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All you need to know about breast implants

What are breast implants?

A breast implant is a medical device that is placed inside the breast to augment, reconstruct, or create the physical form of the breast, for a rounder and perkier contour. 

Which types of breast implants are available?

There are two main types of breast implants: 

Saline

Saline-filled implants are silicone shells filled with sterile salt water (saline). 

If the implant shell leaks, the implant will collapse and the saline is reabsorbed and naturally expelled by the body. This type of implant provides a uniform shape and feel and they are FDA-approved for women over 18. 

Silicone

Silicone gel-filled implants are silicone outer shells filled with a silicone gel. 

According to the American Society of Aesthetic Plastic Surgeons, 88% of breast implant surgeries today use silicone implants.

Women experience a more natural breast and if the implant leaks, the gel may remains within the implant shell or escape into the breast implant pocket. A leaking implant filled with silicone gel does not collapse.

Silicone breast implants are FDA-approved for women age 22 or older.

Gummy bear breast implants

Medically known as form-stable implants, these devices maintain their shape even when the implant shell is broken.

The consistency of the silicone gel inside the implant is thicker and firmer than traditional silicone gel implants.

Shaped gummy bear breast implants have more projection at the bottom and are tapered towards the top. 

Breast implants come in smooth or textured shapes.

Smooth breast implants are the softest feeling and can move with the breast implant pocket, which may give more natural movement.

 

Textured breast implants develop scar tissue to stick to the implant, making them less likely to move around inside of the breast and become repositioned. 


This type of implants can feel firmer because they have a thicker wall when compared to smooth implants.  

Note that breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) occurs most frequently in patients who have breast implants with textured surfaces. 

Make sure you discuss with your plastic surgeon the risks-benefits of having breast implants and about BIA-ALCL. 

A 2019 Food and Drug Administration (FDA) hearings on breast implants safety suggests that 90% of silicone breast implants used in the U.S. have a smooth surface, while only 10% are textured. 

What are the possible risks of breast implants surgery?

Some of the risks and complications associated with breast augmentation are:

  • Scarring

  • Breast implant illness. Some patients have reported cognitive issues, chronic fatigue, and joint pain. Research is ongoing to better understand this issue.

  • Breast pain

  • Infection

  • Often temporary changes in nipple and breast sensation

  • Rupturing or leaking of the implant

  • Bleeding

  • Fluid accumulation

  • Capsular contracture. A hardened “capsule” of tissue can contract around the implant, causing pain and deformity. 

Correcting some of these complications might require additional surgery, either to remove or replace the implants.
 
Breast implant associated-anaplastic large cell lymphoma (BIA-ALCL). 

The FDA has identified an association between breast implants and a rare cancer of the immune system called anaplastic large cell lymphoma (ALCL). 

Implants with textured silicone and polyurethane-foam outer shells tend to carry the highest risk. In most cases, the cancer has been found in the scar tissue and fluid around the implant. 

The FDA recommends MRI screenings for silicone implant ruptures three years after getting your implants and every two years after that—especially because most silicone implant ruptures are “silent,” meaning that they don’t present noticeable symptoms or changes to the breast’s appearance. 

As of December 6, 2019, the American Society of Plastic Surgeons (ASPS) recognizes 303 cases of BIA-ALCL in the U.S. and a total of 871 worldwide, with 33 known deaths.

 

Considering that over 10 million women have implants, the risk is believed to be low (between 1 in 2,207 and 1 in 86,029, according to ASPS), but some patient advocates argue that these rates are underreported and that BIA-ALCL is underdiagnosed. 

As a result of the concern over BIA-ALCL, Allergan—in response to a request by the FDA—announced on July 24, 2019, a wold-wide recall of its Biocell textured breast implants.

How is breast implants surgery like?

Prior to surgery, your doctor will assist you in choosing the right implant size by putting different sized implants into a bra, to see how they feel.

Anesthesia

A general anesthesia is generally used for the comfort of the patient.

Incision

Your plastic surgeon may choose one of the following incision options to place the implants:

  • Inframmammary incision, done in the crease under the breast.

  • Transaxillary incision, in the armpit.

  • Periareolar incision, around the nipple.

The choice of incision depends on several factors, including how much enlargement is involved, the patient’s anatomy, the type of implant, and surgeon-patient preference.

Insertion and implant placing

The breast implant is inserted into a pocket either by:

A submuscular placement goes under the pectoral muscle. 

A submammary, or subglandular, placement goes behind the breast tissue, over the pectoral muscle.

The method for inserting and positioning breast implants depends on the type of implant, degree of enlargement desired, your body type and your surgeon's recommendations.

Incision closing

The surgeon closes the incisions with layered sutures, or stitches, in the breast tissue. Stitches, skin adhesives, and surgical tape close the skin and keep it closed.

The incision lines are visible but these will fade with time. The quality of scar depends on many things, including your genetics, exposure of your body to nicotine and infection.

What should I expect after a breast implants surgery?

Expect some degree of soreness, swelling, and bruising for a few weeks.

Your plastic surgeon will recommend a compression bandage or sports bra for extra support and positioning of the breast implants. 

You should expect two week of work downtime.

You need to avoid any activity that could raise your pulse or blood pressure for two to three weeks for proper healing of the incisions areas. 

A follow-up appointment for the removal of the drainage and the sutures if these are not the ones the body naturally absorbes.

What results should I expect from a  breast implants surgery?

You should expect and improved and restored breast size, volume, and overall body image and self-esteem. 

The results are noticeable right after surgery but they continue to improved in the following weeks as your breast tissue settles and your muscles relax, a phenomenom called the “drop and fluff”. 

While nobody is able to control aging, a stable weight is key to maintaining the look of your breast for long time. 

It may take six to twelve months for your breast to fully set in their final state

How much do breast implants surgery cost?

In the Dominican Republic, breast augmentation procedures range from 4,100 to 4,500 for an all-inclusive package that includes the recovery house, local transportation, and hospital and doctor's fee, basic medication and lab tests.

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