Breast implants are used for augmentative surgery for women who wish to change the size, shape or feel of their breast. A great deal of social emphasis is placed on women’s breast size. This may influence why breast augmentation is the most popular type of cosmetic surgery, according to the American Society of Plastic Surgeons (ASPS). Overall, the ASPS estimated there were 329,000 breast augmentation procedures performed in 2006.

Breast implants also are a common choice for women who want breast reconstructive surgery following a mastectomy. In 2006, about 56,000 women chose breast implants for reconstructive surgery following a mastectomy, according to the ASPS.

A breast implant consists of a round or tear-shaped shell that is filled with sterile saline (saltwater) or silicone gel.

Saline-filled implants are the most common type of breast implant. The lumen or shell of these implants is composed of silicone rubber and they are filled with sterile saline (saltwater). If these implants should leak or rupture, the solution is absorbed by the body. Saline implants have not been associated with any risks of disease. There are three basic types of saline implants with the following variations:

• Single lumen implant that is filled during surgery with a fixed amount of saline through a valve. After surgery, the amount of saline in this implant cannot be adjusted.
  
  
• Single lumen implant that is filled with saline during surgery, but the amount can be adjusted after completion of the procedure.
  
  
• Silicone lumen implant that is prefilled by the manufacturer with a set amount of saline. There are no valves in this type of saline, therefore, the volume of saline cannot be adjusted during or after the surgery.
  

Silicone-filled implants are the second form of devices. In the past several years, there has been much controversy regarding the safety of silicone implants. Studies have associated these implants with connective tissue and autoimmune diseases. In addition, there has been concern with leakage of potentially hazardous levels of the metal platinum from silicone implants. Although available in the United States from 1962 to 1992, the FDA withdrew silicone implants from the market in 1992 for the general public. Since that time, silicone implants were only available to women who were receiving breast reconstruction surgery following a mastectomy or those who had a physical deformity. Their use also was allowed to replace earlier implants that had ruptured. These women could only receive silicone implants by being enrolled in a controlled clinical trial, known as an investigational device experimental (IDE) study.

Both the U.S. Senate and the FDA have investigated the safety of silicone implants. Studies have failed to demonstrate a definitive connection between silicone implants and chronic diseases. As a result, in August of 2005 the FDA granted conditional approval to two companies that manufacture silicone implants. In order to gain final approval, these companies had to satisfy a number of conditions established by the FDA. In November of 2006, the FDA lifted its restrictions on silicone implants, allowing their use for breast augmentation in patients 22 years or older, and for breast reconstruction surgery in patients of any age. In addition, the FDA is requiring the approved companies to continue conducting long-term studies on the safety and efficacy of their silicone implants.

The outer shell of silicone implants is composed of silicone rubber similar to the composition used in saline implants. Some patients claim that silicone implants feel more natural than their saline counterparts. Although the United States limited the use of silicone implants to patients with specific conditions for 14 years, they have always been widely available in other countries, including many in Europe and Asia.

There are three types of silicone-filled breast implants with the following variations:

• Single lumen (shell) implant that is prefilled by the manufacturer with a set amount of silicone gel. There are no valves with this type of implant and the volume of silicone cannot be adjusted.
  
  
• Double lumen implant that is composed of two shells. The inner lumen is prefilled by the manufacturer with a set amount of silicone gel. The outer lumen contains a valve that is filled with saline through a valve during surgery. Adjustments to the volume of saline in the outer shell cannot be made following completion of surgery.
  
  
• Double lumen with an outer shell that is prefilled by the manufacturer with a set amount of silicone gel. The inner shell is filled with saline during surgery through a valve. This type of implant allows for adjustment of the amount of saline in the inner shell after surgery.
  

Breast implants come in all shapes and sizes in order to accommodate individual differences and preferences. Some of the options that should be considered when selecting a breast implant include:

• Shell surface (smooth vs. textured)
  
  
• Size (volume contained in the implant)
  
  
• Shell thickness (also referred to as the envelope or lumen)
  
  
• Single or double lumen (shell)
  
  
• Fill design
  
  
• Shape (round or contoured)
  
  
• Profile (how far it projects forward)
  

When weighing in her surgery options, it is important that the patient realize that she will have to replace the implant within five to 10 years, if not earlier. Implants that rupture, cause scarring or cosmetic problems are the main reasons for replacement.

Breast reconstruction surgery with implants is performed by a plastic surgeon who is skilled in this complex procedure. It is not uncommon for a patient to need two or more surgeries in order to achieve the optimal implant positioning and proportion. The patient may require surgery on the opposite breast to ensure symmetry (similar size and shape) with the reconstructed breast. This surgery also includes nipple reconstruction and possible tattooing of the reconstructed nipple to create a more natural-looking areola (the dark area of skin around the nipple).

Also, if the reconstruction takes place immediately after mastectomy, it is possible for the cosmetic results to be affected by chemotherapy, radiation therapy or other factors that might delay the healing process. For example, chemotherapy or radiation therapy can increase the occurrence of skin necrosis, in which dead tissue forms around the implant. This, in turn, can lead to an infection. If the infection cannot be cured with antibiotics, the implant may need to be removed.

It is important to note that not every breast cancer patient is a candidate for breast implant reconstructive surgery. Patients should discuss this and any other related issues with a qualified plastic surgeon.