1. What prevents bacteria from getting into implants?

Infection is an uncommon problem with breast augmentation. The surface of a foreign body is a location in which the body 's natural defense systems are not as effective, so this is always a potential problem. If a true infection were to develop around the implant, then the implant may need to be removed to clear the infection. The bacteria is on the surface of the implant, not inside the implant.

Anytime a foreign body is placed, the body forms a scar around it. This scar or capsule if it contracts and gets tight makes the implant feel harder and it may be uncomfortable. We try to control bleeding and prevent infection, but there are still some women who develop capsular contracture.

Regardless of the location of the incision or the implant, the nerves going to the nipple can be injured in the process. About 15% of women see some decrease in sensation.


2. What about mammograms after breast augmentation?

Both the saline and the silicone gel implants are of a different optical density to x-ray than normal breast tissue.Therefore, they block the x-rays used for mammograms. Placement of the implants behind the pectoralis muscle gets the implants further from the breast tissue and reduces this interference with mammography. Women with implants should have mammograms done at a facility experienced in performing the exam for women with implants. They do compression or displacement views. That is they try to push the breast tissue away from the implants for the exam in order to maximize the amount of the breast tissue which is seen.


3. What is a "Spectrum" implant and why would someone want one?

There is a saline filled implant which is "adjustable" called the Spectrum. This product is not often used. The cost is higher. The more complicated the device, in theory the more potential there is for failure. The range of adjustability is only about one ounce. In short it sounds like a good idea, but the amount it can be adjusted is not enough to make it worthwhile.


4. What are the specifications for the different implants?

The breast implants available in this country are silicone gel filled implants and saline filled implants. The silicone gel implants are softer, but they are more expensive and more problematic if they rupture. For the current generation of implants the rupture rate is about 5% at ten years. If a saline implant fails, the body absorbs the fluid which is simply IV fluid. If a silicone gel implant breaks, about two thirds of the time the silicone remains within the capsule or scar around the implant. It may be difficult to tell if the implant is in fact broken. Less commonly the silicone will get outside the capsule. The body can form a reaction and a mass.

Microscopic amounts of silicone may be found in lymph nodes, but there is no evidence that this causes harm. If an implant is ruptured then it should be removed and replaced. The manufacturers have a limited warranty that covers replacement of the implant if it were to break, as well as an extended warranty available that also provides funds to help cover the operating room and anesthesia.

Breast implants may be round or more anatomic [teardrop in shape].

The majority of implants used in this country are round, which provides superior fullness. The implants may have a smooth or textured surface.


5. Can implants cause breast cancer?

There is no evidence that breast implants or silicone causes breast cancer or autoimmune disease.


6. How can a woman decide what size implants she wants?

For every frame size there is a range of "normal" sizes. Women choose to have fuller breasts to be in better proportion compared to the rest of their body. Typically women relate that they never were able to buy clothing off the rack and have it fit, or that they had several children and breast fed with loss of volume and want to get back the size they had before. The easiest way to visualize what is right for the one' s own body is to wear a soft bra, the size desired and see what fills it out to look right. In my practice I have different sizes in the office and go through this exercise with the individual women. Most women make a reasonable choice of what looks good to them. There is a physical limitation as to the volume that can be placed, so occasionally a volume less than their goal is the maximum that can be placed. The goal of any cosmetic procedure is to look natural but better. If breast implants are so large as to look unnatural, like Dolly Parton, then a women can look artificial even when wearing clothing.