A breast implant is a medical operation used to enlargement, reinsert, or produce the physical form of breasts. Sacks which made of a silicone outer shell and filled with silicone gel or saline are used. Breast implantation is usually performed to make ordinary breasts larger for beauty purposes. Woman who is having a breast restoration after a mastectomy will need the opposite breast become greater in size in order to make the breasts more symmetric. In addition, breasts that are very unequal in size due to trauma or congenital deformity may also be corrected with an enlargement procedure. The other purposed of breast implantation are for aesthetic breast augmentation and for making breasts in the male-to-female transsexual patient.
A breast implant is usually done under local anaesthesia. The surgical cut is made through the armpit, under the breast area, or around the darkened area around the nipple called the areola. These techniques are wanted to create the most imperceptible scars. The implant is usually placed between the breast tissue and underlying chest muscle. The implant operation takes approximately one to two hours. Before the surgery is performed, the woman should understand her physical condition after breast implantation. Many surgeons find it helpful to have the patient inspection before and after pictures, to interpret expectations.
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There are three general types of breast implant device, defined by the filler material which are saline, silicone, and composite. The saline implant has a silicone shell filled with sterile saline solution whereas the silicone implant has an elastomer silicone shell filled with viscous silicone gel. For the alternative composition implants, they are characterized with miscellaneous fillers, such as soy oil or polypropylene string. In breast implant surgery, the tissue expander device is a temporary breast prosthesis used to form and establish an implant pocket for the permanent breast implant. For the correction of male breast and chest-wall flaws and deformities, the pectoral implant is the breast prosthesis used for the restoration and the aesthetic repair of a man's chest.
1.2 History of Breast Implantation
Breast implant applications have been used to surgically enhance the size in the term of volume, modify the shape, and improve the feel of a woman's breasts since the late nineteenth century, In 1895, surgeon Vincenz Czerny used the patient's autologous adipose tissue, obtained from a benign lumbar lipoma, to repair the breast which is asymmetry from which he had removed a tumor whereas surgeon Robert Gersuny experimented with paraffin injections, with destructive results in 1889. From the first half of the twentieth century, physicians used other materials as breast implant fillers such as ivory, glass balls, ground rubber, ox cartilage, terylene wool, gutta-percha, dicora, polyethylene chips, polyvinyl alcohol which is a formaldehyde polymer sponge called ivalon, a polyethylene sac with ivalon, polyether foam sponge called etheron, polyethylene tape, polyester silastic rubber, and teflon-silicone prostheses.
In the mid-twentieth century, Japanese prostitutes have their breasts injected with substances such as paraffin, sponges and non-medical grade silicone to increase their breast sizes, believing that American servicemen prefer women with large breasts. Besides, Morton I. Berson, in 1945, and Jacques Maliniac, in 1950, each performed flap-based breast augmentations by rotating the patient's chest wall tissue into the breast in order to increase its volume. Furthermore, throughout the 1950s and the 1960s, plastic surgeons used synthetic fillers which including silicone injections received by 50,000 women, from which developed silicone granulomas and breast hardening that required healing by mastectomy. In 1961, the American plastic surgeons Thomas Cronin and Frank Gerow, and the Dow Corning Corporation, developed the first silicone breast prosthesis, filled with silicone gel. In addition, the first enlargement mammoplasty was performed in 1962 by using the Cronin-Gerow Implant prosthesis model 1963. Laboratoires Arion developed and synthesized the saline breast implant, filled with saline solution, and then introduced for use as a medical device in 1964. Richard Mithoff, a Houston lawyer, wins the first lawsuit for a Cleveland woman who claims that her ruptured implants and subsequent surgeries had caused pain and suffering in 1977. She receives a $170,000 settlement from Dow Corning and this case receives little publicity.
In 1982, Federal Food, Drug and Cosmetic Act (FDA) classifies silicone breast implants into a Class III category which would require manufacturers to declare their safety in order to keep them on the market as the silicone breast implants was found out that it will cause cancer to patient. In 1992, The General and Plastic Surgery Devices Panel reviews the new information regarding the safety of silicone breast implants. The panel suggests that the further use of implants be restricted for reconstruction only and that women receiving the implants take part in scientific protocols and those epidemiologic studies be conducted to assess the risk of autoimmune disease. In 1999, The Institute of Medicine releases a 400-page report prepared by an independent committee of 13 researchers. They conclude that although silicone breast implants may be responsible for localized problems such as hardening of breast tissue, implants do not cause any major diseases such as lupus or rheumatoid arthritis. The Institute of Medicine had asked to set up the committee to examine past research and other materials, and conducted public hearings to hear all sides of the issue.
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In 2001, a bra-like device surrounded with silicone that creates a vacuum over the breasts that induces the breast to possibly grow about one cup size. This device has to be worn 10 hours a day for several months to create a breast enlargement effect. This is an idea of augmentation method without implants.
1.3 Types of breast implant device
There are three types of breast implant such as saline implant, silicone implant and alternative composition which are used for breast reconstruction, and breast enlargement procedures.
1.3.1 Saline implants
The saline breast implant is filled with biological-concentration 0.90% w/v salt water. The early models were a relatively delicate application that was shown to failure, usually implant shell rupture, leakage of the saline filler, and deflation of the prosthesis. Contemporary models of saline breast implant are made with stronger, room-temperature vulcanized (RTV) sacks which are made of a silicone elastomer. The rates of deflation of the pre-filled saline breast implant made it a second choice for corrective breast surgery, after the silicone gel type of breast implant was reported in 2006.
1.3.2 Silicone gel implants
There are five generations of silicone breast implant. Each of them was defined by common model-manufacturing techniques. The first generation of silicone gel implant was created by Cronin and Gerow in 1963. It was a silicone rubber envelope filled with viscous silicone-gel. In order to reduce the rotation of the emplaced breast-implant upon the chest wall, it was affixed to the implant pocket with polyethylene terephthalate and attached to the rear of the breast implant sack.
In the 1970s, a second generation of silicone implant which was a thinner device-shell and thinner, low-cohesion silicone-gel filler was produced to improve the functionality appearance and sensation of the silicone breast implant. But in clinical practice, the second-generation was showed brittle, and suffered greater probability of shell rupture, and filler leakage through an intact shell. The silicone implant was then improved by using a polyurethane foam coating for the implant shell. It reduced the incidence of capsular contracture by causing an inflammatory reaction that impeded the formation of a capsule of fibrous collagen tissue around the breast implant. Yet, the materials used to make polyurethane-coated breast implants was briefly terminated because of the potential health-risk posed by 2,4-toluenediamine (TDA), a carcinogenic by-product of the chemical breakdown of the implant's polyurethane foam coating. The second generation of silicone implant was then enhanced to a double lumen breast-implant which composed of a silicone-implant within a saline-implant. Unfortunately, the more complex design of the double-lumen breast-implant suffered a failure rate greater than that of single-lumen breast implants.
In the 1980s, the models of the third and of the fourth generations of breast-implant devices were created with elastomer-coated shells that reduced gel-bleed and a thicker filler gel. There are two types of model which are tapered and round model. The tapered models of breast implant have a uniformly textured surface, to diminish rotation whereas the round models of breast implant are available in smooth-surface and textured-surface types.
Since the mid-1990s, the fifth generation of silicone breast implant is made of a semi-solid gel that mostly to avoid filler leakage and silicone movement from the breast to other part of body. Cohesive Silicone gel Breast Implants in Aesthetic and Reconstructive Breast Surgery (2005) reported there was low incidence rates of capsular contracture and of device-shell breakage, improved medical safety and technical efficacy greater than earlier generations of breast implant device.
1.3.3 Alternative Composition
Some alternative breast implants have the same silicone elastomer shell that surrounds a saline-filled or silicone gel-filled implant. Other types have shells consisting of a different chemical composition. The filler in an alternative breast implant may or may not consist of a gel. The examples of alternative composition breast implant are polyurethane foam-coated implants, soybean-filled breast Implants, hydrogel-filled breast implants, high cohesive silicone gel-filled implants and titanium-coated breast implants. There is no alternative breast implant approved by FDA.
1.4 Surgical procedures
Breast implant emplacement is performed with five types of surgical incisions which are inframammary, periareolar, transaxillary, transumbilical and transabdominal incisions. Inframammary is a cut made to the infra-mammary fold (IMF), which affords maximal access for precise dissection of the tissues and emplacement of the breast implants. Besides that, IMF implantation will produce thicker and more visible surgical scars. For periareolar incision, it can provide an optimal approach when adjustments to the IMF position are required. In periareolar emplacement, the incision is around the medial-half of the areola's edge. Silicone gel implants can be hard to emplace through periareolar incision, because of the short, five-centimetre length of the required access-incision. The scars produced usually are less visible than the IMF-incision scars of women with light-pigment areolae.
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Transaxillary is an cut made to armpit to emplace the implants without producing visible scars on the breast proper whereas trans-umbilical breast augmentation (TUBA) is a less common implant-device emplacement technique which allows emplacing the breast implants without producing visible scars upon the breast proper. In another type of incision - transabdominoplasty breast augmentation (TABA), the breast implants are tunneled superiorly from the abdominal incision into bluntly dissected implant pockets, whilst the patient simultaneously undergoes an abdominoplasty.
The four operation methods to emplacing a breast implant to the implant pocket are described in anatomical relation to the pectoralis major muscle. The first approach is subglandular method which the breast implant is emplaced to the retromammary space, between the breast tissue and the pectoralis major muscle. For subfascial method, the breast implant is emplaced beneath the fascia of the pectoralis major muscle. Subpectoral method is another approach which breast implant is emplaced beneath the pectoralis major muscle, after the surgeon releases the inferior muscular attachments, with or without partial dissection of the subglandular plane. Resultantly, the upper pole of the implant is partially beneath the pectoralis major muscle, while the lower pole of the implant is in the subglandular plane. Submuscular method is which the breast implant is emplaced beneath the pectoralis major muscle, without releasing the inferior origin of the muscle proper. Total muscular coverage of the implant can be succeed by releasing the lateral muscles of the chest wall, either the serratus muscle or the pectoralis minor muscle, or both and suturing it, or them, to the pectoralis major muscle. In breast reconstruction surgery, the submuscular implantation approach effects maximal coverage of the breast implants.
1.5 Complications of Breast Implant
1.5.1 Capsular contracture
After having a breast implant, patient will have a fibrous scar tissue around the implant as part of the healing process. This is a natural reaction that occurs when any foreign object is surgically implanted into the body. The scar tissue will then begin to shrink. The shrinkage is known as capsular contraction. The rate of the shrinkage occurs different from person to person. In some people, the capsule can tighten and squeeze the implant, making the breast feel hard. The patient may experience pain and discomfort.Capsular contracture is an unavoidable complication of breast implant surgery. Everyone who has breast implants will experience capsular contracture to some degree and it is likely further surgery will be needed in the future.
A rupture is a breakage that occurs in the implant's casing. A rupture can be caused if the implant's silicone shell gets weaker over time; the implant is imperfect during the operation; there is a defect in the implant or the breast is hurt.
When a silicone breast implant ruptures, the silicone may spread outside of the scar capsule and into your breast. This can lead to small lumps developing that are known as siliconomas. Siliconomas can be tender to touch and if they are causing pain they have to be removed. In rare cases, the silicone can spread to the muscles under breast, the lymph nodes under armpit area or around the nerves to arms.
1.5.4 Gel bleed
Gel bleed occurs to some degree in all breast implants. It is where small molecules of silicone polymer separate from the implant surface and are taken up into the surrounding tissues or lymphatic system. If the silicone molecules get into the lymphatic system, they may cause lymph nodes swollen. This is usually a minor problem, but sometimes enlarged lymph nodes can become uncomfortable.
1.5.5 Nipple sensation
After having breast implant operation, patients' nipples may be more sensitive. Sometimes, the nipples can become sensitive as they are painful. Increased sensitivity usually lasts for between three to six months. The patients need to seek for doctor if the sensation of pain is continuously for long time.
After having breast implant operation, fluid can build up around your implant. This is known as a seroma and it is quite common. In more serious cases, further surgery may be needed to discard the fluid. However, seromas usually resolve without needing to be discarded.
1.5.7 Infection and bleeding
When the patient is having an implant fitted for breast reconstruction following a breast removal, the patient may have a greater risk of infection and bleeding. Most infections can be treated by using antibiotics. However, if patient's breast becomes severely infected, she needs to have the implant removed to prevent further infection. The implant will be re-inserted after the infection has cleared up. However, it is essential that the implant is not re-inserted too fast, as this can increase the risk of infection. Some research suggests that the risk of infection and bleeding may be increased if the patient is a smoker, because the wounds will take longer to heal.