INFORMATION ABOUT IMPLANT CHOICE BY PRACTITIONERS

The purpose of a breast implant is to restore the morphology or enhance the cosmetic appearance of the breast.

Implantation requires surgery which, in the vast majority of cases, proves highly beneficial in both psychological and cosmetic terms. Women who have had a successful procedure recognize that it enhanced their femininity and self-esteem. This is particularly so for those who have had breast reconstruction following partial or total breast removal because the procedure helps restore their body image.

Many believe that breast implants and the silicone used to make them can cause serious, systemic, debilitating problems such as cancers and autoimmune diseases. To date, no published scientific studies support this fear.

However, like any surgical procedure, implantation can lead to local and systemic complications which can require medical treatment or even follow-up surgery.

BREAST ANATOMY

The breast consists of adipose tissue with mammary glands. Each compartment of a mammary gland consists of lobules and ducts. When breast-feeding, milk is produced in the lobules and then channeled to the nipple through ducts. This entire structure overlying the pectoral muscle is what gives the breast its shape, sensitivity and texture. Breasts are supported by a system based on skin and fibers which run through the mammary gland. In pregnancy, the glands temporarily swell and subsequently—as after sudden weight loss or under the influence of gravity—the skin and fibers stretch inducing the collapse of the breast.

A breast implant augments the volume of the breast.

An implant on its own may not be able to lift the bosom, correct asymmetry or compensate for the stretching of the skin. In addition to implantation, your surgeon may suggest complementary procedures to fulfil your specific needs.

CHOICE OF INCISION POINT AND POSITIONING OF THE IMPLANT

Choice of incision point

You should discuss with your surgeon the pros and cons of the different incision points in your case. Three sites are commonly used.

Around the nipple
Periareolar
 In the armpit
Transaxillary
 In the submammary fold
Inframammary
Periareolaire Transaxillaire Inframammaire
This incision is usually relatively invisible.

Compared with other incision points, cutting into mammary tissue carries higher risks of altering sensory function, infection and problems with breast-feeding.
 This incision poses fewer problems with subsequent breast-feeding and lets the surgeon use small, less invasive instruments.

This approach is more complicated and is associated with a higher risk of damage to the implant and mispositioning.
 This incision affords easy access to the implantation site and simple manipulation of the implant.

The 4-5 centimeter long incision is usually the most visible.

 

Positioning of the implant

You should also talk to your surgeon about the position of the implant that best matches your morphology. The ideal position will depend on the thickness of the mammary tissue and its capacity to envelop the implant. Each possible position has pros and cons that you should be aware of and discuss with your surgeon.

Retro-pectoral Prepectoral
Part of the implant is positioned below the pectoralis major muscle The implant is positioned above the pectoralis major muscle and below the mammary gland
retro-pectorale pre-pectorale

Procedure may take longer
Recovery may take longer
Operation may be more painful
Follow-up surgery may be more difficult
Implants less visible and less palpable
Less chance of contraction of the capsule
Mammography easier
Preferable if the mammary tissue is thin or weak

 

Procedure may be quicker
Recovery may be quicker
Operation may be less painful
Easier access for follow-up surgery
Implants more visible and more palpable
Contraction of the capsule more likely
Mammography more difficult
May be contraindicated if the mammary tissue is thin or weak

THE VARIOUS TYPES OF IMPLANT

Breast implants differ from one another in terms of five features. Generally speaking, a breast implant consists of a covering made of a silicone elastomer which is filled with a substance which may be more or less gelatinous.

The characteristic features are:

  • Size
  • Shape
  • Texture of the covering
  • Filler
  • Profile

All these features should be discussed with your surgeon to identify the implant that best suits your wants, needs and morphology.

 

Size

The first thing to know is that implant size is expressed in cubic centimeters (cc) rather than cup size. Choosing the right bulk for your body is key to ensuring an outcome that meets your expectations. The final volume is determined by a combination of an implant’s breadth (a), the length of its base (b) and its projection (c).

A big volume does not necessarily mean that you breasts will look bigger because that will depend on your body and your figure. Your surgeon is the only one who can estimate the ideal implant volume for the desired outcome.

 

Shape

Two shapes are possible, i.e. round and anatomical (“drop-shaped”) implants, each of which has distinct issues.

Round implant
The influence of gravity tends to diminish the curve of the upper breast, making the chest look flatter and less full. This type of implant fills out the existing mammary tissue by augmenting the volume, especially higher up, giving the breast a more domed shape.


Anatomical (drop-shaped) implant
This implant has a more natural shape that imitates the body’s original curves. The implant fills out the existing mammary tissue with subtle augmentation of the upper part and more marked augmentation lower down.


Texture of the covering

Implants can be smooth, textured or micro-textured.
A special process may be carried out to make the surface a little rough to promote adhesion to surrounding tissue. Such adhesion prevents rotation of an anatomical implant and has an impact on the development of capsular contraction. A textured implant may require a longer incision because it is more difficult to insert. This can oblige the surgeon to exert more force, which exacerbates the risk of damaging the implant and may reduce its lifetime.
Factors like the position of the implant, its size and the amounts of skin and tissue covering it can affect how it feels on palpation, e.g. prepectoral implants tend to be more palpable than retropectoral ones.

 

Filler

Arion breast implants can be filled with different substances.
The silicone gel used in MONOBLOC® silicone SoftOne® implants is viscous, i.e. it is not liquid so it will remain stable and keep its shape even if the covering ruptures. Its viscosity makes its consistency close to that of the mammary gland tissue.

The aqueous gel used in MONOBLOC® Hydrogel CMC implants is made of cellulose and normal saline. It is soluble in water and radio-transparent, making it more compatible with screening for and diagnosing mammary disease. Its viscosity also makes its consistency close to that of mammary gland tissue.
Aqueous CMC gel is currently the only alternative filling substance between silicone and normal saline.


 

Profile

An implant’s profile will depend on its frontward projection from the chest wall.

Round MONOBLOC® silicone implants are available in Low, High and Extra-High profiles

 

Anatomical MONOBLOC® silicone implants are available in various profiles of base and projection to create a natural look.

       

Prefilled round MONOBLOC hydrogel implants are available in High and Low profiles.

     

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