All About Breast Implants

Speaker 1 (00:03):
Welcome to Kind of Beautiful with board certified plastic surgeon Dr. Tracy Pfeifer, the podcast for women seeking the very best of modern beauty.

Dr, Pfeifer (00:17):
Patients always ask how long the uh breast implants will last, which I think is a great question and it is a little bit confusing because in the stratosphere of the internet and person-to-person communication, a lot of people will say 10 years. And that was true in the past with the older generation devices. But now your implant could theoretically be a lifetime device. You do not have to change the implant because it's 10 years old. If you're happy with the aesthetic result, you do not need to change it. If you have a capsular contracture, which is some firm scar tissue around the implant, the breast doesn't feel soft anymore or it's distorting the shape of the implant, you're gonna wanna change it, not because the device has a problem, but because we don't like the aesthetic result anymore. So the decision to have your breast implants revised or changed is really up to the patient and it's almost always driven by a cosmetic or aesthetic consideration.

(01:29):
They want to be a little bit smaller, they want to be a little bit bigger. Occasionally patients want to take them out completely or you have something like a capsular contracture. There's also a situation which we call a leak or a rupture, which I actually don't prefer that word because again, that refers to the old generation implants where the silicone inside the shell was like a water consistency. So if the shell wore out a little bit, just like if you had a piece of paper, you're folding it back and forth and it eventually thins out and kind of splits. That's what can happen with the shell of the implant. It's not a long split, it's usually a stored split or sometimes only like a pinpoint opening. But when the implants had were filled with silicone, that was like water, it would leak out. So they called this when it happened to leak.

(02:19):
Now the implants are filled with a very cohesive silicone gel. It's more like a jello or a jello molasses hybrid consistency. So even if you get a little split in the shell of the implant, that silicone is not gonna seep out. So in the past with the old implants that were filled with water like silicone, it was recommended that you change them every 10 years because it seemed like the shells were splitting at around 10 years and silicone is very sticky. So they didn't want this liquid like silicone getting outside the implant and we would clean it out. It's all treatable, but they were trying to avoid that cause it's a little bit messy so to speak. So now we don't have that situation. Even if there's a tear, it's not gonna seep out. And sticky silicone is getting all over everything. Plus remember that the she have been redesigned so they're much more durable than they will.

(03:16):
So not only is the inside silicone cohesive, but the shells are very durable now and it's not necessary to change it every 10 years unless you have a cosmetic concern with your implant. And another thing to consider is that the manufacturers all have warranties now. So if your implant does have a tear in it, they will replace it forever for free. So if you wanna have a revision because you have a tear in your implant, they will replace the implant for free. Even if you have a tear in your implant, you don't need to change it. That's totally up to you the patient. It's not medically harmful or dangerous from a health standpoint. Occasionally a patient will notice a shape change, but most likely it would be either on an ultrasound or an M R I. It will show that there's an irregularity and M R I is the gold standard, but a skilled ultrasound technician and a radiologist can also pick it up on ultrasound.

(04:20):
The warranty will cover replacement of the device that has a tear. Let's say you have 300 cc implants, you feel a little something, you get an ultrasound, it says, oh, you have a tear. And you're like, well I've had my implants 12 years ago. I had a baby since then with breastfeeding, I actually lost a little volume. So I wanna increase the size a little bit. You can switch that implant to a slightly larger implant, which they will give to you for free. And you can switch the other side to match even though it doesn't have a tear and they will replace that implant for free. Also, if the tear happens within 20 years, and this depends, this is part of the warranty and it depends on which implant brand we're using. But for example, if the patient is using a Ciantra implant, they will help cover out-of-pocket expenses up to I think $3,500.

(05:22):
But it may be more for up to 20 years after the surgery. So implants, they will always replace for a tear and up to 20 years they will help out-of-pocket expenses. Some patients will have an insurance policy that will also help for removal of a silicone implant with a tear. But it's very important for everybody to understand. I think everybody does that. Insurance policies change frequently. You can check your coverage before you have breast augmentation surgery to see if it does cover uh, what's called capsulectomy, which is removal of the ruptured implant. But your policy could change next year. So just because it covers it now, it may not. So what I always tell patients going forward is that you may need a revision at some point in the future. If you're 20 years old, most likely you're gonna need revision and you have to plan on that.

(06:19):
You have to understand that there's gonna be some additional out-of-pocket expense at some point. When it comes to deciding which type of implant is best for the patient regarding the brand or the degree of cohesiveness, is it a gummy bear? Is it a a less cohesive implant? I really try to customize it depending on what the patient's tissues dictate and what postoperative result the patient is looking for. I do not limit myself to one brand. I use Sientra, Allergan and Mentor. I do not use the Ideal implants, which is a saline filled option. And in general I prefer a silicone filled implant over a saline filled implant. And that's for several reasons. Silicone implants feel more natural. They feel very soft for the same amount of volume and aesthetic result. They're lighter. So they weigh less and because of their compressibility, they're very squishy and soft compared to saline, which is kind of stiff.

(07:28):
A silicone implant leads to less stretching of the tissue over time, therefore less sagging of the breast over time. And it gives a very natural result because it is so soft and squishy. So for example, most patients in my practice who need breast implants have very little breast tissue. So the thinner your breast tissue is the less padding that you have overlying the implant. So if you have thinner tissues, the characteristics of the implant are gonna be much more perceptible, both visually and by feeling. So if you put in a saline filled implant in a patient with thin tissues, that very round look, which I don't find particularly natural looking, is gonna be more likely to happen. As is more tissue stretch. If you're putting an implant in a patient that has very little breast tissue, that skin is gonna need to relax and stretch to accommodate the implant.

(08:33):
And with a saline implant, it's much more likely that it's gonna stretch like more and just keep stretching. So I like silicone. There's many more options in terms of sizes and dimensions. There are more fill options in terms of is it 85% filled or 93% filled? There's more options in terms of it. A very sort of less cohesive implant all the way up to like super cohesive. Lots of different options with all three of those brands. So silicone is usually the way to go. Now if somebody doesn't wanna have silicone, you know, we'll make it happen with saline, but they have to understand that it's gonna be possibly more visible. You might see an edge, you might have a little more rippling with the saline implant. And all of these factors are more likely if somebody has thin tissues, patients often are curious about, you know, what is the implant gonna feel like?

(09:32):
Can you feel it? And it really is different for every person. So I would say that you're not really aware of them after about three months they become sort of incorporated into who you are. And in the beginning you'll be like, oh, you know, my breasts are fuller. And if you feel it, you might feel especially along the crease or along the outside of the breast, you might feel like, what is this? Cuz you can almost feel like a little, it's hard to describe like a little sponginess there. It's kind of like if you have your bra on, like a padded bra and if you kind of like bounce your fingers off of your padded bra, that's kind of what the implant will feel like in areas where your overlying breast tissue is thin. So you're not really gonna like say, oh, you know, I feel this thing.

(10:19):
It's not like that. But if the best way I can describe it, if you bounced your breasts off of a padded bra, that's what it could feel like. Especially along the crease. It's not really an issue for very many people. If somebody's super super thin with like no breast shape, no breast tissue, they're gonna feel it a little bit more. But it's, it's a trade off and the patients are very happy to make that trade because you know, what else can you do? I don't believe in putting fat into the breast. So fat transfers for me are not an option. And you can't usually get the volume that you want with fat transfers. And there's problems. Sometimes you can develop like cysts and the, well, not all the fat survives. And so I think the best thing for patients, the most consistent way to deliver the result that they want with the least amount of issues postoperatively is using an implant.

(11:07):
And I think silicone is the best for most patients. The question of breastfeeding after breast augmentation is really an interesting one. And there's no reason from a health standpoint or a risk standpoint that a patient could not breastfeed. So the silicone is not gonna get into the breast milk and be transmitted to the baby. So it's safe to breastfeed. The question is, will there be enough milk produced to adequately provide nutrition to the baby? There was a study in Brazil where they had patients who had had no implants, they got pregnant, they breastfed, they subsequently had breast implants, got pregnant and I think it was 93 of the patients could still breastfeed after having the implants. And the reason why this is a study or even looked at is because the implant is going to compress the breast tissue a bit. So if the tissue is compressed and it kind of atrophies and thins out if you get pregnant, is there gonna be enough viable breast tissue that's actively producing milk to make enough milk to feed the baby?

(12:21):
And at least this one study showed that there was, so in my practice, all of my patients that I know of and we don't have a hundred percent follow-up, have been able to breastfeed if they got pregnant after having implants. So it's safe. And from the information that we have, the majority of people are able to breastfeed in terms of all the different options with implants, the shape, the profile, whether or not it's gonna be smooth or textured. All of these things are discussed in detail during the consultation and it's a lot of information for patients to absorb. And I think sometimes what the patients worry about is that why am I learning all this stuff? I don't, I just trust the doctor to pick out the right size implant for me, <laugh>. And of course I'm going to be guiding the decision. But it's important for patients to understand the pros and cons of each decision so that they're part of the decision making process.

(13:15):
And once you go through the trying on and understanding a little bit about the implants, it all really falls into place. So for example, let's say we had a patient who exercises a lot, almost like a bodybuilder type of excersiser. Now if you have a smooth surfaced implant as opposed to a textured surface implant, think of the texture, it's like a little mini Velcro. If you put a smooth implant underneath the pectoralis major muscle, which is what we mean when it's subpectoral or submuscular, every time that pectoralis major muscle contracts, it's gonna push down on the smooth implant, which is not tethered to the tissue in any way. It's basically freely mobile in the pocket. It's gonna push on the implant and it's gonna push it out to the side. Now, short term, if you were in the gym, let's say doing flies, you might see your implant kind of moving out and then coming back together when the muscle relaxes.

(14:21):
If you do this repetitively over months or years, you can start to stretch, open the implant pocket so that the implant is gonna sit towards the outside of the breast because the muscle's basically pushing it into this expanded pocket, which is the on the side. So we have to think about all of these things. We have to think about our own breast tissue. Let's say somebody is very thin, she's like a ballerina type person. Okay, very little breast tissue. If you put that implant on top of the pectoralis major muscle, you might see a little speed bump or like a step off because you're going from the clavicles down to the top of the breast and then the implant's there and it's on top of the muscle and there's no tissue to kind of camouflage the area where the implant is starting. Whereas if you put it underneath the muscle, the muscle is nice and thick and it will camouflage that transition zone between no implant and implant.

(15:26):
So the patient physical features, the tissue thickness, what activity she likes to participate in. All of these things are very important in terms of determining which pocket we're gonna use, meaning under or over the muscle, as well as whether we're gonna use smooth or textured surface devices. In the United States, a lot of plastic surgeons, the majority do not use texture devices and we could talk about that in more detail later. I do use texture devices because in certain situations they have a lot of benefits for patients. Almost always we make the incision in the inframammary fold because there's a lower capsular contracture rate associated with using that incision. So there is a lot of information that I share with the patient, but as the patient understands the pros and cons, the advantages, disadvantages of each choice, understanding her own particular wants and desires and her tissues, it all falls into place what's going to be the right implant for her.

(16:36):
It's important also for the patients to remember that we're talking about short, short term and we're also talking about long term. So we don't wanna look great for three years. We wanna look great for, you know, nine or 10 years, you know, before you have children or your weight changes. So we don't wanna do things that in five years we're gonna say, oh, our tissues are damaged now cause we use an oversized implant and our tissue couldn't accommodate. Now we're stretched out and saggy. We have to always think about the future and maintaining the best result for the longest period of time when we're making these decisions. If you'd like to schedule a consultation with the office, you can reach out to us directly by telephone, uh, which is on the website, dr pfeifer.com, or you can reach us through the contact uh, page that's on the website and Arlene will get back to you within 24 hours of you reaching out to us and we certainly look forward to hearing from people. If you have any questions or wanna find out more about your options

Speaker 1 (17:36):
To learn more, go to kind of beautiful podcast.com or follow Dr. Pfeifer on Instagram at Dr. Tracy Pfeifer, spelled P F E I F E R. Links to learn more about Dr. Pfeifer and anything else mentioned on today's show are available in the show notes. The Kind of Beautiful podcast is a production of The Axis, t h e a x i s.io.