LOCATION OF INCISIONS

The most common incision is an inframammary approach, made just underneath the fold of the breast. Another approach involves the circumareolar area: an incision is made just around the lower part of the areola (the darker area of the nipple). A third approach is to place the implants by inserting them at the underarm or axilla area. (See Fig. 12-6.) All incisions heal relatively well. Your surgeon will discuss the appropriate incision for you. Some surgeons are able to use a special endoscope and place breast implants through a small incision in the belly button (umbilicus). Very few surgeons are currently trained in this technique, however.

TYPES OF IMPLANTS AVAILABLE

Saline implants are currently available to all women interested in breast augmentation. If patients who have previously undergone breast augmentation with silicone implants wish to have them replaced, they can, if they are willing to become part of an ongoing FDA–Mentor study. Occasionally, a woman who has had saline implants and is bothered by problems with them can switch over to silicone, depending on whether she satisfies the criteria for the Mentor or McGhan study: thin skin, severe wrinkling, ptosis, or for breast reconstruction. If a patient has undergone a breast augmentation with saline implants and is unhappy with the "feel" of the implant, she may satisfy the criteria of the FDA–Mentor study to have silicone implants instead. Plastic surgeons must fulfill special requirements of the FDA–Mentor and its local hospital IRB (investigation review board) before they are allowed to place silicone implants.

The Saline Breast Implant versus the Silicone Breast Implant

The advantages and disadvantages of saline and silicone implants are always included as part of the discussion during my preoperative consultation:

Saline Implants: Advantages and Disadvantages

• No known connection with autoimmune disease.
• If it ruptures, your body will absorb the saline fluid.
• Occasionally, patients will feel on the side of the implant a "rippling" of the implant. If the implant is under just breast tissue, you may actually see "rippling." A surgeon must overfill the implant by 10 percent to eliminate some of the rippling.
• The feel of the implant may be firm, whereas silicone implants feel more like breast tissue.
• Safe per the FDA's current recommendation.
• Recommended by most rheumatologists as an alternative to silicone augmentation.
• Less incidence of capsulary contracture (scarring around the implant).

Silicone Implants: Advantages and Disadvantages

• Concern for connection with autoimmune diseases.
• If it ruptures, the body will not absorb the silicone.
• Silicone has been found in the local and distant lymph nodes and may travel to other locations and affect us systemically—how it does, at this point, nobody knows.
• Feels more like breast tissue.
• Increased incidence of capsular-scarring contracture.