WHAT WOMEN SHOULD KNOW ABOUT SILICONE BREAST IMPLANTS BEFORE SURGERY

By Dr. Joseph A. Broujerdi Plastic & Reconstructive Surgeon based out of Beverly Hills,  California

In November 2006, the FDA once again approved the use of silicone breast implants after a long trial period. I'm sure many women still have concerns and questions regarding the use of these implants. They should know that silicon implants were extensively studied in breast cancer patients post mastectomy and for breast reconstructive surgeries, with great results. The excitement surrounding this recent FDA approval is warranted, as it provides new patients with greater options for breast augmentation. However, as with any surgery, there are risks that patients should be fully aware of before they make an informed decision.

A silicone gel-filled breast implant is composed of an implant shell comprised of a silicone rubber that is pre-filled with a silicone (cohesive) gel. The shell has been thickened to reduce rupture and bleeding. The FDA has approved this implant for females who are at least 22 years old, and the FDA, the manufacturer and the surgeon are all able to monitor each implant, in the event of a problem, through a tracking device.

There are many factors a woman should know before choosing between silicone or saline breast implants. They should be aware that, if they choose silicone, the possibility of more than one surgery might exist, and they have a higher potential of post-operative complications. The "re-operation" rate is 15% for women who have silicone breast surgeries within the first three years. Silicone implants are a good option for females with thin breast tissue, and this type of implant also has a more natural feel. Rippling is far less likely to occur in women with silicone implants than in women with saline implants. A slightly longer surgical incision, however, is used for insertion of silicone implants. The incision sites for insertion of silicone implants are periareolar (around the pigmented area surrounding the nipple) and infra-mammary (which is under the skin fold of the breast.) These two incisions are the primary ones used by most surgeons.

Another point women should know is that silicone or saline implants may impact a woman's ability to breast feed by decreasing or eliminating milk production. Much of this depends on the position of the implant (whether it is below or over the muscles,) as well as the route of insertion of the implant. Also, many of the changes to the breast following this procedure are irreversible, in case a woman later decides to have the implants removed, and nipple sensation can be altered.

For women who choose a silicone implant, I strongly recommend regular screenings to assess whether a rupture exists, since no big warning signs are associated with that event. A silicone implant patient should have a regular MRI every 3 years, as well as annual breast examinations, and thereafter MRIs are recommended once every two years. There is a potential for internal bleeding in the breast, which means that the silicone is slowly diffusing out of the implant over time. Since no symptoms are associated with this situation, the breasts require frequent monitoring. The incidence of silicone implant ruptures increases slowly over the years. Although ruptures are silent, there may be symptoms associated with them, including hard knots, lumps surrounding the implant or the armpit, and a general hardening of the breast. The FDA requires that serious injuries be reported directly to them.

The incidence of women with either type of implant developing breast cancer is no different from those without implants. The possibility of connective tissue disease after augmentation with silicon is the same for patients who've not have implant surgery at all, and if a silicone implant happens to leak into the breast , there would be a local tissue reaction or enlargement of the lymph nodes. Again, regular check-ups are critical. The bottom line is that silicone implants can be a great solution to the right woman, as long as she is aware of the potential set-backs that could lie ahead.