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Evaluating Your Options

Sydney plastic surgeon Dr Darryl Hodgkinson discusses the history of breast implants and how they can enhance a patient’s overall body shape.

At the annual meeting of the American Society for Aesthetic Plastic Surgeons in November 2008 in Chicago, it was announced that breast augmentation from a survey of the American surgeons is now the most popular procedure – even greater than liposuction. This attests to the fact that most patients are highly satisfied with the procedure, and it can achieve for them enhancement of their figure and improvement of their body image.

History

Pre and post breast augmentation by Dr Hodgkinson
with 320cc silicone gel implants

The first implants were saline in the early 1960s, but because they were prone to rupturing they were for the most part replaced by silicone gel implants.

The silicone within this older style implant was very thin and tended to leak out through the implant, causin capsular contraction, which is a build-up of fibrous tissue around the implant that makes the breast feel very firm. The rate of capsular contracture at this time was up to 50 percent. There was also a suggestion that perhaps it caused systemic disease such as rheumatoid arthritis.

However, a moratorium on implants in the United States between 1992 and 2006 allowed for a reassessment of gel implants and the introduction of the latest model of implants which use a different style of gel. These are less likely to cause the problem of capsular contraction hardness and have reduced the rate of capsular contracture to around five to eight percent of patients. The recent introduction of polyurethane foam-coated implants is looking like it will be a viable option in reducing implant hardening further still.

Implants today

Pre and post breast augmentation by Dr Hodgkinson
with 250cc silicone gel implants

The two implants that are most readily available now are those filled with saline and those filled with the new generation of silicone gel. However, there are many different shapes, sizes and projections that the surgeon has to be comfortable with because every patient is unique and has a different desire.

Careful examination and consultation with the patient is essential before undergoing breast augmentation. The surgeon assesses the size and shape of the patient’s chest, the amount of breast tissue, the amount of droop, the amount of asymmetry, the position of the breasts on the chest wall, and takes into account their desires, occupation, social activities and sporting life.

The possible consequences of a breast implant should also be discussed, including the likelihood that a secondary procedure might be necessary in the future.

The consultation allows the surgeon to select the most appropriate implant for the patient and the look they want to achieve. An experienced surgeon will be able to offer all the options available, including each incision site such as through the armpit, belly button, nipple, areola or underneath the breast in the inframammary fold.

Depending on the various factors, including the chest wall, thickness of tissues, desired result and implant type, one of these incisions will be chosen that most suits the patient’s desires. It can be confusing to patients, however the time spent with their surgeon to discuss the various options is time well spent and will result in the best possible result for each individual patient.