Breast implant surgery has started with silicone implants in 1962. They had a natural tear drop shape. They developed a high rate of capsular contracture. They were replaced by rounded implant with better shell, to decrease capsular contracture (implant hardening).
In the mean while, a new generation of saline implant had started in France aiming to decrease capsular contracture and skin incision. In 1992 a moratorium, on silicone implant use, was placed in North America. Multiple research on the subject had proven the materiel safety. The implant is back on the market with a new silicone material, called the cohesive gel implant, that prevent silicone leaking and tissue infiltration if the implant rupture.
The choice of breast implant
Saline implant: It needs good soft tissues coverage, so the implant is place behind the pectoral muscle. It is a good alternative to silicone implant if patient don’t like silicone.
Silicone implant: It has a softer texture, unless the patient develops capsular contracture like in 10-15 % of the cases. The hardening goes from implant feel in the breast to hard texture.
The silicone has softer texture, can be placed in front or behind the pectoral muscle. It is a more versatile prosthesis.
Implant can be textured or smooth. Textured implant is used if it is placed in front of the pectoral muscle. When used behind a smooth implant is usually used.
Two shapes exists : Round implant, used mostly in patients looking for filling the upper breast area. Secondary to breast-feeding or weight loss. Shaped implant: patient interested in the most natural shape implants
In front of the muscle: It can’t be used in skinny patients. It’s Useful in-patient with breast descent (ptosis). Behind the pectoral muscle: It is used for all saline implant, in all skinny patients.
Inframamary: gives direct access to the breast. The scar is hidden in the breast fold.
Around the nipple: the scar is well hidden, mostly used when the surgery is combined with breast lift.
Axillary: well hidden scar. It does not work when it is associated with a ptotic breast (low breast position).