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Best Breasts

Dr John Kippen

These days, many people are requesting a saline implant because they don’t want silicone in their body. Silicone or saline refers to the fill only, what is on the inside. The shell or envelope is still silicone. Saline implants are an empty silicone shell or bag that is filled with saline (salty liquid) at the time of surgery. The part that is in contact with your body is still silicone.

Older silicone fill was more liquid and runny. If an implant did rupture or break, that silicone was free to leak out. Newer implants, however, have a cohesive gel fill, which has the consistency of a gel and often described as ‘Turkish delight’ or ‘gummy bear’. These implants can be cut in half and quarters and the gel will still stay together, where it is. It is less likely for the gel to migrate.

A capsule is scar tissue that the body deposits around any implanted device. Scar tissue can become orientated and linear and can then contract. Capsule contracture is the commonest complication associated with implants. Contracture around devices such as pacemakers, have little effect because pacemakers are hard plastic boxes.  Contracture around a breast implant causes hardening, visible distortion and can be painful. Sides are not equally involved. (Capsules around old liquid filled implants may be beneficial as the capsule scar contains the liquid silicone and prevents it from migrating).

Studies from the US recently showed the capsule contracture rates to be higher than anticipated and probably occurring earlier than previously reported. Within eight years nearly 17 per cent of women needed to be re-operated for visibly distorted or painful capsules. Polyurethane foam coated implants (PFCI) have been shown to have lower capsule contracture rates. 

The PFCI surface, has a higher co-efficient of friction also known as a velcro effect. Where they are placed, they remain. This is useful in treating conditions where other implants have moved or displaced. Bottoming out is where implants have moved down. Implants moving together is called synmastia and obliterates the cleavage between breasts. PFCI may be technically more difficult to use and placement techniques may need to be altered slightly. Any competent surgeon should have no difficulty with this.

A common criticism is that they are hard to remove. When any implants are removed, it is best to try to remove the entire capsule so there is no scar tissue left. By operating in a plane between the capsule and breast tissue, ensures this. This is the same plane that PFCI would be removed – there should be no difference in difficulty.

PCFI are not associated with any increase in risks or complications associated with other implants. There is a reported incidence of a rash that occurs in less than two per cent of placements. It is of no clinical significance other than being little itchy. The rash lasts less than a week.

The cost of PCFI shaped or tear drop implants is the same as compared to their round implants. Some companies charge more for shaped implants. The range for selection is also equivalent to other companies.

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