To boob or not to boob?

‘Make Life More Beautiful’ is a trademarked slogan of an American breast implant manufacturer. Indeed, a vast number of women choose to make their life more beautiful with breast augmentation using implants.

According to the Food and Drug Administration (FDA), currently there are between five and 10 million women with breast implants worldwide.

Breast augmentation has consistently ranked as the most commonly performed cosmetic procedure for the last decade, both worldwide and in South Africa.

Statistics from the International Society of Aesthetic Plastic Surgery (ISAPS) show that in 2016 alone 1 449 337 breast enlargements using silicone implants and a further 61 780 using saline implants were performed worldwide.

Furthermore, ISAPS statistics demonstrate a steady increase in the number of breast augmentations performed per year, with the number in 2016 growing by 11% compared to 2015. According to FDA statistics, a further 100 000 women choose to have implant-based breast reconstruction.

So, what makes breast implants so popular? 

A study, published in the Plastic and Reconstructive Surgery Journal in May 2013, reported that a staggering 98% of women who underwent breast augmentation felt that the results met or exceeded their expectations.

Women in this study reported improved self-esteem and improved quality of life. Other studies have demonstrated improved body image and sexual satisfaction. “I feel more like a woman” is a common statement amongst women with breast implants.

While some women get breast implants as part of a primary breast augmentation, for others it’s part of the “mommy make-over” to “get their body back” after having children. Yet, other patients choose breast implants for reconstruction after treatment of breast cancer.

It seems that breast implants do make life more beautiful, but what should you know and consider before deciding to get breast implants?

Here are some frequently asked questions:

What are breast implants?

Breast implants are medical devices used to enlarge the breast size; correct the breast shape; or reconstruct the breast/s after a mastectomy or in cases of congenital abnormality.

What is in a breast implant?

Breast implants consist of a shell and a fill. The shell is made of silicone and may be smooth or textured. The fill can either be silicone or saline.

Will I have changes in nipple sensation?

There may be an increase or decrease in the feeling in the nipple and/or breast. In most cases this is temporary and will fully recover. However, there is a small percentage of cases where the changes may be permanent.

What shapes do implants come in and which one is better?

Implants come in two shapes: round and anatomical. Round implants are shaped as a half-   sphere so they offer more projection in the upper pole of the breasts (cleavage). Anatomical implants are shaped as a teardrop, offering less projection in the upper pole and more in the lower pole of the breasts, which is the natural shape of the breasts (hence the name anatomical). The choice of implant shape largely depends on the preferences of the patient. This should be discussed in the pre-operative consultation with your surgeon.

What can go wrong with my breast implants?

Both silicone and saline implants may rupture and/or leak. Saline implants may deflate. The tissue capsule around the implants may tighten (capsular contracture) causing the breasts to become hard, distorted and in advanced cases painful. Implants may get displaced due to gravity, trauma or capsular contracture. Wrinkling of the implant (rippling) may be seen or felt through the skin.

Where will the scars be?

In cases of breast augmentation, scars may be placed in the inframammary crease, around the areola, in the armpit and even in the belly button (in the case of saline implants). The advantages and disadvantages of each scar position should be discussed in the pre-operative consultation. In cases of breast reconstruction post mastectomy, scars may vary dependent on the position of the cancer and the size of the breasts. Common incisions are lazy S, extending from the areola to the side of the breast, around the areolar, in the inframammary crease and inverted T-incision. Both breast surgeon and reconstructive surgeon discuss incision placement with the patient before the surgery.

Where are breast implants  placed?

In cases of breast augmentation, implants may be placed under the breast or under the muscle. The advantages and disadvantages of either placement should be discussed in the pre-operative consultation. As a rule, women who do not have sufficient soft tissue cover in the upper pole of the breasts (less than 2cm on a pinch test), the implants should be placed under the muscle to avoid visibility.In cases of breast reconstruction post mastectomy, implants are usually placed under the muscle to provide the necessary soft tissue cover.

Can I avoid wearing a bra and will my breast implants ever sag? 

Although breasts with implants tend to hold their shape longer and better than natural breasts, no one can withstand the effects of aging and gravity. Unfortunately, we cannot stop the process of aging. However, we can counteract gravity. So, wearing a good bra is important for maintaining your breast shape whether you have breast implants or not. Changes in size of the breasts with pregnancy or weight fluctuations can also predispose to breast sagging.

What follow-up screening is necessary after placement of breast implants? 

The investigation of choice in women with breast implants is an MRI. FDA recommends performing an MRI three years after placement of implants and every second year thereafter to monitor for silent rupture (rupture of implants is asymptomatic as the silicone is contained within the tissue capsule). Over the age of 40, a routine mammogram and ultrasound should be performed yearly for breast cancer screening.

Is it more difficult to detect breast cancer in a woman with breast implants? 

Special views displacing the breast tissue of the implants, also known as Eklund views, will be required to adequately visualise the breast tissue following breast augmentation. It is very important to go to a radiology centre that specialises in breast imaging and inform the radiologist that you have implants.

Do breast implants last a lifetime?

In most cases implants need to be replaced. The longer you’ve had implants, the higher the likelihood of developing problems (capsular contracture, rupture, leak, etc.). It’s not true that breast implants should be changed every five or 10 years. However, they certainly need to be monitored and replaced should a problem develop.

Can old breast implants be reused? 

No, it is not safe to reuse old implants. It places the patient at higher risk of infection and other implant-related complications.

Will I be able to breastfeed?

Pregnancy and breastfeeding are not affected by breast augmentation so most patients with breast implants can successfully breastfeed. Studies showed no increase of silicone content in breast milk of women with breast implants. In case of breast reconstruction post mastectomy, breast tissue is removed during the mastectomy so breastfeeding is not possible.

Do breast implants cause breast cancer?

No, breasts implants are not associated with increased incidence of breast cancer. In fact, studies have shown that patients with implants get diagnosed with breast cancer at an earlier stage, therefore have a better prognosis. Although, it has recently been established that breast implants are associated with a rare treatable type of T-cell lymphoma – Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). This disease is extremely rare; as of February 1, 2017, 359 were reported to FDA1.

In summary, although there is extensive research available, thorough discussions with your surgeon and careful contemplation are a must. 

Getting breast implants may be one of the most satisfying decisions of your life.

Dr Alexandra Grubnik is a plastic and reconstructive surgeon with special interest in breast surgery, breast reconstruction, body contouring and cosmetic surgery. She practices at Netcare Milpark Hospital and Netcare Rosebank Hospital.

MEET OUR EXPERT – Dr Alexandra Grubnik

Dr Alexandra Grubnik is a plastic and reconstructive surgeon with special interest in breast surgery, breast reconstruction, body contouring and cosmetic surgery. She practices at Netcare Milpark Hospital and Netcare Rosebank Hospital.