What is a breast implant?

A breast implant consists of a silicone elastomer (rubber) shell which is filled with either saline solution (salt water) or silicone gel.

Saline Versus Silicone Gel

With saline implants, the shell is filled from an IV bottle with sterile salt water; silicone gel implants are filled with a semi-solid silicone gel, which has the consistency of a gummy bear.

History of Saline and Silicone Gel Implants

Both types of implants have been in constant use since the 1960s. In 1992, the U.S. Food and Drug Administration (FDA) issued a moratorium on silicone gel implants based on concerns that they might be the cause of autoimmune diseases such as lupus and rheumatoid arthritis.

Silicone gel implants have always been overwhelmingly the most popular type of implant due to their realistic, natural look and feel in most women. From 1992 to 2007, saline-filled implants were the only option available to women in the United States seeking breast augmentation. Throughout that time period, however, silicone gel remained the implant of choice for women in Europe, South America, and Canada.

In 2007, the FDA removed the restriction on silicone gel breast implants after overwhelming evidence revealed that silicone gel implants did not cause  such diseases.

The Evidence showed that a woman’s risk of developing any autoimmune disease is the same whether or not she has silicone gel implants. The FDA has approved them for use in cosmetic breast enhancement surgery, finding no link between silicone gel breast implants and connective tissue disease, breast cancer or reproductive problems. In addition, the FDA has approved three companies (Mentor, Allergan and Sientra) to develop and market breast implants and continue to collect data on their long-term safety and efficacy. For more information, please see the FDA breast implant information provided on their site.

Pros and Cons of Silicone implants

The major advantage of silicone gel implants is cosmetic: they look and feel softer and more natural than the saline implants. They typically cannot be distinguished from normal breasts, provided they do not develop a capsular contracture. There is also a lower rate of rippling with silicone implants. Hence, in thin women with little breast tissue, silicone is the implant of choice. If the same women chose saline implants, they would most likely have visible rippling with the implants. Also, because silicone is lighter than saline, the risk of downward displacement due to gravity is lower.

The disadvantages of silicone gel breast implants include higher cost (by about ,000) and a typically longer scar (since they come pre-filled). In general, larger implants require longer scars.

Finally, silicone gel implants tend to rupture “silently,” such that there is no visible evidence that a rupture has occurred. Physical examination by  Dr. Jensen will identify only 20 percent of ruptures, whereas magnetic resonance imaging (MRI) can identify up to 90 percent of ruptures. So women with silicone gel breast implants are encouraged to have regular MRI scans.

The Safety of Silicone

Part of Our Everyday Lives

The silicone in breast implants is made from silicon, a natural element derived from the silica found in sand and rock. Silicone has proven to be an ideal material for use in medical devices due to its high degree of biocompatibility. Today, silicone is used in a wide array of medical devices including catheters, implants, and as the cover or sheath of probes and pacemakers.

Silicone is manufactured in various forms and has been used for over 60 years in everyday products. Some of the common uses of silicone include:

• Baby Products
• Pacifiers and bottle nipples
• Hair and Skin Care
• Shampoos, conditioners, hairspray, creams, and lotions
• Makeup
• Foundation and lipstick
• Medical Products
• Bandages and dressing, contact lenses, gastrointestinal medications, medical lubricant for needles and syringes, and various types of implants

Pros and Cons of Saline Implants

The advantage of saline implants is a presumed lower rate of revision surgery than with silicone gel implants. Saline implants tend to have early capsular contractures, than both early and late as seen with silicone gel implants. Further, the scar is usually shorter, as saline implants can be filled after they are placed, allowing a smaller incision such as in the armpit. The primary disadvantages of saline implants are that they tend to look round and feel firm and unnatural, particularly in thin women with little breast tissue. In addition, saline implants have a higher rate of downward displacement than with silicone, as they are heavier than their silicone counterparts.

Other Options for Breast Enlargement

Autologous fat grafting removes fat with special harvesting needles from an area of your body in which there are abundant fat cells, such as your thighs, abdomen and hips. After a process of preparation and concentration, the fat cells are injected into your breast. This is a less common method than breast implant augmentation and is still undergoing clinical studies and research for safety and effectiveness.

Implant Placement?

The breast implant is placed either under your breast tissue (subglandular position) or under your pectoralis muscle (submuscular position).

Implant Position

Implants can be placed In one of two positions: between the breast and the chest wall muscles, or between the pectoralis major muscle and the ribs. Either way, they are centered under each breast and nipple.

Above the Muscle

Position of the implant above the chest wall muscles is known as subglandular placement  and offers few advantages. This operation involves less discomfort and faster recovery because the muscle itself is not disturbed. Your breasts immediately appear more natural because swelling is minimal. In athletic muscular women (body-builders), it causes less distortion of the breast when the pectoralis muscle is flexed.

Women with ample breast tissue might be more likely to select sub glandular placement than women with very modest breasts, as larger breasts tend to show less rippling.

Disadvantages include a higher risk of capsular contracture and greater interference with mammography. Women with thin skin, low body fat, or petite breasts are very likely to feel and see the implants through the skin and are more likely to have rippling and wrinkling. Large implants are more likely to displace downward, and the risk of nipple numbness is higher.

Subpectoral Placment

Implant position below the muscle , also known as submuscular or more correctly as subpectoral placement, offers the advantages of a lower rate of capsular contracture, less interference with mammography, lower rate of rippling, and less likelihood of downward displacement. Thin women with petite breasts may obtain the best cosmetic result with the implant placed under the muscle, which provides one more layer of padding between the implant and the skin.

Disadvantages include greater postoperative pain and a longer recovery period.  During this time, the upper portion of the breast appears unnaturally full due to the fact the muscle is holding the implant up. Once the muscle and skin have relaxed the implants will drop into a more natural position.  And after swelling subsides, flexing the pectoralis muscles, such as during exercise, may cause the breasts to move and look distorted.

Dr. Jensen can help you decide which placement is best for you.

Incision Placement

The incision is made as inconspicuously as possible, either in the breast fold, under the arm, or around the nipple.

Under the Breast

An incision under the breast, or inframammary incision, is hidden along the natural skin fold, in the shadow of the breast. It often heals with minimal scarring and affords Dr. Jensen excellent visibility for surgery. But if it heals poorly, it will be visible when you are wearing no clothing. If Dr. Jensen needs to lower your breast crease for optimal positioning of the implant, your scar might end up on the undersurface of the breast, rather than in the crease. Women who have asymmetric breast creases before surgery should expect asymmetrical positions of their scars after surgery. One of the main advantages of this incision is that it allows Dr. Jensen greater visibility and to lower the implants (if needed) while they are in place. This may help Dr. Jensen achieve better breast implant position symmetry.  Best for silicone implants.

Around the Nipple

An incision around the nipple is designed to camouflage the scar by placing it at the

junction of the nipple skin (the Areola), and the natural skin. Typically the incision goes halfway around the bottom of the areola. Because of the sharp color transition in this area, the scar is not easily seen. Dr. Jensen prefers to use this incision in patients who have a short distance between the areola and the inframammary crease ( snoopy deformity).  However, because the nipple is the focal point of the breast, any imperfection, no matter how small, may be obvious. Also, this incision imposes a slightly higher risk of not being able to breast feed than the other incisions. Finally, because areola size limits incision size, women with small areolas or large silicone implants may not be candidates for this incision, as implant placement might not be technically possible.

Under the Arm

With endoscopic breast augmentation, Dr. Jensen uses an endoscope, an instrument that enables him to see images of the patient’s internal body structure through small incisions. This tool enables him to better position the implants and often results in fewer scars, because only a few small incisions are required.

Because silicone implants arrive prefilled from the manufacturer, silicone implants may be damaged when placed through this incision, thereby rendering this incision ill-advised in women seeking large silicone implants.

The scar is well hidden. Rarely the scar remains noticeable after healing, and can be visible in evening gowns, tank tops, and bathing suits.

Through the Belly Button

Also called transumbilical breast augmentation (TUBA), placement of implants is performed through a small incision around the belly button. It is only an option for saline implants, as silicone implants are too large to fit through the incision. Because of a high incidence of malposition and hematoma, Dr. Jensen does not recommend this incision.

Length of Scar

Since saline implants are filled after they are placed, Dr. Jensen will use a small (3-4 cm) incision. Since silicone implants come prefilled from the manufacturer, the incision must be long enough to accommodate the implant. Small implants (less than 350 mL) can often be placed through a 3-4 cm incision. Medium size implants (350-500 mL) can often be placed through a 4-6 cm incision. Large implants (greater than 500 mL) often require a 5 cm or larger incision.

Scar Visibility

Scars from breast augmentation gradually fade over months to even years. Occasionally, they become wide or unsightly. The final visibility of your scar depends more on your own  healing process than on the surgeon’s technique. It may take one to two years for your scar to mature.

Dr Jensen can explain more about each type of incision to help you decide which is best for you.

Are all implants alike?

Most breast implants share some standard features, like a silicone rubber shell and a valve for filling with saline solution. However, to better meet each individual woman’s needs, breast implants come in different shapes, profiles, sizes and textures.

Some implants are round, and some are anatomical. The shape of the implants you choose can affect the shape of your augmented breasts.

Implant Surface

The outer surface of an implant can be either smooth or textured. The surface of the implant is indiscernible following surgery.

Textured

Textured implants have a surface that feels fuzzy. They were developed because they impose a lower risk of capsular contracture with the silicone implants only.

Smooth

Smooth implants offer the advantage of a lower rate of rippling with saline implants.

Most plastic surgeons only use smooth implants for saline implants.

Implant Shape

Implants may be teardrop-shaped or round. Round implants are shaped like a round disk bun (.. Teardrop (anatomic) implants have greater fullness in the lower half and less fullness in the upper half.

Teardrop (anatomic or shaped)

Because the breast has greater fullness toward the bottom, we have found that in flat chested individuals and in breast reconstruction, the teardrop implants provide a more natural result.

Teardrop implants must be oriented under the breast with the Narrowest portion at the top of the breast. One problem with teardrop shaped implants is that they may rotate at any time following surgery. This results in a sideways or upside-down appearing breast. To reduce this risk of rotation, teardrop implants are now textured; however, the risk of rotation remains about 15 percent. Teardrop implants cost approximately 00 more than round implants. Because of these drawbacks, we tend to reserve them for women with extremely little or no breast tissue.

Round

Round implants have several advantages. They may rotate freely under the breast without cosmetic consequences, they may be textured or smooth, and their cost is lower. Because the contents gravitate to the lower pole of the implant when a woman stands, the lower pole will naturally fill, thus negating the need for a teardrop implant.

Both types of implants can increase your breast size. Depending on the look you want to achieve, you may prefer one type of implant over the other.

Determining implant size

Many women tend to think of their breasts in terms of bra cup size. For instance, if you’re a 34 A now, you may know you would like to be about a 34 C after your augmentation. At the same time, you may have concerns about breast shape and proportions that bra cup size alone can’t describe. You may know that you’d like to have a certain amount of cleavage, or more of an “hourglass” figure. You should discuss your personal preferences with Dr. Jensen; so that he can take that into account in choosing the right implant size and shape for you.

An implant will add volume to your total breast tissue. For this reason, the larger you want your cup size to be, the larger the volume (measured in “ccs”) of the implant Dr. Jensen will consider. However, cup size may not be your only consideration.

Dimensions like breast width, height, and projection describe breast shape, and may help both you and Dr. Jensen think more specifically about the individual results that you want. For this reason, implant size can also be chosen based on dimensions.

Breast width is an especially important dimension, because it determines how much cleavage there is between your breasts. Breast width also determines the outside curve of your breasts, which you may want to increase to balance better with your hips.

Dr. Jensen will also evaluate your existing breast tissue coverage. If you do not have much breast tissue for coverage of the implant, Dr. Jensen may warn you that if you go as large (in breast width) as you’d ideally like to, you may risk having visible or palpable implant edges. You may even risk significant surgical complications.

Implant Size

Deciding upon the right implant size can be the most challenging decision for some patients. This is because cup size is not standardized and varies among bra manufacturers. Also cup size varies depending on the chest circumference, for example, the cup of a 32C bra is smaller than the cup of a 34C bra. So informing Dr. Jensen which cup size you desire may be of limited help. Dr. Jensen may ask your desired cup size to get a general idea of your goals. Do not misinterpret this as a guarantee of the final size.

Typically, implant sizes range from 200-600 mL, although larger and smaller implants are available. Implants are typically manufactured in 25-30 mL increments. As the volume of the implant grows, so does its diameter and projection.

Tips for Selecting Size

There are a number of ways to help in selecting the best implant size for you.

• It might be useful to discuss proportion with Dr. Jensen. Many women seek augmentation to make their breasts proportionate to the rest of their bodies, in which case Dr. Jensen can measure your breast diameter to select an implant size that provides a proportionate augmentation. This method is based on tables and is usually very conservative in it’s recommendations.  Others might want their final size to be either larger or smaller than the recommendations by the manufacturer. Of course, one drawback of this approach is that your concept of proportion may be very different than the manufacturer.
• Using sizers appears to be the best way to give patients what they want.  These are placed in a special bra and will show you very accurately what you will look like after your surgery.  You will have plenty of time to try these on during your consultation with Dr. Jensen.
• If you seek large breasts, please let Dr. Jensen know. The only way we can provide you with your desired result is if you are open about your goals. Now is not the time to be shy. Be aware, also, that very large implants (especially saline) are more likely to displace downward. You must balance these issues with a desire for very large implants.
• Although 30 cc may sound like a lot, it is not. It is merely a fluid ounce. So if you are struggling between two similar sizes ie. a 360 cc implant and a 390 cc implant, you should stop torturing yourself. They are so similar in size that if you like one, you will also like the other. On the other hand, if you end up deciding (after surgery) that the 360 is too small, then the 390 would also have been too small. If you have narrowed your choice down to two or three sizes, I recommend you choose the largest among them, as this is associated with greater satisfaction in the end.
• The following is a rule of thumb guideline for the volume required to change a single cup size. Remember this is just a guideline.

Bra Circumference	Volume Needed to Increase by One Cup Size
32 34 36 38	100-200 cc 150-250cc 200-300cc 250-350cc

Pitfalls in Size Selection

The following are not necessarily useful ways to select implant size:

• Avoid relying on before and after photos of other women: this can be very misleading, especially when height, weight, and chest diameter are different in every person.
• Avoid lingerie ads: it is impossible to tell which size implant will give the size equal to that seen in an ad.
• Do not request the same size implant as a friend whose implanted breasts appear aesthetic to you: this simply does not work unless you are identical twins.
• Do not select a smaller implant than you desire with the hope that “no one will notice.” Those who do most often complain later, “But no one noticed!”
• Do not select a size larger than you like because “everyone on the Internet said they wished they had gone larger.” Be honest with yourself while trying the sizers, trust your own judgment and you will most likely select the appropriate size.

What about the surgery itself?

Beyond any discussion of breast shape and size, Dr. Jensen will want to evaluate your current physical health and health history before scheduling you for surgery. Breast augmentation is elective surgery. Before you proceed, you and Dr. Jensen will have to decide whether the benefits of breast augmentation surgery outweigh the risks in your case.

If you have any condition that could compromise the healing process, or if surgery could jeopardize your condition, Dr. Jensen may prefer not to operate until the condition is resolved. Infections, a history of poor wound healing, some medications, and even smoking may be reasons not to operate.

The surgery is usually performed in our own outpatient surgery center. The surgery is usually performed on an outpatient basis, not requiring an overnight hospital stay. Sedation anesthesia is most commonly used, although General anesthesia may also be an option. Dr. Jensen can discuss the choice of anesthesia with you in more detail.

The surgery usually lasts one to two hours. Dr. Jensen will make an incision and create a pocket. Then, the implant will be placed in the pocket, filled and positioned. Finally, the incision will be closed with dissolving stitches, and possibly taped.

Preoperative Checklist

A Few Days Prior to Surgery

• Follow any pre-surgery instructions from Dr. Jensen.
• Fill any prescriptions even if you won’t need the medicine until after the procedure.
• Ask a friend or relative to take you to and from surgery, as well as help you for up to 48 hours following surgery. In the days following your surgery it is best to limit physical activity—particularly if it places any strain on your chest wall muscles.
• If you have young children, arrange for childcare for at least 2-3 days.
• Seek help with pet care, including walks and litter changes.
• Make sure you have the items that you may need for recovery as recommended by Dr. Jensen.
• Make sure you have a supply of comfortable clothes and pajamas to wear in the days after surgery.

The Day Before Surgery

• Remember to follow pre-surgery instructions provided by Dr. Jensen or his staff regarding eating and drinking.
• Pick out some loose-fitting pants and a top that opens in front to wear after surgery.
• Prepare a relaxing environment for recovery by taking care of household chores like doing the dishes and taking out the trash.
• Your TV can be a great companion during recovery—set it up ahead of time with your favorite movies and TV shows.
• You may want to sleep on your couch or recliner for the first few nights following surgery. If so, make up your couch with sheets and a pillow before you leave home.
• Get plenty of rest before the big day!

Before You Head Off to Surgery

• Follow Dr. Jensen’s preoperative instructions very carefully.
• Shower before your appointment.
• Do not use makeup, hairspray, or deodorant as it can interfere with the anesthesia.
• Wear comfortable clothes, including a shirt that opens in the front. You may also want to bring warm socks for your comfort.
• Do not wear jewelry.
• Place your toiletries, such as your toothbrush, within easy reach.
• Bring lip balm to moisturize your lips.
• If you normally wear contact lenses, put on eyeglasses instead. You may bring your contact lenses and eyeglass case with you if you feel you’ll want your contact lenses after the procedure.
• Confirm that someone is staying with you after the surgery.

Postoperative Tips

• Have someone stay with you for at least the first 48 hours post-surgery.
• Drink plenty of water and other fluids. Drinking frequently will help replenish body fluids lost due to surgery.
• Wear the compression bra that was placed in the operating room.
• Focus on relaxing, especially your shoulders.

How will I feel after surgery?

You’ll probably feel somewhat tired and sore for several days following the operation, and your breasts may remain swollen and sensitive to physical contact for as long as a month. You may also experience a feeling of tightness in the breast area as your skin adjusts to your new breast size. The full results of your augmentation may not be visible until your breast tissue (and muscle, if the implant has been placed submuscularly) adjusts.

If the implant is placed submuscularly, you may feel more discomfort for several days longer than if it is placed in the subglandular position. You may also have difficulty raising your arms above your head until you heal, and Dr. Jensen may at first restrict your arm motion. The “tradeoff” is that submuscular placement may reduce the risk of complications later like severe contraction of the tissue capsule around the implant (called “capsular contracture”), visible or palpable implant edges, or interference with mammography.

Postoperative care is usually quite simple, perhaps involving use of a postoperative bra or jog bra for extra support and positioning while you heal. At Dr. Jensen’s recommendation, you will most likely be able to return to work within a few days, although you should avoid any strenuous activities that could raise your pulse and blood pressure for at least a couple of weeks.

Dr. Jensen and his staff can tell you more about the usual recovery process, and may have other specific recommendations based on your individual case. If any unusual symptoms occur after surgery, such as fever or noticeable swelling or redness in one breast, you should contact the Center immediately.

What about complications?

Undergoing any invasive surgical procedure means running the risk of complications like the effects of anesthesia, infection, swelling, bleeding, pain and delayed healing. In addition, there are potential complications specific to breast implants, including:

• Deflation of the implant
• Interference with mammography
• Contraction of the scar tissue capsule around the implant (capsular contracture)
• Replacement or revision surgeries
• Calcium deposits in the tissue capsule around the implant
• Changes in nipple and breast sensation
• Shifting of the implant

In addition to known complications, there are unanswered questions about whether silicone breast implants could increase your, or your child’s, risk for connective tissue disorders. Studies so far have ruled out a large risk for such disorders, but for statistical reasons based on study size and methods, larger studies will be needed to rule out any risk.

Separate concerns have been raised about the unknown risk of breast implants and cancer. At this time, there is no scientific evidence that women with silicone breast implants are more susceptible to cancer than other women.

In addition to the information booklet mentioned above, the FDA has published a summary of potential complications called Information for Women Considering Breast Implants. This summary has been reprinted at the end of this page and is also available separately from Dr. Jensen. You should thoroughly read and understand this information before deciding to proceed with surgery.

FDA Information for Women Considering Breast Implants

Saline-filled breast implants (silicone envelopes filled with  salt water) were already in use in 1976 when the Food and Drug Administration (FDA) began regulating medical devices. Under this 1976 law, manufacturers could continue selling devices already on the market (“grandfathered”). But the 1976 law made it clear that at some time in the future, FDA would require manufacturers to submit their research data showing that these products are safe and effective. Women need to know that until this call for research data occurs, laboratory, animal, and human tests on some of these “grandfathered” products-including saline breast implants-may not have been completed by the manufacturer or reviewed by FDA.

Women considering breast implants for breast enlargement or reconstruction should receive the following information about implants (and, when appropriate, other options for reconstruction) before surgery is scheduled. This will allow them time to review the material and discuss possible risks and benefits with her doctor. For some women, breast implants can improve their quality of life. Some breast cancer survivors believe that getting implants has been an important part of their recovery. However, other women find external breast forms to be satisfactory.

Reconstruction options include breast implants or surgery using tissue from a patient’s own abdomen, back, or buttocks to form a new breast. This surgery requires sufficient fat tissue and a longer operation, and like any other procedure, it is not always successful.

For each woman, whether her goal is augmentation or reconstruction, the benefits may be different. With her doctor’s advice, each woman must decide whether or not she wishes to accept the possible risks in order to achieve the expected results.

Breast implant surgery presents the same general risks associated with anesthesia and any other surgery. After the surgery, there are other special risks related to breast implants. (The manufacturer’s package insert for these devices gives additional, more detailed information. Your surgeon has a copy and can provide it to you.)

Most common risks

Deflation.

Breast implants cannot be expected to last forever. Some implants deflate (or rupture) in the first few months after being implanted and some deflate after several years; yet some seem to be intact 10 or more years after the surgery. It is not known when deflation is most likely to happen.

The implant can break due to injury to the breast or through normal wear over time, releasing the saline (salt water) or silicone filling. Researchers are doing studies to determine rupture rates over time. Whenever a saline-filled implant does deflate, it usually happens quickly and requires surgery to remove and, if desired, replace the ruptured implant. Since salt water is naturally present in the body, the leaked saline from the implant will be absorbed by the body instead of being treated as foreign matter.  Rupture of a silicone implant is much more difficult to detect and it is recommended that the patient get an MRI after 2 years then every 3 years.

Making Breast Cancer Harder to Find.

The implant could interfere with finding breast cancer during mammography. It can “hide” suspicious-looking patches of tissue in the breast, making it difficult to interpret results. The implant may also make it difficult to perform mammography. Since the breast is squeezed during mammography, it is possible for an implant to rupture during the procedure. It is essential that every woman who has a breast implant tell her mammography technologist before the procedure. The technologist can use special techniques to minimize the possibility of rupture and to get the best possible views of the breast tissue.

Because more x-ray views are necessary with these special techniques, women with breast implants will receive more radiation than women without implants who receive a normal exam. However, the benefit of the mammogram in finding cancer outweighs the risk of the additional x-rays.

Capsular Contracture.

The scar tissue or capsule that normally forms around the implant may tighten and squeeze the implant. This is called capsular contracture. Over several months to years, some women have changes in breast shape, hardness, or pain as a result of this contraction. No good data are available on how often this happens. If these conditions are severe, more surgery may be needed to correct or remove the implants.

Other known risks

Calcium Deposits in the Tissue Around the Implant.

When calcium deposits, which are not harmful, occur, they can be seen on mammograms. These deposits must be identified as different from the calcium that is often a sign of breast cancer. Occasionally, it is necessary to surgically remove and examine a small amount of tissue to see whether or not it is cancer. This can frequently be done without removing the implant.

Additional Surgeries.

Women should understand there is a fairly high chance they will need to have additional surgery at some point to replace or remove the implant when and if it wears out.

Also, problems such as deflation, capsular contracture, infection, shifting, and calcium deposits can require removal of the implants. Discuss the risk of these additional surgeries with your physician.

Many women decide to have the implants replaced, but some women do not.

Infection.

Infection can occur with any surgery. The frequency of infection with implant surgery is not known, but a prospective patient should ask her surgeon what his or her experience has been. Most infections resulting from surgery appear within a few days to weeks after the operation. However, infection is possible at any time after surgery. Infections with foreign bodies present (such as implants) are harder to treat than infections in normal body tissues. If an infection does not respond to antibiotics, the implant may have to be removed. After the infection is treated, a new breast implant can usually be put in.

Hematoma.

A hematoma is a collection of blood inside the body (in this case, around the implant or around the incision). Swelling, pain, and bruising may result. The chance of getting a hematoma is not known, but a woman thinking about breast implants should ask her surgeon about his or her experience. If a hematoma occurs, it will usually be soon after surgery. (It can also occur at any time after injury to the breast.) Small hematomas are absorbed by the body, but large ones may have to be drained surgically for proper healing. Surgical draining causes scarring, which is minimal in most women.

Delayed Wound Healing.

In rare instances, the implant stretches the skin abnormally, depriving it of blood supply and allowing the implant to push out through the skin. This complication usually requires additional surgery.

Changes in Feeling in the Nipple and Breast.

Feeling in the nipple and breast can increase or decrease after implant surgery. Changes in feeling can be temporary or permanent and may affect sexual response or the ability to nurse a baby. (See the paragraph on breast-feeding below.)

Shifting of the Implant.

Sometimes an implant may shift from its initial placement, giving the breasts an unnatural look. An implant may become visible at the surface of the breast as a result of the device pushing through the layers of skin. Further surgery is needed to correct this problem.

If the implant shifts, it may become possible to feel the implant through the skin. (Placing the implant beneath the muscle may help to minimize this problem.)

Other problems with appearance could include incorrect implant size, visible scars, uneven appearance, and wrinkling of the implant.

Unknown risks

In addition to these known risks, there are unanswered questions about saline-filled breast implants. For example, can the implants bring on symptoms of autoimmune diseases such as lupus, scleroderma, and rheumatoid arthritis? Can they bring on neurological symptoms similar to multiple sclerosis in some women? Can the implants increase the risk of cancer? (Because saline-filled implants contain only salt water, any risk that might be related to silicone gel would not occur with this type of product.) There is some concern, but little information, about possible risks from the silicone rubber material of the envelope. Also, questions have been raised about the potential for the saline to become contaminated with fungus or bacteria. If so, these organisms might be released into the woman’s body if her implant deflated.

Autoimmune Diseases.

According to scientific studies, women with breast implants in general are not at an increased risk for autoimmune or connective tissue diseases. However, these studies are too small to detect whether there might be a slightly increased risk of any one of these rare diseases. Also, these current studies have looked only for the symptoms of known autoimmune diseases, rather than the variety of symptoms that some women report experiencing. Some of the reported symptoms include:

• Swelling and/or joint pain or arthritis-like pain:
• General aching
• Unusual hair loss
• Unexplained or unusual loss of energy
• Greater chance of getting colds, viruses, and flu
• Swollen glands or Iymph nodes
• Rash
• Memory problems, headaches
• Muscle weakness or burning
• Nausea, vomiting
• Irritable bowel syndrome.

Breast-Feeding and Children.

Questions have been raised about whether or not breast implants present safety concerns for nursing infants of women with breast implants. Some women with breast implants have reported health problems in their breast-fed children.

Only very limited research has been conducted in this area and at this time there is no scientific evidence that this is a problem. It is not known if there are risks in nursing for women with breast implants or if the children of women with breast implants are more likely to have health problems.

Cancer.

At this time, there is no scientific evidence that women with saline-filled breast implants are more susceptible to cancer than other women.

Dr. Jensen will provide you with a patient educational brochure pertaining to your specific type of implant chosen.