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Breast implants, silicone or saline?

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» Breast implants, silicone or saline? - Argentina Plastic surgery

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Rodriguez Palacios® Medical Center Library - Plastic Surgery
By RP Doctors
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Breast augmentation surgery is quite popular nowadays. Thousands of women realize their dreams of enlarging what nature gave them, or recovering what maternity took away from them, through breast implant surgery. Statistics show that the preeminent reason why women undergo this surgery is to feel better about their own bodies, and to feel sexier and more in proportion. Clearly, the new female beauty standards tend toward larger breasts than decades ago.

On March 16, 2009, the American Society for Aesthetic Plastic Surgery (ASAPS) announced statistics showing that during 2008, 355,671 breast implant surgeries were performed in the United States (compared with 1992, when 32,607 surgical procedures were performed). From that total, 48.1% accounts for people between 19 and 34 years of age. The exponential growth of this kind of aesthetic surgery in Argentina is similar to the increase observed in the rest of the world. Thus, liposuction is no longer the most popular surgical procedure; Breast Implant surgery is currently the most frequent procedure in the field of Aesthetic Plastic Surgery.

Breast prostheses were first used in the 1960s. There are records which date back to 1890 on the use of various materials and substances to augment the size of breasts: paraffin, ivory, glass balls, polyvinyl sponges, ox cartilage, rubber and liquid silicone injections were tried in the 1950s. The outcomes were not good at all and, in many cases, the procedures led to disastrous results: breast infections, inflammatory processes, migrations, hardening of breast tissues and severe cases developed which made it necessary to surgically remove a part of or the entire breast tissue (mastectomy) to stop the infections and damage caused by these products to the body organs.

With this history behind, the first breast prostheses were introduced in the 1960s, and they consisted in two kinds of implants: silicone prostheses and inflatable saline prostheses.

With the advent of breast implants, along came a scientific controversy which was transferred to the general public by the media.

Is it or is it not dangerous to have a silicone implant inside your body for life?

In 1977, a woman won one of the first lawsuits for damages ever filed against an implant manufacturing company, due to the rupture of her silicone breast implants. During the 1980s and 1990s, litigation continued. Silicone was linked and associated with an increased incidence of breast cancer, after autoimmune diseases such as lupus, rheumatoid arthritis, and with implant rupture and migration of the silicone (liquid by the time) to the tissues surrounding the breasts and also those farther away.

In November 1991, the FDA declared a moratorium so that industries would remove silicone implants from general sale for aesthetic purposes, until the FDA could assess the studies submitted by such companies. In 1992, after evaluation of such studies, the FDA decided not to approve the sale of these prostheses in light of the new, insufficient evidence to guarantee the safety and effectiveness of breast augmentation silicone implants. Therefore, the sale of silicone prostheses for cosmetic purposes was forbidden in the US, and it was subsequently banned in many countries, including Argentina. However, the use of implants in breast reconstruction procedures was not forbidden.

But new scientific research confirmed how unfounded were these associations, with which silicone implants had been linked.

Manufacturing companies improved their designs throughout 5 generations of silicone breast implants, and created prosthetic capsules with several layers, which are firmer. By the mid-1980s, the first roughened- or textured-surface implants were developed in order to lower the incidence of severe capsule contracture and to reduce implant replacement rates; additionally, gel-filled implants were enhanced as well, and they now offer better cohesion than the liquid silicone contained in first-generation prostheses. The silicone cohesive gel was again improved in the 1990s, when a highly-cohesive, semi-solid silicone gel was developed and this upgrade significantly removed the possibility of migration. This means that, if the prosthetic cover ruptures, the risk of content migration is nearly or totally nonexistent. Studies performed on women after 3 years of implant placement detected ruptures in 0.5 % of the cases (1 patient every 200) and in no such rupture cases did migration of the silicone gel occur.

In spite of all these innovations, the FDA (Food and Drug Administration, USA) maintained the ban on silicone-filled prostheses for cosmetic purposes for several years. For a long time, thousands of American women had inflatable prostheses implanted with saline or liquid, while most of the patients in the rest of the world used silicone cohesive gel instead.

Inflatable implants are made up of a silicone cover. This allows them to be introduced folded through small incisions (even from the umbilical area). After being placed in the planned area, either behind the pectoral muscle or the mammary gland, they are filled with saline or liquid until the desired size is achieved. It is necessary to overfill these implants in order to avoid creases, which may cause damages to the cover and lead to filtrations.

Saline implants have some drawbacks with respect to silicone: They may deflate over time and thus have a higher risk of visible wrinkling of the skin (rippling) and then lead to or facilitate rupture of the silicone cover.

After a 14-year ban, the FDA authorized in 2006 the use of silicone gel implants for breast augmentation and a new era started in breast surgery in the United States.

Today, most of the plastic surgeons in the rest of the world use silicone gel-filled implants. These designs achieve an undisputed natural feel of the breast, both at sight and touch. There is no such thing as an expiration date for the implanted prostheses. As long as check-ups continue to be normal and there is no evidence of rupture, capsule contracture or asymmetries, there is no need to replace the implants. Some women need to change their implants after a certain period, generally after 10 years after the implant was placed; the replacement surgery involves no greater inconveniences.

Implantation of silicone cohesive gel breast prostheses has endured the test of time. Millions of implanted women enjoy their new body look with a minimal incidence of health risks, which allows them to go through maternity and nursing without risks for the baby.




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