Correction of Breast Implant Complications

Dr. Hilton Becker is a recognized expert on Breast Implants. He has developed several adjustable breast implants and published numerous articles and book chapters on breast implant complications and how to treat them.

Complications related to Saline implants

Although results with saline implants are generally good, the complications seen with saline implants may include:

• Rippling and thinning of the tissues
• Excessive sagging – if saline implants were placed above the muscle
• Distortion and excessive muscle movement if they were placed beneath the muscle
• Stretching of the areola

Fortunately, now that Silicone Gel Implants have been approved by the FDA, they offer a viable solution to many of the problems that were caused by saline implants.

“Our patients who have had problems with saline implants are delighted by the feel and shape of the new gel implants. By replacing gel implants above the muscle under the Fascia, abnormal movement is eliminated and a more natural shape and feel is restored.”

Complications following saline breast implant surgery are often related to the physical characteristics of saline verses that of breast tissue. Saline is heavier than breast tissue, and when confined to a flexible silicone bag it has more of a tendency to ripple, compared to a silicone gel implant. Saline implants therefore have a greater tendency to become ptotic (sag), especially when placed above the muscle.

Conversion from sub-muscular to sub-fascial position

Breast implants are commonly placed in the sub muscular position.

It is believed that the extra layer of muscle offers additional support to the implant decreases the incidence of capsular contraction, and gives a more natural upper pole contour, However sub-muscular placement causes distortion of the implant on contraction.T his can be very bothersome to patients.

Many surgeons therefore detach the muscle inferiorly. This may lead to double bubble deformity when the muscle retracts. Furthermore, release of the muscle results in the upward movement of the muscle leaving the lower half of the implant devoid of muscle coverage.

Patients who are bothered by muscle contraction and distortion can have their implants placed above the muscle in the subfascial plane. The fascia is the lining of the muscle which offers support to the implant while eliminating the negative effect of muscle contraction on the implant.

We currently perform most of our breast augmentations and breast implant revisions in the subfascial plane.

In cases where the fascia is damaged or excessively thin, the fascia can be strengthened with the placement of an absorb-able mesh.

Capsular contraction

Capsular contraction is a result of the body’s reaction to the implant, this results in tightening of the tissues around the implant.

Dissatisfaction with size, symmetry and shape

The treatment of these complications is often difficult and complex.

The availability of the New Cohesive Gel (MemoryGel – Gummy bear) implants, and mesh (biologic and synthetic), provide new options that are highly successful in treating these complications.

Use of Adjustable Implants to Treat Breast Implant Complications

A new implant has recently been FDA approved for use under an adjunct study. Offering many advantages over standard implants, the Smooth Becker 50/50 implant is an adjustable implant that contains 50% silicone gel and 50% saline.

The implant is adjustable after surgery by means of a small injection dome that allows the inner saline compartment to be increased or decreased.

The advantages of the Smooth Becker 50/50 implant include:

• Post-operative adjustability
• Ability to stretch scar tissue
• Ability to modify the shape after surgery
• Ability to change the size of the implant after surgery to the size desired by the patient and to match more accurately the size of the opposite breast in case of asymmetry

SMOOTH SHELL

• More natural feel
• More elasticity of shell
• Less rippling

50% SILICONE

• More natural feel
• Lighter in weight, less tendency towards sagging

Replacement of Saline Implants with Silicone Gel Implants

Now that silicone gel implants have been approved for use by the FDA, women have the option of having the most natural form of breast enlargement available.

When Silicone gel implants were not available in the United States, woman had only two options available to them:

1. Use saline implants placed above the muscle – Due to the weight of the saline implant they would tend to sag excessively, resulting in an abnormal shape, commonly known as Rock-In-The-Sock. Rippling was also problematic.
2. Place the saline implant under the muscle. Although this technique reduced sagging, muscle contracture resulted in abnormal distortion of the implant.

Patients, who have previously had saline implants and are dissatisfied with their results, can now have their saline implants replaced with the New Cohesive Gel (MemoryGel – Gummy bear) implants.

It is of my opinion that the most beautiful and natural results in breast augmentation are seen with Silicone Gel implants, placed above the muscle in the Sub-Fascial position.

Our patients who have received these implants are happier than ever.