"The trick is to keep the risks manageable," says Bunkis.

Q: “I want to get my boobs done – are breast implants safe?”

-Kelly B. San Clemente

A: Fashion may be fickle but women have been coveting fuller breasts for years. If you are considering a breast augmentation, or any surgical procedure, you have to understand that there are risks, as there are with any activity in life, but the trick is to keep the risks manageable. I’ll give you a little history of breast augmentation and review some of the refinements that have taken place to make this operation safe in the vast majority of instances.

Prior to 1960, many attempts at breast enlargement with large globs of patient’s fat, various sponges and liquid silicone injections caused many disasters and few, if any, natural feeling or looking breasts. The modern era of breast implantation began in the early 1960’s with the introduction of silicone gel implants. Silicone is a chemical element that occurs in combination as the most abundant element next to oxygen in the earth's crust and is used for many things in the medical and electronics fields. The original implants frequently ruptured. Another problem with early implantation attempts was the development of capsular contractures – an unnatural firmness of the breasts. Every type of implant inserted into the human body develops a thin layer of scar tissue around the implant, and even the softest, most natural feeling breasts have this layer of scar tissue surrounding the implants. With a breast implant, the idea is to create a large pocket under the breast tissue and to put an implant in the space which is significantly smaller than the confines of the space, allowing the implant to move and the breast to feel natural.

Two factors can cause the breast to feel unnaturally firm: first of all, if too large an implant has been chosen for any given patient and the implant does not have room to move around, the breast does not have a chance to feel normal and will feel hard; and secondly, if an appropriate pocket was originally created for a given implant but the scar tissue contracts, shrinks down, the implant again will not have room to move and the breast will feel hard as well.
 
Saline implants were introduced to counter these problems but were found to be less satisfactory because the saline filled bags just did not feel as good as a silicone implant in the average patient, and the contracture problems occurred anyway, thus proving that it was not the presence of silicone per say that caused the contracture. In the early days of breast augmentation, some saline implants had steroids placed within the implants in an attempt to control the scar tissue build up (and it did) but in some cases, the steroid caused tissue thinning and erosion of the implants through the skin, leading to removal of the implant – thus, that practice was abaondoned. Early implant patients also had a significant infection rate but by the 1980’s, most of these problems were solved, all patients given antibiotics for example, and very few patients today experience an infection.

Refinements in implant materials and surgical techniques lead to improving results throughout the 1980’s, and continued popularity of such implants. In the early 1990’s, a Connie Chung television show raised doubt regarding safety of breast implants, bringing to light that many patients were now walking around with ruptured breast implants and questioning whether breast implant patients had a higher likelihood of developing autoimmune diseases such as arthritis or lupus. Much publicity ensued and the safety of implants was reviewed by the FDA as well as other regulatory health agencies world wide. Most issued rulings that the safety of silicone breast implants had to be studied further and such implants were removed from the market. Hundreds of scientific studies were carried out, some retrospective, looking at the history of previously performed cases. Others were prospective, studying patients after new implants were inserted in carefully monitored situations. These prospective studies were set up by the major implant manufacturers in the United States, under the auspices of the FDA, and all data was presented to the FDA. I was chosen to be one of the investigators in these studies and was able to have access to silicone implants during the years that they were not available to non-investigators. After carefully studying all the data from these studies and other studies worldwide, the FDA concluded that silicone implants do not increase the incidence of any other diseases. We now know that all implants, whether gel or saline filled, will rupture eventually but the important thing to know is that with current implants and early detection, there is little likelihood of harm to the patient following a rupture of either saline or gel filled implants. In November of 2006, silicone gel implants were reapproved by the FDA for breast augmentation in the United States and this created a flurry of interest in breast augmentation with gel implants. More and more women opt for breast augmentation each year. 212,500 breast augmentations were performed in the year 2000 but the number had increased to 291,350 by 2005, a 37% increase, and in spite or our current weak economy, this number just continues to grow!

Today’s implants have two major changes compared to implants used prior to 1990. The gel that was used in the 1960’s through the 1980’s was a thick, gooey liquid. The gel in implants today is “cohesive”, the consistency of a marshmallow – when cut in half, these implants stay in one piece and do not “leak”. Secondly, today’s implants contain thicker and more durable shells. And finally, surgical techniques, antibiotics and anesthetic agents have improved greatly since the early days of breast implantation, making the procedure a very safe one with low surgical risks. Incisions now are much shorter and more hidden, a variety of different approaches, including entry through the arm pit or nipple area, have been developed and placement of the implants above or beneath the pectoralis major muscle has been perfected.

Some patients today still choose a saline implant but most of these do not feel as natural as the average breast containing a silicone gel implant. Breast implant surgery is obviously very elective and prospective patients should not be in a hurry to make a decision before they have truly been educated regarding the various aspects of breast implantation surgery (http://www.ocps.com/breast-augmentation/). The proper thing to do at this time is to go over all the indications, alternatives and risks and provide each patient with the pros and cons of all available implants types and to let them participate in the implant choice. But once my patients have had a full consultation, including an opportunity to see or feel both types of implants, most today choose a gel implant for themselves.

If you have any specific questions about cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options. Pease feel free to contact our office at 949-888-9700 to set up an appointment with Dr. Bunkis; you may also check out our web site at www.orangecountyplasticsurgery.com to see examples of patients similar to your age and size to see what’s realistic for you in our breast enhancement photo gallery (http://www.ocps.com/gallery_detail.php?cid=57). I must say that breast enhancement patients are some of the happiest patients after their procedures! Here are some examples of ways that patients express their thanks to us!
 

(Actual patient of Dr. Bunkis) Young female, before and after breast augmentation with 360 cc, subpectoral implants