breast implants have been approved, but with certain restrictions. They are only available to patients over 22 years of age.  Furthermore, only the cohesive gel (memory gel – gummy bear) implants are available.  If you have had or are considering Breast Augmentation, here are some facts you need to know. 

Due to the firmer nature of the cohesive gel, a larger than normal incision is necessary; therefore, the inframammary (under the breast) incision is preferable for the insertion of these implants.  The gel implant may also be inserted through a breast lift incision or an abdominoplasty (tummy tuck) incision.

Saline-filled implants, on the other hand, are placed through a smaller incision, as they are not filled until they are placed in the pocket.

• More natural position, appearance and feel
• Less painful, quicker recovery

• Less tapered upper pole (less noticable with sub fascial placement)
• Possible increase in capsular contraction

• Gives more coverage and support to the implant, particularly in thin patients with small breasts
• More natural upper pole fullness
• Possible less interference with mammography
• Slightly less risk of capsular contracture

• More painful
• Longer recovery
• More movement with muscle contracture
• Possibility of visible step-off at muscle edge

• Very low leakage rate (cohesive)
• Lighter than saline therefore less tendency to cause sagging if placed above the muscle
• More natural feel
• Less chance of rippling

• Larger incision necessary

• Smaller incision
• Lower cost
• Slightly less incidence of capsular contracture

• Higher leakage rate
• Higher incidence of rippling
• Heavier than gel, therefore preferable placement is behind the muscle to avoid sagging

• Volume can be changed after surgery
• Patient has input into final size
• Better able to correct asymmetry
• Better able to treat complications following previous breast surgery i.e., irregularities in shape, capsular contracture, symmastia  (disruption of midline)

• Injection dome has to be removed (can be buried or externalized)
• If the injection dome is buried, a second minor procedure, performed under local anesthetic, is necessary to remove the infection dome.

• More natural feel
• Less incidence of seroma (fluid) formation after surgery

• May decrease capsular contracture (This has not been proven with the new cohesive gel implants)

• Smooth, round, moderate profile- plus cohesive gel implants, preferably placed above the muscle, under the fascia (sub-fascial).

• Adjustable saline implants with external injection ports
• If the patient wishes to ultimately have silicone gel implants, adjustable saline implants are used to expand and adjust the pocket above the muscle.  These can subsequently be replaced with silicone gel implants, usually with local anesthetics.

• Submuscular saline implants are removed, the muscle is returned to its original position and new silicone gel implants are placed above the muscle (it is usually not necessary to remove the capsule unless it is calcified)

Now you can change the size of your breasts without additional surgery.

The adjustable breast implant which was developed in 1985 by Dr. Becker is used in this procedure. The implant consists of a membrane that is filled with saline via detachable domes.  Saline (salt water solution) is added or removed from the implant post operatively by inserting a thin needle through the skin into the injection dome. Once the patient is satisfied with the size and shape of her breasts, the dome is removed usually three to six months post-operatively. The implant seals at the self-sealing valve.  Alternatively the injection dome may be exteriorized and removed one week later.

It is the ability of the adjustable breast implant to correct or improve difficult breast problems such as ptosis (sagging), symmastia (loss of cleavage), tubular breast deformity, and Polands syndrome (unilateral non-development) that makes this implant so unique. The adjustable-fill breast implant is useful in expanding underlying tissue and generating more breast tissue to create a more natural and symmetrical breast shape. Because these implants can be filled gradually over a period of several months, discomfort is minimized while the skin slowly stretches. In order to avoid the unnatural, hard-looking appearance of some augmentation, especially the upper fullness, adjustable breast implants can be overfilled, and then the volume reduced, allowing the breast to relax, producing a more natural appearance.

"My patients love the adjustable implant because it allows them to ‘try the size on' before the augmentation is finalized"  In the past, augmentation patients would immediately think their breasts were too big, due to the normal swelling that always follows surgery. Of course, over time in the weeks following the procedure, the swelling would decrease and patients would then complain that they looked smaller than they expected.  It can also be that they get used to the size and wish they had gone bigger.

"Now, the adjustable breast implant allows the volume to be corrected after surgery."

One of the most common problems seen in women after breast feeding is atrophy (shrinkage) and sagging of the breast.  The best procedure to correct this problem is combining a breast augmentation with a breast lift.  However combining the two procedures can sometimes be problematic.  A mastopexy (breast lift) involves skin incisions around the areola and often a vertical incision as well.  Placing a breast implant at the same time can place excessive tension on the wounds, resulting in poor scars. The two procedures are at odds with each other.  The mastopexy procedure tightens the skin while the augmentation procedure expands the skin.  Tension can also in terfere with circulation to the skin and occasionally lead to skin and even nipple loss.  In some cases therefore when performing an augmentation mastopexy I use adjustable implants in order to decrease the tension on the skin during the healing phase.

Adjustable implants are available in a saline version (Spectrum) and a gel version (The Becker 50/50).  The implant has a thin tube attached to it which can be brought out through the skin.  An injection dome is attached to the filling tube allowing the implant to be adjusted and filled after the procedure.

The adjustable implant is positioned in the usual fashion.  The saline implant normally placed sub muscularly (under the muscle).  The adjustable gel implant can be placed above the muscle.

The implant is filled to the desired volume after completing the mastopexy.  At the end of the procedure 25 – 50% of the saline is removed, reducing the tension on the incision and also reducing the pain postoperatively.

Five to seven days after surgery the implants are filled to the desired volume. Over filling results in more projection and symmetry (breasts even) can be obtained.

The fill tubes are then removed with a gentle pull, thus allowing the three-way valve to close.  Once fill tube is removed, adjustments cannot be made.

The more complex cases such as marked asymmetry (Polands Syndrome) or constricted breasts (Tubular Breasts) improved results can be obtained by burring the fill tube and adjusting the volume over several months.  This has been extremely successful and has normalized many major breast deformities some of my patients that have been unfortunate to have.

A minor procedure under local anesthetic is then required to remove the fill tube