Breast implant
There are three general types of breast implant devices, defined by their filler material: saline solution, silicone gel, and composite filler. The saline implant has an elastomer silicone shell filled with sterile saline solution during surgery; the silicone implant has an elastomer silicone shell pre-filled with viscous silicone gel; and the alternative composition implants featured miscellaneous fillers, such as soy oil, polypropylene string, etc. Composite implants are typically not recommended for use anymore and, in fact, their use is banned in the United States and Europe due to associated health risks and complications.
In surgical practice, for the reconstruction of a breast, the tissue expander device is a temporary breast prosthesis used to form and establish an implant pocket for the future permanent breast implant. For the correction of male breast defects and deformities, the pectoral implant is the breast prosthesis used for the reconstruction and the aesthetic repair of a man’s chest wall.
Procedure The surgical procedure for breast augmentation takes approximately one to two hours. Variations in the procedure include the incision type, implant material, and implant pocket placement.
Incision types Breast implants for augmentation may be placed via various types of incisions:
Inframammary - an incision is placed below the breast in the infra-mammary fold (IMF). This incision is the most common approach and affords maximum access for precise dissection and placement of an implant. It is often the preferred technique for silicone gel implants due to the longer incisions required. This method can leave slightly more visible scars in smaller breasts which don't drape over the IMF. In addition, the scar may heal thicker.
Periareolar - an incision is placed along the areolar border. This incision provides an optimal approach when adjustments to the IMF position or mastopexy (breast lift) procedures are planned. The incision is generally placed around the inferior half, or the medial half of the areola's circumference. Silicone gel implants can be difficult to place via this incision due to the length of incision required (~ 5cm) for access. As the scars from this method occur on the edge of the areola, they are often less visible than scars from inframammary incisions in women with lighter areolar pigment. There is a higher incidence of capsular contracture with this technique.
Transaxillary - an incision is placed in the armpit and the dissection tunnels medially. This approach allows implants to be placed with no visible scars on the breast and is more likely to consistently achieve symmetry of the inferior implant position. Revisions of transaxillary-placed implants may require inframammary or periareolar incisions (but not always). Transaxillary procedures can be performed with or without an endoscope.
Transumbilical (TUBA) - a less common technique where an incision is placed in the navel and dissection tunnels superiorly. This approach enables implants to be placed with no visible scars on the breast, but makes appropriate dissection and implant placement more difficult. In that regard it is pertinent that a published medical journal report analyzed a consecutive series of more than 1300 TUBA cases done by a single surgeon over a 15 year span, with no instance of incorrect implant placement. Transumbilical procedures are performed bluntly, with or without an endoscope (tiny lighted video camera) to assist dissection. This technique is not appropriate for placing silicone gel implants due to potential damage of the implant shell if attempting insertion through the small 2 cm incision in the navel, and as those implants are pre-filled they cannot be passed through that incision.
Transabdominoplasty (TABA)- procedure similar to TUBA, where the implants are tunneled up from the abdomen into bluntly dissected pockets while a patient is simultaneously undergoing an abdominoplasty procedure.
- Subtype Of
- Breast augmentation
- Relevant Specialties
- Plastic and Reconstructive Surgery
