Saline-filled Breast Implants

Saline-filled breast implants have been the implant of choice in the last several years. They are most often round, smooth implants, placed beneath the pectoral muscle. This placement is not a recent innovation. It was utilized in the era of silicone gel implants when one of the annoying complications was a frequent and troublesome firmness caused by a fibrous capsular contracture around the silicone gel implant. Placing the implant beneath the pectoral muscle produces softer breasts, since the muscle moved and displaced the implant. The shift to saline-filled implants that have fewer problems with firmness in any location has made firmness much less frequent.

Placement of a large implant beneath the muscle can produce a crampy discomfort. Ice packs and muscle relaxants such as Flexeril can ease this discomfort. A division of the insertion of the muscle allowing it to ride upward over the implant produces an improved shape, and allows for some initial relaxation of the stretch that produces the cramps and discomfort.

Contour implants have been utilized to provide more tapered upper breast fullness. Upper breast fullness is a function of the size and placement of round implants. A large implant makes the fullness in the upper quadrants more noticeable. One approach that conceals this fullness is the placement of implants beneath the pectoral muscle. The muscle has a flattening effect on the upper pole of the breast. As the size of the implant increases, the fullness becomes more obvious. At some point a compromise is found between a larger size and a natural appearance. If the implant is to be beneath the muscle, a round implant is usually used. This is because implants may turn beneath the muscle, and a contour implant looks out of place if it gets inverted.

Contour implants are usually placed on top of the muscle, beneath the breast tissue. They can provide a smoother upper pole, but they become rounded and full as larger sizes are placed in tight skin envelopes. With time, the fullness in the upper quadrant decreases as the skin stretches.

Post operative change in the upper breast fullness is nicely illustrated in the video, sub muscular augmentation. At two weeks the breast is high riding and the skin is shiny, but as the skin stretches the appearance changes. As time passes the position and shape of the breast is lower and sleeker in the upper quadrants.

Optimal size is a combination of factors. By far the most important is patient preference. Although is difficult to explain the right size, women do know it when they see it. The best way to see it is to try it on. To do this you need a bra that is the size that you think you would like to be. The best bra to show your new size is in an under wire bra that fits fairly tightly and has the straps shortened, so when the weight of the filled implants is added the breasts don't sag. A bra with a fairly inelastic cup that has a smooth surface allows viewing the intended size without distracting patterns and texture. A light colored sweater or tee shirt to try over the bra-and-implants combination completes the necessary list of things to bring to the office the day of consultation.

After the choice of size has been determined the base size is measured. The base size of the implant is affected by the position of the nipple over the breast mound and the width of the breast, as well as the desirability of fullness in the upper quadrant of the breast. Some women find the full upper quadrants very desirable; others think too much fullness in this area looks unnatural. Sometimes photos of the breasts that you find ideal are helpful in explaining your preferences.

If the nipple is not centered over the breast mound, a small compensation can be made with the implant placement. Further changes can be made with a concentric mastopexy, which can move and reduce a large diameter areola or lift a breast that has a minor ptosis, or droop. If reshaping of the breast is needed, a standard mastopexy can centralize the nipple and reshape the breast with or without a change in the breast volume, whether you're interested in reduction or augmentation.

Implants are available in a wide variety of volumes, base sizes, and projections. Once the volume that looks the best has been selected, and a measurement of your ideal base size has been made; it is usually possible to pick an implant that is best suited to you and the size you wish to be.

 

Saline-Filled Breast Implants

  • Single lumen implants that are filled during the operation with a fixed volume of saline through a valve. There are no adjustments of the saline volume after the operation.
  • A second type is a single lumen implant that is filled during the operation with saline through a valve. This type of implant allows for adjustments of the saline volume after the operation.

The silicone rubber shell for a saline-filled breast implant has the following general composition:

  • Cured polymeric (large) silicones
  • Approximately 20% of finely powdered silica that is tightly bound to the silicone polymers
  • Small amounts of smaller silicones
  • Minute amounts (parts per million) of metals, including a metal catalyst (usually tin, zinc, or platinum)
  • Traces of readily evaporating materials (volatiles), such as xylene and other organic compounds.

The filler is sterile saline that is injected utilizing a closed system to avoid contamination.

Saline-filled breast implant.

These are saline implants of different sizes. 300cc moderate-profile, 475cc high-profile, and 275cc low-profile. Once the proper volume is selected, the profile, or projection, and the base size are selected to provide the best fit to the patient's chest wall and breast diameter.