will employ temporary implants in order to assess the effects of various sizes and configurations.

By offering many different styles of breast implants, I can customize the appearance that would be most appropriate and desirable for my patients. For example, patients who are very narrow and desire significant projection would be best served with higher profile implants whereas women who are broad with a moderate amount of breast tissue present may benefit more from moderate profile implants. Many of the patients that I perform implant exchanges on were done elsewhere and indicated that they were never offered or explained the options.

It is essentially unanimous that women prefer the silicone implants over the saline ones as they feel similar to breast tissue. When switching between fill materials, virtually all go from saline to silicone whereas the opposite is almost never performed due to aesthetic issues.

If you would like more information on silicone or saline breast implants, breast augmentation, breast lifts or any other plastic surgery procedure that I perform or to schedule a consultation with me, you can call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Having been in plastic surgery practice for over 22 years in Scottsdale and Phoenix, Arizona, I have long been involved and dealt with and witnessed the multitude of factors and issues regarding silicone and saline breast implants. Prior to 1992, my patients used silicone implants exclusively and were quite happy. During the period of the moratorium in which all my breast augmentation patients and some of my mastopexy and breast reconstruction patients utilized saline implants, I noted that the aesthetic results and level of satisfaction with the naturalness of outcome were decreased and compromised compared to results with silicone implants.

This sentiment came as no surprise. Why? Silicone breast implants feel very natural and “soft”, like breast tissue, so that when they are in place, it often is very difficult to discern their presence particularly for the non-professional. Saline implants, on the other hand, can often be detected, either by sight, feel or both. This is exacerbated in very thin patients who often have “rippling” seen through their skin. These issues and others such as deflations do detract from their popularity. In patients of mine who have had both types of breast implants, every single one of them preferred and were far more satisfied with the silicone ones.

In the more than 3 year period since the lifting of the moratorium on the usage of silicone breast implants, virtually none of my patients select saline implants for their breast surgery which translates to around 99% silicone usage. For the rare few who do, it is only because of the lower cost of the saline implants.

If you are interested in obtaining additional information on silicone or saline breast implants, breast augmentation, mastopexy or any other plastic surgery procedure that I perform or to schedule a consultation with me, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

What happens to the saline? Your body will absorb the fluid which is harmless. As it does, your breast will further decrease in size.

Once it is apparent that the implant is ruptured, I recommend that the situation be addressed sooner than later. The reason for this is that the tissue which had been previously stretched out will contract around the deflated breast implant over time and form variable amounts of somewhat constrictive scar tissue. This can make it more difficult to reacquire the level of symmetry that had been present prior to the deflation.

The plastic surgery options available for treatment of a ruptured saline breast implant following a breast augmentation fall into four general categories:

1. Replace just the deflated implant.
2. Elect to undergo a bilateral implant exchange. With this approach, one can also change size, style and switch to silicone implants
3. Remove both breast implants (also known as bilateral explantation).
4. Do nothing at all. This option is almost never selected.

In your consultation, I would discuss each of the above options in detail including the pros and cons in order to allow you to make an informed decision.

If you would like additional information on breast implants, breast augmentation, mastopexy with breast enlargement or any other plastic surgery procedure or to schedule a consultation, you can call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

In the most recent large study, published in the International Journal of Cancer in January 2009, over 6200 Swedish and Danish women were followed post-implantation for a mean duration of over 16.5 years with over thirteen percent having the implants for at least twenty five years. What the researchers determined was that there was a statistically significant 27% reduction in risk of developing breast cancer in women with silicone gel breast implants. This is not a new finding as several studies performed previously reached the same conclusions with some actually showing risk reductions as high as 37 to 53%.

This is great news, of course, for both those women who have had a breast augmentation and those that are contemplating it. Why there is a lowered risk of breast cancer in women who have had silicone breast implants is not entirely clear and there may be several other factors in play. In discussing the procedure with my patients, I do not them that having breast implants will lower their risk of developing breast cancer. What I do indicate is that all evidence points to no increased risk of this type of cancer.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Implant manufacturers sought to simulate these results by incorporating the texturing within the silicone outer shell of the implants without the need for polyurethane. These began appearing around 1986 from a variety of manufacturers and are still being offered today along with the smooth surfaced ones.

So, which is the better choice? The answer is not exactly straightforward. It may depend on several factors as well as on physician preference. Research data on textured versus smooth implants at times has been inconclusive with regard to the development of capsular contracture. For implants placed above the muscle (submammary), there may be a lower rate of firmness developing when the textured surfaced ones are used. However, textured saline implants in this location are associated with a high rate of rippling and irregularities of the skin contour, severely compromising the aesthetic result as compared to the smooth surfaced ones. This can also create discomfort in the breast where the edges of the implant are poking into the skin. The implant may also have a shorter life span.

Research results for the implants placed behind the muscle (submuscular) are less clear. There may be slight differences in the capsular contracture rates and durability between the textured and smooth implants, whether they are silicone or saline.

So, what do I recommend from my years of experience? For several reasons, rarely would I place an implant above the muscle. If I did, it surely would not be a textured saline one! My choice for saline implants behind the muscle is also smooth because they clearly provide a better aesthetic outcome.

Why saline implants placed above the muscle are not recommended - Frontal view (not my patient!)

Why saline implants above the muscle are not recommended - Oblique view (not my patient!)

Both smooth and textured silicone implants placed behind the muscle can yield great results. I base my recommendation largely but not solely on the dimensions of the implant that I am looking for. The textured and smooth implant configurations as designed by the manufacturer of preference, Allergan Corporation, are slightly different throughout the range of sizes with the latter tending to be slightly more projecting and less wide. If someone had a history of capsular contracture, I would more likely consider a textured surfaced implant in that situation.

I find that implant surface type is a non-issue with my patients. They will defer to my recommendations here. After all, they have much more important decisions to make. Like implant size…!

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona