Breast augmentation is a procedure that may be performed using a number of different breast implant techniques. In Australia, the two primary types of breast implants used are silicone-filled implants and saline-filled implants, each with its own set of advantages and disadvantages. Virtually all surgeons now use silicone implants which are filled with a cohesive silicone gel.
In recent years, silicone implants have gained prominence due to their superior safety and aesthetic outcomes. The preferred breast implants of choice that Dr Mark Hanikeri uses in his breast augmentation patients are Mentor and Motiva implants.
Mentor and Motiva are two well-known manufacturers of cohesive gel breast implants with both brands offering a range of implant options, including round and anatomically shaped implants. Round implants are symmetrical and generally provide more fullness to the upper part of the breast, while anatomical implants are shaped more like a natural breast and are designed to provide a more subtle result.
Silicone implants for safety and aesthetics
These gels do not have the same risks associated with previous more liquid gels which were subject to migration of the gel within and outside the breast, particularly after implant rupture. These cohesive gels have been in use since the 1990’s.
They have minimal risks associated with gel migration (even after implant rupture) and are not only associated with subtle aesthetic results, but offer peace of mind regarding risk management. This makes them a popular choice among both patients and surgeons.
Saline implants: A safe alternative with some trade-offs
An alternative to silicone implants has always been saline filled implants which still have an outer shell made of silicone. Saline implants have been in use for decades and are associated with very good aesthetic results. One significant advantage of saline implants is that, in the event of rupture, the saline is harmlessly reabsorbed into the body’s circulation without causing adverse side effects. Additionally, saline implants can be inserted through smaller incisions on average than silicone filled implants, particularly the cohesive gel tear drop shaped implants which do require a significantly larger incision than smooth round saline or gel implants. This can be appealing to patients who want minimal scarring.
However, there are trade-offs with saline implants. They tend to have a higher rupture rate than silicone filled implants and when rupture does occur, the breast deflates completely, necessitating surgery for symmetry restoration. Saline implants also tend to feel less natural than silicone implants and exhibit more visible and palpable rippling compared to silicone implants, although rippling is a characteristic of all breast implants.
Surgical approaches: Inframammary, trans-axillary and trans-areolar
The surgical approach for inserting implants is a matter of patient preferences and surgeon expertise. The three commonly used approaches are:
Inframammary approach: This approach involves making an incision underneath the breast, providing a high degree of predictability regarding implant orientation and location. It is the preferred choice for revision surgery, which is often required by breast augmentation patients over time and virtually always requires an inframammary incision.
Trans-axillary (Armpit) Approach: This approach can provide relatively unobtrusive scars however, the dissection of the implant pocket through the trans-axillary route is less precise and occasionally results in a less aesthetic result compared with the inframammary approach. In many cases the trans-axillary route is associated with a ‘blind dissection’ of the pocket using blunt surgical dissectors to create the pocket without the opportunity to cauterise blood vessels which are invariably present in the plane of dissection. This can lead to issues such as bleeding and haematoma formation as well as the suspicion of a higher rate of capsule contracture associated with residual blood and potential bacterial contamination in the pocket.
Trans-Areolar (Nipple) Approach: This approach results in aesthetically pleasing scars, but requires a reasonable-sized areola for safe surgery. Furthermore, the trans-areolar approach may lead to increased damage to the ducts leading to the nipple which can interfere with breast feeding. There is also a higher risk of nipple sensation loss and a potentially elevated risk of infection and capsular contracture.
In summary, the inframammary approach is the most common method used by Dr Mark Hanikeri for inserting breast implants and is generally associated with fewer complications compared to the other two common methods. It allows for a high degree of predictability in implant placement and orientation, while often leaving barely visible scars. Ultimately, the choice of technique should be a collaborative decision between the patient and the surgeon, considering individual preference, anatomy and desired outcomes.