Breast Surgeries – AUGMENTATION MASTOPLASTIES–  silicone IMPLANTS
 
Breast augmentation is obtained by means of a silicone implant, the scars being not as important as in cases of Reduction Mamoplasties. On the opposite, they are very small and barely noticeable. 

But lets analyze this surgery in detail: it serves patients that have small breasts and wish to increase them and also serves cases of small and drooping breasts. When increased by silicone implants, the small volume is corrected and at the same time the undesirable “drooping breast”. 

silicone : what is the implant and what its implications?

silicone implantation is the placement of a prosthesis manufactured by specialized companies, made of solid silicone coverage (with the consistence of a plastic bag) and filled with silicone gel, a kind of gelatin.   

The production, quality and performance of this product are under the responsibility of specialized companies that has to comply with the norms and be registered at the State Department of Health in order to sell them in the market.   

This silicone gel that fills in the prosthesis was formerly a thick and viscous “liquid”, that leaked when the external coverage ruptured.  

Today this filling in substance has been substituted by a cohesive gel, an evolution of the industry, that remains in place even if the coverage ruptures. And this rupture seems less probable now since more resistant coverages are being manufactured. 

And how does the coverage ruptures? 

It rarely ruptures due to trauma (bumping or squeezing the breast). It is very resistant, more even than human tissues that coats the prosthesis. But, with the former implants (until approximately 1990), practice established that the prosthesis coverage “dissolved” spontaneously after being several years in the human body.   
With this spontaneous rupture of the capsule, the outdated silicone gel (non cohesive) leaked and involved neighboring tissues, sometimes migrating to more distant areas.

At this time, an hypothesis was brought up that silicone could lead to other diseases. For this reason,  several countries totally or partially abolished its use and started to study the subject. 

Today, more than 10 years later, it is a worldwide consent that there is no proven correlation between silicone and cancer or any other disease, and professionals that for some time had drawbacks regarding silicone are using it without any concerns. 

In spite of the use of cohesive silicone and a thicker silicone prosthesis coating, none of the professionals can guarantee that this capsule won't rupture in future years as previously happened. However, as imaging resources are very precise nowadays  (cat-scan, mammography, echography and magnetic resonance imaging), we can detect accurately when a capsule has ruptured.  

In our service, we do not adopt the idea that the silicone should be substituted every few years. We believe the patient should be advised of the possibility that the prosthesis may rupture spontaneously as was evidenced in former reported experiences. However, should this happen, it will be detected by a radiological assistance of the preventive exams. If rupture of the prosthesis capsule is evidenced, the prosthesis must be substituted. 

I cannot stop approaching, in this chapter, the subject of capsular contractures. 

What is a capsular contracture? 

It is the formation of a cicatricial coverage that the organism produces around the entire prosthesis, isolating it. This is a common event whenever a strange body is implanted in the human body, as in the case of silicone .   

When this capsule is very firm and constrictive, according to the individual reaction of each organism, the enlarged breast becomes hard and the contour is altered with variable intensities that depend on the degree of the contracture.   

These contractures were formerly present in 20 to 40% of patients submitted to this surgery and with different intensity degrees. Today, modern prostheses downsized contractures to an insignificant rate, being present in just 0,5% of our cases and in a very minor contracture degree.

The scars of ”silicone breast implants” 

The approach for this surgery are: 

• Axillary;  
• Peri-areolar;  
• Trans-areolar, described by Pitanguy;  
• Sub-mammary.

In our service we use any one of these, depending on the indication of each case, a decision taken jointly with the patient. In general we avoid the axillary approach since we consider it the less suitable.

Silicone implants and breast disease preventive exams.

It is a constant concern of the patients if the silicone will impede any preventive exam of breast diseases. 
At first, this was fact. However, radiologists developed special X-ray incidences specific for the study of breasts with silicone implants and thus overcame the problem. Therefore, this should not constitute a concern anymore. 

The cost benefit relation of this operation:  

I consider augmentation Mamoplasty as one of the most interesting procedures in aesthetic surgery for its graceful results and the small  “cost” regarding the scars. They are not very important, of approximately 3,5cm, whatever the approach chosen. The cost benefit relation is very favorable for the patient