The patients must be at least 18 years old, and can be excluded in the presence of infection, nursing mothers, autoimmune diseases, or other diseases that impair wound healing.
The implants are most likely safe bases upon prior research, but the final study results will not be available for some time. This must be discussed with your plastic surgeon.
16. What are the warranties for breast implants? Do they
differ from company to company?
Both Mentor and Inamed (formerly McGhan) have similar (not identical) warranties on their implants (see ebreastaug.com's Implant Manufacturers section). Your plastic surgeon will give you this information.
In general, if the implant has a deflation or rupture, the patient will receive: replacement of the implant (for lifetime), and about $1200 paid toward the surgical fee, anesthesia etc. (See Mentor's Warranty or Inamed (formerly McGhan's Warranty)
The warranty is not valid if: a) the patient wants a replacement for cosmetic reasons, b) the deflation or rupture is secondary to a surgical procedure, c) the implants are replaced because of capsular contracture. The warranty does not extend to the opposite side implant in the event that one implant ruptures or leaks.
17. How long do implants last?
The data on implant longevity is variable. Implant leakage is
usually caused by a leak in the valve area. Other causes of implant
failure include a tear, hole or rip in the implant, this can occur over
time. If a saline implant leaks, the salt water gets absorbed by
the body with no adverse effects. Many women can get a lifetime out
of their implants with no exchange needed, but it is best to think that
you may need an implant exchange at sometime in your life. Implant
leakage reports between 1to 5% per year.
18. Why do breast implants need to be replaced?
The only reason to replace implants is if there is a problem with them. For example; leakage, capsular contracture, change in shape, asymmetry, or a patient who is unhappy with size or position. Some plastic surgeons will recommend changing silicone implants even if there is not a visible problem. Speak with your plastic surgeon about implant exchanges.
19. What is the most common incision for breast implants, and what are
the options?
The most commonly used incision is inframammary (crease incision). Many plastic surgeons use this incision because it arguably gives good control in placement of the implants and the incision is usually not visible.
The periareolar (around the areola), is an incision in which usually heals well. Some plastic surgeons feel that there may be more of a chance in alteration of sensation utilizing this incision. In addition, some feel that there may be a higher rate of implant exposure to the body's own bacteria from the patients milk ducts.
The transaxillary incision is a procedure in which an incision is made in the armpit. Some plastic surgeons feel that this incision gives less implant placement control. Discuss this with your own plastic surgeon.
The Transumbilical procedure uses an incision inside the umbilicus (belly button). Many plastic surgeons feel that the disadvantages outweigh the advantages. Speak with your plastic surgeon about this.
The correct incision depends on each patient's own anatomy, and your plastic surgeon's feelings about each procedure. Listen to the guidance from your individual plastic surgeon.
20. Mammary (subglandular) placement of the implant?
This can be a confusing issue for most patients. There are two distinct pockets that the implant can be placed. The submammary and submuscular placement. The decision of where to put the implant depends on the patient's goals and anatomy. Discuss this with your plastic surgeon, because there are advantages and disadvantages to each placement. Subglandular (submammary): means that the implant is placed immediately below the breast tissue. This placement often creates a more visibleand "less natural" result. In addition, often more "ripples" or folds in the implant may be seen. Some plastic surgeons feel that other disadvantages to subglandular placement include the possibility of increase capsular formation rates, and more difficulty with mammograms. Subglandular placement may be appropriate for those women who have a large amount of soft tissue coverage (breast tissue), have a droop to the breast, and for some reason do not want to undergo a breast lift procedure. Submuscular (subpectoral): means that the implant is placed behind the muscle of the chest wall called the pectoralis muscle. With this placement, the implant is partially covered by the pectoralis muscle. (the upper aspect of the implant is completely covered) This placement has many advantages which include a more natural" look, less rippling, less ability to feel the implant, and perhaps less capsular contracture. If at all possible, this placement is preferred.
21. How long does the procedure take?
It usually takes approximately 1-2hours for the routine breast augmentation procedure.
22. Do I need to take antibiotics before and after surgery?
No good studies exist to determine the length of time a patient should take antibiotics, but it is common to take antibiotics for a short course after the breast augmentation procedure. It is questionable whether antibiotics are needed when a patient undergoes other procedures after a breast augmentation has been performed. Antibiotics should probably be used when a patient undergoes any procedure in which "bacteria" may be released into the blood stream. These include, but are not limited to: Dental work, colonoscopy, gynecologic procedures, other major surgeries, and others.
23. What is Arnica and should I take it?
Arnica is a homeopathic medication which is presumed to reduce pain, swelling, and bruising. Arnica can be taken by pill or cream form. Ask your doctor his feeling about arnica.
24. What is breast ptosis?
Ptosisis a term that means droopiness of the breast. There are degrees of how droopy the breast is, and the degree of droopiness will determine if a procedure needs to be performed. Often a breast implant alone will take care of the droop, but at times a breast lift (mastopexy) may need to be performed either at the same time as the augmentation or as a delayed procedure.
25.I have breast implants. I would like to learn to dive, but am afraid of what the pressure will do to the implants. Are there any studies on this?
Silicone and saline implants are used for cosmetic enhancement or augmentation of the normal breast size and shape of reconstruction, particularly after radical breast surgery for cancer or trauma. In one study, by Dr. Richard Vann, Vice President of Research at DAN, mammary (breast) implants were placed in the Duke University Medical Center hyperbaric chamber. The study did not simulate the implant in human tissue. Three types were tested: silicone-, saline-, and silicone-saline-filled. In this experiment, the researchers simulated various depth/time profiles of recreational scuba diving.
Here's what they found:
There was an insignificant increase in bubble size (one to four percent) in both saline and silicone gel implants, depending on the depth and duration of the dive. The least volume change occurred in the saline-filled implant, because nitrogen is less soluble in saline than silicone.
The silicone-saline-filled type showed the greatest volume change. Bubble formation in implants led to a small volume increase, which is not likely to damage the implants or surrounding tissue. If gas bubbles do form in the implant, they resolve over time.
Fitness and Diving Issues
Once sufficient time has passed after surgery, when the diver has resumed normal activities and there is no danger of infection, she may begin scuba diving. Breast implants do not pose a problem to diving from the standpoint of gas absorption or changes in size and are not a contraindication for participation in recreational scuba diving.
Avoid buoyancy compensators with constrictive chest straps, which can put undue pressure on the seams and contribute to risk of rupture.
Additional Considerations
Breast implants filled with saline are neutrally buoyant. Silicone implants are heavier than water, however, and they may alter buoyancy and attitude (trim) in the water, particularly if the implants are large. Appropriate training and appropriate adjustment of weights help overcome these difficulties.