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The non-cosmetic use of breast implants is for breast reconstruction, sex reassignment surgery, and for abnormalities, usually congenital, that affect the shape and size of the breast. In breast plastic surgery, breast implants are usually used either for cosmetic reasons or to reconstruct the breast such as after a mastectomy, to correct genetic deformities or as part of male-to-female sex reassignment surgery.

A bit of trivia: breast implants have been known since 1895 when they were first used to augment the size or shape of a woman’s breasts. The earliest known breast implant was attempted by a Dr. Czerny, using a woman’s own fatty tissue from a lipoma (a fatty tumor) on her back.

Saline-filled breast implants were first manufactured in France in 1964 and were introduced by Arion with the goal of being surgically placed using smaller incisions than they had been using. In the mid 1980s, advances in manufacturing principles brought about elastomer-coated shells to decrease gel bleed. They are filled with a thicker, more cohesive gel; they are sold under restricted conditions in the U.S. and Canada, and are widely used in other countries. For women who have very little breast tissue, or for post-mastectomy reconstruction, plastic surgeons believe the silicone gel implants are superior. In patients who have more breast tissue, the saline implants can look very similar to silicone gel implants.

One manufacturer did produce a model of pre-filled saline implants but it has been reported to have had high failure rates following surgical implantation. It was predominantly silicone implants designed in the 1970s that were involved in the class-action lawsuits against Dow-Corning and other manufacturers in the early 1990s. Compared to silicone gel implants, the saline implants are more likely to cause cosmetic problems likes rippling and wrinkling and other problems, that can be noticeable to the eye or to the touch.

Two Houston, Texas, plastic surgeons developed the first silicone breast prosthesis with the Dow Corning Corporation back in 1961. Although some people think that saline implants don’t contain any silicone, the saline implant shells are made of silicone elastomer. The implants are filled with saline solution after the implant is placed in the body.

When breast implants that have been implanted for a long period of time are removed, a mastopexy is often performed to tighten up any loose skin. This additional surgery is usually done at the same time and at an additional expense, but this is the best time to do it rather than go back later, avoiding more surgery and everything that goes with it, the most cost-effective too. It has been shown that extracapsular silicone does have the potential to migrate to other parts of the body. However most complications have appeared to be limited to the breast and axillae as inflammatory nodules (granulomas) and enlarged lymph glands in the armpit area, which are called axillary lymphadenopathy. Both manufacturers and doctors are required to tell women that implants are not meant to be permanent and that most recipients will probably need to have additional surgery to replace or remove their implants.

In one study it was reported that only 30% of ruptures, in patients with no symptoms, are accurately detected by experienced plastic surgeons, compared to 86% that are detected by MRI. The general international consensus in the medical field is that silicone implants in breast plastic surgery have been shown not to cause systemic illness, thus excluding the possibility that a small group of patients may become ill through (as yet) unknown mechanisms may prove difficult. This has been questioned by many women experiencing a variety of serious health issues. An intracapsular rupture can progress to the outside of the capsule, called an extracapsular rupture, and it’s generally agreed upon that both of these conditions indicate the need for removal of the implant.

The FDA has recommended that MRIs be considered to screen for silent rupture starting at about three years after implantation and then every two years thereafter. Some patients opt to get them every year. Since the early 1990s, independent reviewers have examined studies concerning the links between silicone gel breast implants and systemic diseases. The consensus of these reviews is that there is no specifically clear evidence of a causal link between the implantation of silicone breast implants in breast plastic surgery and systemic disease. Some wonder who is funding these studies and that should clearly be stated.

When silicone implants do rupture they rarely deflate. The silicone from the implant can leak out into the intracapsular space around the implant area. Researchers must study and compare a large group of women, who don’t have breast implants who are of similar age, health and social status and who are followed for a long time, meaning 10 to 20 years, before a relationship between the women with breast implants and any diseases can be made.

The general international consensus is that silicone implants in breast plastic surgery has not been shown to cause systemic illness, but one must keep in mind that many women have reported a connection to symptoms they’re having and their breast augmentation. Some doctors who have other specialties than plastic surgery, like dermatologists, also perform breast plastic surgery, like breast augmentation. If you decide upon any type of breast plastic surgery, make sure use choose a board-certified plastic surgeon instead. And keep in mind that all surgeries, including breast augmentation, have serious risks, both during surgery and after surgery. Make sure you know what they are.

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