Breast Augmentation : Austin plastic surgeon, Dr. Ersek

When breasts are too small to fill a shirt or blouse, they are often described and perceived by women as deformed. Since 1962 about a million women have had breast augmentation, with 90% of them pleased with the results. There have been some severe problems with silicone gel in the past. Those problems are not related to any disease or immune phenomenon. Those problems are related to the fact that silicone gel is chemically inert and if an implant should break, it cannot be easily removed from the body. When silicone gel implants are ruptured, for instance as in an automobile accident when the seat belt in a collision impinges on the implant and breaks it that gel because it is moldable and movable can be compressed and propelled out of the area of the breast into the surrounding tissue. Weeks or months later, that can be felt as a nodule, and the patient of course, is quite alarmed because they think they have a tumor that can only be proven by biopsy. Gel can also shoot up the arm, cause lumps that can be misdiagnosed causing unnecessary removal of tissue, and lumps that may interfere with x-rays. In addition, the silicone gel can be forced down the nerves of the arm and because it is chemically inert it cannot be removed except by removing the nerve which, of course, would leave a terrible deficit.

Therefore, when reasonable alternatives were discovered, many surgeons stopped using silicone gel on patients, when confronted with a choice between a water-soluble jelly-like material such as Novagold or Mistigold, overwhelmingly choose that material over silicone gel. At the present time, we have three types of breast implants available throughout the world--saline, PVP (Novagold), and various vegetable oils such as soybean and peanut oil. Of the three variations, they each have certain characteristics.

Silicone Gel

Silicone gel is still available in some parts of the world, but it is the wrong thing to put inside the human body. Even if the implant is not broken, it has been found to migrate through the shell of the implant and to be picked up by the lymphatics where it may be misdiagnosed as a tumor inside the chest cavity, misdiagnosed as tumor in lymph nodes, and silicone gel blocks x-rays for normal mammography. Since one in nine women are likely to get breast cancer eventually, it is inappropriate to put something as big as a baseball in the breast that will block those x-rays. Therefore, although silicone gel remains available, its only advantage over anything else is the fact that it feels natural. Silicone gel in a silicone bag feels squishy like a bag of fat or similar to a normal breast. It has no other benefits.

Saline

Saline has been around as an implant filler material since 1964 and it x-rays nearly like normal breast tissue but is rather watery to the feel. It is certainly safer than silicone gel and is a reasonable substitute. Saline may support the growth of some bacteria and other organisms, although this is rarely significant.

Soybean Peanut and other vegatable oils.

A variety of oils and fats have been tried, and they had the advantage of x-raying quite well, about like air but not like normal breast tissue. However, if the implant should break, as in a car accident this material is not water soluble and so it lingers around through the tissue as small bubbles of oil for several months before the body can break ft up and digest it. The material is not toxic but it has been reported by Barnes University in St. Louis to support the growth of some microorganisms. It does lubricate the inside of the shell, however, and is less watery than saline but not nearly as viscous as other materials.

PVP

PVP is polyvinyl pyrrolidine that has been a material used in a variety of pharmaceuticals since 1934. Hundreds of thousands of people have had PVP used as a blood substitute, injected intravenously in Europe. It is widely used throughout the United States and elsewhere and has multiple FDA approvals for a variety of uses. It was approved by the FDA for breast implants on October 19, 1990. PVP has a viscosity much greater than water or saline but not quite so jellylike as silicone gel. PVP is the best available, nearly ideal substance for @ breast implants. It x-rays just like normal tissue. It lubricates the inside of the shell seven times better than saline or silicone so that the likelihood of full flaw fracture phenomenon or weakening of the shell from friction is greatly reduced.

PVP is chemically inert with the body and should the implant break, this material is scavenged by the lymphatic system and excreted in the urine, unchanged, within a week. It does not harbor any bacteria. Thousands and thousands of women have had Mistigold and Novagold implants throughout the world and where they are available, they are the most popular. They have recently been granted a CE mark so that they are now available throughout the free world including China. The CE mark is CE #048 1, and they have been submitted to the U.S. FDA and, hopefully, Novagold will soon be available in the United States. In the meantime, they can be obtained in any European country, the Cayman Islands, South America, and even China. Following this description will be a list of scientific papers that have been published on Novagold, the newest PVP containing implant.

Breast Augmentation

In general, breast implants can be placed beneath the breast tissue or beneath the pectoralis muscle under the breast The incision to place these implants can be positioned either around the nipple, through the nipple, under the breast m the crease, or through the armpit or, in a few cases, through a tummy tuck incision. The preference is that of the patient, and any of these approaches are appropriate. Most people choose the armpit incision because it is remote from the breast and does not leave any mark on the breast at all. The implant is usually placed under the muscle unless the breast is rather long or the muscle rather high or if the breast needs a lift. But, in most cases, it can be placed under the muscle. The benefit of having the implant under the muscle is that the muscle then serves as a buffer zone between the breast itself and the implant. One of the problems with breast implants is the fact that they sometimes get hardened as a result of scar tissue that forms around them. This scar tissue is more likely to form if the implant is exposed to any bacteria such as in the breast gland itself. So by placing them under the muscle we decrease that opportunity.

At the present time there are smooth-surfaced and textured-surface implants available. Most prefer the textured surface because tissue ingrowth prevents micro-motion so the implant stays in place and by being under muscle they have a little bit of pressure there. Implants come in a variety of sizes, as small as a tangerine to as large as a cantaloupe. What size implant is chosen depends to some extent on what the patient's configuration is.

Before and Afters

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