Silicone Implants

There are many different materials that are given to patients regarding Breast Reconstruction. Some are form the plastic surgeon's office, some are from the implant company, others are from our society ASPS. Some patients receive all types. There is not a requirement to give out the booklets from the company but it may be helpful. There are many different materials that are given to patients regarding Breast Reconstruction. Some are form the plastic surgeon's office, some are from the implant company, others are from our society ASPS. Some patients receive all types. There is not a requirement to give out the booklets from the company but it may be helpful.

No, there is not one company that is better than the other.The silicone implants by the company Mentor or Allergan can be used equally. There is a new company named Sientra that has FDA approval to sell silicone implants but I have no experience with them yet. No, there is not one company that is better than the other.The silicone implants by the company Mentor or Allergan can be used equally. There is a new company named Sientra that has FDA approval to sell silicone implants but I have no experience with them yet.

That depends on what you mean by “not healing quickly.” If you have an unhealed wound, then something is really wrong, and you should see your surgeon. If it simply hurts or “doesn’t feel right,” then it may improve with time, or you may be developing capsular contracture (a common problem with implants), which may not go away. If you still want a flap, you may well still be able to have one from your buttock or elsewhere.

Richard M. Kline Jr., M.D. That depends on what you mean by “not healing quickly.” If you have an unhealed wound, then something is really wrong, and you should see your surgeon. If it simply hurts or “doesn’t feel right,” then it may improve with time, or you may be developing capsular contracture (a common problem with implants), which may not go away. If you still want a flap, you may well still be able to have one from your buttock or elsewhere.

Richard M. Kline Jr., M.D.

I have annual breast MRI because I still have one natural breast and one of my original breast tumors was only discovered on MRI. My most recent breast MRI noted that there is residual breast tissue in the implant side. For this very reason I would say that yes, you should have annual breast MRI, both to check the integrity of the implant and to check for further malignancy. Unfortunately it is usually the insurance companies placing restrictions on doing this, not he doctors or the patients. I would pay for it myself to be sure I was cancer free. This is actually a controversial area among plastic surgeons, but at the current time the official guidelines are to obtain an MRI 3 years postoperatively and then every 2 years after that. However, if there is a suspected problem with an implant, the MRI may certainly be obtained at the time of the concern. Furthermore, the official guidelines may change in the future, but your plastic surgeon should be able to keep you updated on this.

I have performed many silicone implant reconstructions over the years, and have never had anyone "reject" an implant. Thus, while I think the chances of this happening are very small, nearly anything is possible in medicine. As mentioned in one of the responses to the above questions, however, there are other issues that can develop over time with implants, such as capsular contracture formation or leaks, but most patients do well with implants. I have performed many silicone implant reconstructions over the years, and have never had anyone "reject" an implant. Thus, while I think the chances of this happening are very small, nearly anything is possible in medicine. As mentioned in one of the responses to the above questions, however, there are other issues that can develop over time with implants, such as capsular contracture formation or leaks, but most patients do well with implants.

One of the most common complications marring the reconstructive outcome is capsular contracture, or heavy, sometimes painful scarring around the implant, which can be seen with either saline or silicone implants. Other common problems include implant malposition, and asymmetry. While not really a side effect, implants are only made up to about 800 cc volume, which is not large enough to reconstruct many large breasts (in which case flap reconstruction with your own tissue may potentially provide more material). Other possible complications include infection, wound healing problems, skin loss, and chest wall deformities.

Richard M. Kline Jr., M.D. The most bothersome side effects I have experienced are numbness along the scar and coldness of the skin on the breasts. The surgery itself can have a long recovery period. Be sure to exercise as much as they will let you.

Yes, the silicone implants will definitely feel softer than expanders. You will still need to adjust to them too however. Yes, the silicone implants will definitely feel softer than expanders. You will still need to adjust to them too however.

Debbie-
Like chemobrainfog, I’d like to comment on most of your questions at once. You ask terrific questions and along with the info you get here, I’m sure you will also get some input from your surgeon. I have the traditional implants and did not opt to find a surgeon who uses the gummy bear type, although I did know about them. If your surgeon uses the gummy bears, ask to hold one and also hold a traditional implant. Understand what your breasts will look like with both of them. They will give different cosmetic results. Ask about weight too. There may be a difference between the two. One person I met who had the gummy bears said they had a harder feel than the traditional ones, but not having ever felt one, I do not know if that is the case.
As far as implants vs tissue expanders, the implants are much softer! Tissue expanders, filled with saline, are hard to the touch and uncomfortable especially if you wear tight clothing or if you are a stomach sleeper. Silicone implants are nothing like that. I sleep on my stomach with no problems.
With regard to the registration, each implant has a serial number just like and appliance or even food. Again, your surgeon will give you info on this, but the registry is for our benefit in case there is a problem with some of the implants. You can be notified about any issues with them. You will get a card to keep in a safe place with these numbers. I keep one in my wallet and one at home in my file.
To my knowledge, there are only 2 companies who make approved silicone implants for use in the US. Your surgeon will use implants from the company he/she likes best. I wouldn’t worry about this particular thing.
During the time I had my expanders in place, it felt like this process would last forever. I had the expanders in for close to 8 months and I too was ready to perform my own swap surgery.
Keep asking questions! One day soon you will be on this side giving your story and advice to others who need information.
AHi Debbie,
I think I may be able to answer all of your questions in one post. And, if you want to discuss this, let me know. I'm happy to answer all of your questions. Sometimes the answers to questions produce more questions. There are two different types of silicone implants. Traditional and those that are commonly referred to as "gummy bears."

I have gummy bears. The are "cohesive gel" implants. Technically, these guys are still in a clinical "study" .. not a trial... their safety has been established. That is probably why you are "registering" your implants. They have a more natural shape and appearance than a "regular" silicone implant (my opinion).

Not too sure if more than one company makes them but this is the info about the FDA approval on them:
http://www.cohesivebreastimplants.com/410_siliconefilledbreastimplant.html
Only certain doctors have been allowed to offer this to their patients. There was a recent incident because "we" (the recipients) are supposed to be answering an annual questionnaire and the doctors haven't been compliant..... (really, the patients don't show up but the docs got the blame).

There is a HUGE difference (again, was for me, everyone is different) in the way the implant feels. The expanders were not my favorite thing. Toward the end, I was ready to operate on myself. I had them in for a long time (six months) and they were "fully filled" which was a big mistake on my part. I had to wait to complete chemo before the exchange surgery. They overfill them to get a good cosmetic result and they are the most distorted looking things.

I haven't had any side effects. I am aware they are "not mine" but they don't hurt in any way. I'm going back to see if there is anything else you wanted to know....

Hope this helps! Where are you in this surgical process?

AnneMarie

I chose silicone implants (over saline) when I found out that I was not a candidate for any type of flap surgery. I asked my plastic surgeon a ridiculous number of questions and he patiently answered them all. Here are a few to consider. What is capsular contracture and is there any way to prevent this from happening? What causes it? The size of the implant was important- I wanted to be about the same size so my clothes would fit! Unfortunately implants come in cc’s and not cup sizes and they are also not exactly the same shape as a real breast. There are many different implants, so I asked if he could find ones that had more projection rather than being flat. (and he did!) I asked if there would be any restrictions on my life with the implants with respect to sports, daily activity, etc. The safety of silicone was a concern. I asked about the construction and filling material of the implant (how it differs from the ones that were taken off the market years ago). The current literature says someone with silicone implants should have an MRI every 2-3 years to check for leakage. I asked my PS his opinion of that. I also asked about his percentage of times he needed to do revision surgery. Good luck with making your decision. I believe we can be more comfortable with our choices if we are prepared and educated. Silicone or saline implants, while generally very safe from a medical perspective, are still subject to some complications. The most common problem is that either type implant can develop a hard capsule of scar tissue around it (capsular contracture), which is sometimes painful, and makes the breast mound hard (and often unattractive). Generally speaking, the thicker and more normal the soft tissue covering around them, the better result implants tend to give when used for reconstruction. The presence of radiation injury greatly decreases the chances of success when using either silicone or saline implants for reconstruction, and flaps may be a better alternative in that case.

Richard M. Kline Jr., M.D.

You're right, the data collection process has certainly been far from complete in terms of % of patients followed.

Personally I prefer to use the patient's own tissue for the breast reconstruction whenever possible. In my opinion it provides the most "natural" reconstruction and avoids the long-term issues that have been associated with implants.

However, no single procedure is best for everyone and patients must choose what they feel most comfortable with. Our job as plastic surgeons is to ensure our patients have all the information they need to allow them to make that decision.

Dr C
http://www.PRMA-enhance.com You're right, the data collection process has certainly been far from complete in terms of % of patients followed.

Personally I prefer to use the patient's own tissue for the breast reconstruction whenever possible. In my opinion it provides the most "natural" reconstruction and avoids the long-term issues that have been associated with implants.

However, no single procedure is best for everyone and patients must choose what they feel most comfortable with. Our job as plastic surgeons is to ensure our patients have all the information they need to allow them to make that decision.

Dr C
http://www.PRMA-enhance.com

Wow, that's a huge topic!

Silicone implants are as safe as saline implants in my opinion. Both are associated with risks including (but not limited to) capsular contracture (hardening), infection, sensation changes, pain, and the need for further surgery.

I have not seen any scientific evidence that shows breast implants cause cancer, rheumatologic disorders or autoimmune disorders. It is important to remember that both types have a silicone outer shell, so even saline implants contain some silicone.

Here's the latest comprehensive info on breast implant safety from the FDA, including silicone implants:
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/default.htm

I hope that helps.

Dr C
http://www.PRMA-enhance.com Wow, that's a huge topic!

Silicone implants are as safe as saline implants in my opinion. Both are associated with risks including (but not limited to) capsular contracture (hardening), infection, sensation changes, pain, and the need for further surgery.

I have not seen any scientific evidence that shows breast implants cause cancer, rheumatologic disorders or autoimmune disorders. It is important to remember that both types have a silicone outer shell, so even saline implants contain some silicone.

Here's the latest comprehensive info on breast implant safety from the FDA, including silicone implants:
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/default.htm

I hope that helps.

Dr C
http://www.PRMA-enhance.com