Current Trend in Breast Implant Size

The trend in cosmetic surgery nowadays is the natural look.  This is particularly true in breast augmentation that most patients are choosing implants which come in “conservative sizes.”

Anecdotal evidence shows that a significant number of patients choose breast implant sizes (described in cubic centimeter) between 350cc and 500cc.  They can provide enough volume especially in the upper poles without leading to inappropriately large, grapefruit-shaped breasts.

Women should remember that cc alone does not determine the final size, although in many cases a 150-200cc can increase the breast to one cup. 

(Important note:  Implants with a size of 250-350cc may transform a petite lady’s AA cup to D cup, while the same size may only increase the bust size of a larger and/or taller lady by a cup or two.)

Large breast implants usually start at 600cc, and women with a large body frame more often than not have no problem using them.  This is particularly true if they have sufficient amounts of breast tissue and fat, reducing the risk of visible and palpable wrinkling.

By contrast, large implants can be very problematic for thin and petite women not only because they often lead to a “heavy top look,” but they also result to higher risk of wrinkling and rippling.

Also, when large implants are used on thin women or patients with very little tissue, more often than not their breasts appear unusually round—the most common telltale sign of plastic surgery.

Meanwhile, there are two kinds of breast implants used in the US:  the saline implant which is filled with a sterile mixture of salt and water, and the silicone implant which contains a cohesive gel.

Currently, breast manufacturers in the US do not produce silicone implants larger than 850cc, even if there is no law prohibiting them to do so.  This is because common sense tells that excessively large sizes can lead to chronic back pain, longer recovery, stretch marks, and bottoming out which will eventually force a patient to downsize her implants.

But some saline implants, which are filled once inside the breast pocket, are larger than 850cc.  However, they are rarely used as [ethical] plastic surgeons will not push the body’s limit for the sake of aesthetic goals.  

Contrary to popular belief, patients can achieve a prominent cleavage without having to choose larger implants.  In fact, some smaller implants can provide this sexy feature by offering more projection.

Knowing If Breast Implant Surgery Is Right for You

For the past couple of years, breast implant surgery has been the most sought-after aesthetic operation that in 2011 alone, about 307,000 procedures were performed, according to survey released by the American Society of Plastic Surgeons.

But despite the growing popularity of breast implant surgery, not all people who desire to increase their bust size and/or want to achieve a more prominent cleavage are good candidates for this procedure.

As with any cosmetic surgery, breast augmentation involves some risks, recovery, and of course money.  For these reasons, you should be able to answer these questions before you consult a plastic surgeon:

*  Do you have “healthy” motivations?

If you want to undergo a cosmetic surgery, bear in mind that your motivations should be based on your personal happiness.  But if you want this to please other people (your partner or colleagues), you would most likely end up dissatisfied since physical improvements do not automatically result to “better relationships.”

*  Do you have realistic goals and expectations?

If you have very small breasts (double A cup), desiring to achieve a full D cup is definitely over the top.  Take note that because you have limited breast tissue and fat, “inappropriately” large implants can lead not just to fake look but also to higher risk of wrinkling/rippling and bottoming out.

*  Do you have enough money?

Because breast augmentation is an elective procedure, don’t expect that your health insurance will cover the surgical expenses; this means you have to spend your own savings or seek loans.

Aside from the surgical costs, you should also consider the possibility of a revision breast augmentation, MRI screening (if you would choose silicone implants), and other expenses after your operation.

*  Are you physically healthy?

Your plastic surgeon will interview you and ask you to undergo laboratory examinations to determine if you are healthy and are not suffering from medical conditions that may compromise your recovery.

Be as honest as you can, particularly when your doctor asks you about your previous surgeries, medical conditions, allergies, and current medications.  Also, you should tell the truth if your surgeon raises the topic of smoking and drinking habits.

*  Are you emotionally stable?

If you are emotionally stable and fully understand and accept the ramifications of having breast implant surgery, you can proceed with the procedure as long as you meet the other requirements.  But if you’re suffering from depression and other psychological and emotional issues, talking to a therapist is way better than consulting a plastic surgeon.

Asian Breast Augmentation

About 307,000 breast augmentation surgeries were performed in 2011, making it the most popular cosmetic plastic surgery during the period.

In a 2011 survey released by the American Society of Plastic Surgeons, breast augmentation was one of the top three cosmetic surgeries performed on Asian-Americans, which has always been the trend. 

Because Asian women often have a smaller frame than Caucasians, the general rule is to limit the implant size particularly if the aim is to create a natural appearance instead of an operated look.

Small- to moderate-sized breast implants are particularly ideal when dealing with patients who have little breast tissue to prevent or at least minimize the risk of visible wrinkling and rippling. 

Nowadays, the trend is the natural look which can be easily achieved by using smaller breast implants.  In fact, many plastic surgeons have noticed that most of their recent patients asked for implants filled between 300 and 350 cubic centimeter or cc which is often enough to add volume without giving a heavy top look.

Aside from the implant size, Asian women should also consider the implant profile or the projection off the chest wall.  As mentioned earlier, they generally have a smaller frame and chest “band” than Caucasians so these certain anatomical features should be taken into consideration.

In general, patients with a small chest “band” should use high-profile implants which offer more forward projection and smaller base, which is important to avoid the unnatural look. 

On the other hand, petite patients in general should avoid low-profile implants which have a bigger base but offer less projection as they can occupy too much space on the chest band, resulting to “bursting” appearance.

To date, a growing number of women choose silicone breast implant over the saline version because it provides a more natural look and feel with its viscous filling.  Meanwhile, the US Food and Drug Administration has recently approved the fifth generation of silicone implant which has a more cohesive gel than its predecessor, in addition to being form-stable.

But still, salineimplants, which are filled with a sterile mixture of salt and water, can provide a natural look and feel as long as there is an ample amount of breast tissue and fat; but if this is not the case, unnatural contour and higher risk of wrinkling are usually the results.

But despite some concerns, saline implants are still endorsed due to their surgical flexibility and are easy to replace during a revision breast augmentation.

Saline Breast Implants Info

Saline breast implants are used to increase the bust size or create more fullness especially in the cleavage and upper poles.  However, these devices are also used to reconstruct the breasts after mastectomy or cancer surgery in which the affected tissue or tumor is removed.

Saline implants vary in volume (defined by cubic centimeter or cc), shell thickness, shape (round vs teardrop), and shell surface (smooth vs textured).  They are also available in inflatable and prefilled version.

In the US, only the inflatable saline implants are available, meaning they are filled at the time of breast augmentation surgery.  With this design, plastic surgeons can insert the device using a very small incision, thereby minimizing the appearance of scars.

By contrast, prefilled saline and silicone gel implants require longer incisions.

As its name suggests, saline implant is filled with saline, which is a sterile mixture of salt and water.  And with its content, there is no serious risk in case of leak, although the tradeoff is that the affected breast will immediately look deflated and will need a revision surgery.

On the other hand, a leak in silicone implants that is undetected for a long period of time can lead to inflammation of the tissue, pain, and discomfort.  Because of such risks, patients with this implant type are required to undergo regular MRI breast screening at least every two years.

In the US, the typical size of saline implant ranges between 120cc and 850cc, although women who want to go larger will need custom-made implants.  But because of the risks associated with extreme sizes, most plastic surgeons would likely decline any surgery to patients who are “going overboard.”

All inflatable saline implants have valves, which are often located in front.  Most manufacturers use diaphragm valve; it has a “male portion” at the end of its tubing that when snapped into the “female receptor hole,” is left into the implant shell, thereby sealing the device. 

Meanwhile, women with limited tissue or small breasts are often advised to stay away from saline implant because it can lead to unnatural outcome (the bosom appears unusually round).  By contrast, patients with ample amounts of tissue have no problem with this implant; in fact, there is no visible difference if they use silicone or saline.

Because of the watery consistency, saline implants may lead to sloshing effect, thus increasing the risk of downward displacement.  To avoid this problem, many plastic surgeons intentionally overfill the shell with saline solution. 

Europe Seeks Tougher Breast Implant Test

With the controversies surrounding French-made PIP breast implants, the European Union is seeking tougher tests and inspections for these devices in an effort to protect consumers from substandard products.

Because of the slack system, some experts believe the implants manufactured by PIP have been sold in many parts of the world.  (But surprisingly, the devices did not reach the US after the FDA found the company’s failure to adhere in good manufacturing practices). 

Investigation shows that since 2000, PIP has developed a simple way to deceive third party auditors from discovering that it was using industrial grade silicone gel intended for making mattresses.  With this plan, the company was able to lower the manufacturing costs of its devices—of course at the expense of thousands of women who had the substandard implants.

According to estimates, about 400,000 PIP silicone breast implants were sold in UK, Spain, Australia, Brazil, Argentina, Colombia, and Chile.

To hide the industrial-grade silicone gel, PIP workers placed the barrels containing this substance in a separate warehouse while auditors were making a routine visit.  Meanwhile, one employee has admitted that he was asked to erase evidences from the computer system before the audits and add them again afterwards.

And as the company’s way to celebrate its fraudulent act, employees threw huge parties every time the auditors left the premise.

Going back to the EU regulators’ plan to overhaul the rules, the aim is to prevent medical device makers in charge of checking the safety of their own products, and to further beef up transparency. 

However, concrete plans to improve the oversight system are yet to be determined later this year.  But one possible solution is to carry out unannounced audits particularly when dealing with companies suspected of fraudulent acts.

In January 2012, PIP founder Jean-Claude Mas, 72, has been charged of involuntary injury two years after the French health ministry banned his company’s silicone breast implants which were sold in 65 countries.  The devices have been found to be prone to rupture because of their thin shell; in fact about 14 percent of women who have them removed suffered from leak.

Surprisingly, while Mas has admitted deceiving the French authorities for 13 years, he called the victims who filed complaints against him as those “who want to make money.”

The PIP founder has also criticized authorities for offering victims to pay for the removal of implants because it can put them to a “surgery risk.”

Effects of Saline Breast Implants Depend on the Amount of Tissue

As its name suggests, saline breast implant is filled with sterile saltwater; for this reason it provides a less favorable cosmetic outcome for women with little breast tissue and fat.  By contrast, patients with an ample amount of tissue will usually enjoy a more natural result because of the “thicker coverage.”

The reason why women with almost no breast tissue will have unnatural result with saline implants is that there is little coverage.  In fact, the implants will be easily felt through the skin, regardless if these are positioned under or over the muscle, particularly in the lateral side and bottom of the breasts.

And instead of having a teardrop-shaped breast, it would end up being unnaturally round.  So for women with little amount of tissue, silicone breast implants, which are filled with a cohesive gel that mimics the feel of glandular tissue and fat, are the best options for them. 

(However, using teardrop-shaped implants, which are always available in textured surface to prevent them from flipping over, are not advisable for women with a very small breast because of the higher risk of rippling.)

Another concern of using saline implants on women with limited breast tissue is the higher risk of rippling and wrinkling of the shell, which is caused by “lack of coverage.”  This problem may be even aggravated with the use of textured implants with large “graininess.”

On the other hand, patients with moderate to significant amount of glandular tissue—particularly those with firm breasts—will likely enjoy a more natural result with saline implants.  In fact, regardless of the type of implants they would use, it is easier for them to achieve a favorable cosmetic result.

But despite having more amounts of tissue and fat, women should still limit themselves from using large saline implants (filled with more than 500 cubic centimeter or cc) because it can lead to a higher risk of downward displacement than silicone implants with the same size.

Meanwhile, women with a modest amount of tissue will achieve a result somewhere in-between.  They will most likely feel the implant shell through their skin with saline implants, although the shape of their breasts will appear natural as if they have used the silicone version. 

In general, silicone breast implants are still the best option for these patients to achieve a more natural feel.  (When plastic surgeons mention the word “feel,” they are talking about the sensation of the breast as it is being touched by fingers.)

Substandard Breast Implants from France Did Not Reach the US—ASPS

About 30,000 women in France will receive surgery to remove the defective breast implants which are highly prone to rupture and leak, while approximately 50,000 patients in UK have these substandard devices which were manufactured by Poly Implant Prothese (PIP).

While the defective siliconebreast implants were exported to Brazil, UK, Chile, Argentina, Spain, Colombia, and Venezuela, the American Society of PlasticSurgeons (ASPS) said the products were never approved in the US.

In Germany and possibly elsewhere in Europe, the substandard PIP breast implants were sold under the brand name “M,” according to the ASPS website.  Meanwhile, about 80 percent of devices were exported outside France.

In a statement published on its web site, the ASPS said that “an American woman would need to have been implanted outside the United States in order to have received the implants that are now the subject of concern in France.”

According to earlier reports, about 50 clinics in UK have reported implant ruptures although the government said “there is no need to remove the products en masse.”

While the total number of British women with ruptured implants—which have been found to have a fragile shell—is still unknown, experts have estimated that about 1,000 patients could be affected.  However, this is just a conservative estimates assuming that implant failure rate is only 2 percent.

PIP’s cheap implants have been reported to be made of low-grade industrial silicone designed for mattress, making them “unfit for human use.”

Fazel Fatah, president of the British Association of Aesthetic Plastic Surgeons (BAAPS), said the “quality of the silicone in PIP implants is not of medical grade, therefore, these are not fit to be implanted into humans.”

While there is a call for the UK government to “require women with the substandard devices to undergo implant removal” and “to shoulder the surgical expenses,” the spokesman for private medical clinics said that it would be “irresponsible” to remove all the implants as clinics could not afford to pay all the related costs.

The spokesman added that their study has suggested that the rupture rate of PIP implants is “between 1 and 2 percent” which is described as “within the acceptable industry standard.”  However a separate study has shown that failure rate is approximately 7 percent.

PIP, which filed for bankruptcy two years ago, has been warned by US Food and Drug Administration in 2000 that its implants were substandard as the company failed to follow “good manufacturing practices.”

Woman Tries to Have the Largest Breast Implants in the World

In an attempt to make history, Sheyla Hershey, 31, had undergone 30 breast surgeries to make her bust the biggest in the world through implants.  But just recently, she was forced to undergo an emergency procedure to remove her 38KKK cup size implants due to bad reaction and unusual pain during her recovery. 

However, what is more surprising is that she is still determined to hold the record for having the largest breast implant size in the world.  In fact, she was reported to have traveled to Mexico in order to receive a new operation to “reinflate” her breasts, even without her husband’s knowledge.

In an interview with the Daily Mail, Hershey was quoted saying that she felt “deformed without her breasts.” 

“I feel like I lost my leg,” she added.

Hershey regained her previous 38MMM cup size with a procedure that injected saline solution inside her breast implants.  Her husband only thought that she was going to Mexico in order to reconstruct her bust.

With the result of her new operation, she said she was happy and “felt whole again.”  Meanwhile, some experts believe she was suffering from body dysmorphic disorder, a type of mental illness in which the sufferers are extremely conscious to their body image and preoccupied with their slight or imaginary defects of their physical features.

According to previous reports, Hershey is also suffering from bipolar disorder.

Dr. Tarick Smaili, one of the leading plastic surgeons in Los Angeles, said that breast implants are reasonably safe “as long as they come in sizes appropriate to the body-frame and amount of tissue and skin of patients.”

“A good and ethical plastic surgeon will not push the body’s limit by introducing breast implant size that is way too large for a patient.  Violating this principle will likely result to higher risk of implant visibility, unusually painful recovery, and other serious complications,” Smaili said.

Smaili said that he was also concerned with the significant scar tissue associated with having multiple breast surgeries, which are necessary if one is going to have inordinately large breast implants.

“Hershey is likely having multiple breast implant surgery to slowly stretch her tissue and skin, however, it is also possible that she is using tissue expanders, which are temporary implants injected with saline every couple of weeks, so her breast can house larger sizes”, the surgeon added.

Meanwhile, the US Food and Drug Administration does not impose any limit on breast implant size although US manufacturers Mentor and Allergan do not offer implants larger than 800cc.

Subfascial Breast Implant Placement Overview

With the advances in plasticsurgery, there are many available surgical techniques in breast augmentation to accommodate a specific anatomical feature, achieve the goals and expectations of a patient, create the most natural result possible, and minimize the risk of complications.

Nowadays, there are many breast implant placement techniques available to patients, although the most popular are the submuscular (the device is placed behind the muscles) and subglandular (the device is placed behind the tissues).

Meanwhile, there is a new technique called subfascial breast implant placement which is a compromise between submuscular and subglandular methods; it combines the benefits of the two primary placement options while eliminating the disadvantages associated with them.

The subfascial technique greatly resembles the subglandularimplant placement, with one major difference.  While the pectoral muscle is not touched, the fibrous fascia tissue is dissected from its front wall in order to place the breast implants beneath this layer.

Perhaps one of the possible advantages of subfascial implant placement is that it can isolate the device from the breast tissue, which leads to greater accuracy during mammogram examination.

Another benefit is the shorter recovery because the chest muscles are not disturbed, which is the case in submuscular implant placement.  And for this reason, patients can also expect less swelling, bruising, pain, tenderness, and other postoperative symptoms.

In terms of breast appearance, the technique provides a very natural result because it mimics the innate movement and contour of the tissue.  In addition, it provides added support from the strong fascia layer.

And unlike the subglandular implant placement, the subfascial technique prevents the risk of visible and palpable wrinkling because there is a fibrous fascia that provides coverage to the implant shell.

While the subfascial placement can lower the risk of capsular contracture (hardening of the scar tissue around the implants) compared with the subglandualr technique, it is not as effective as the submuscular implant placement which completely isolates the breast implants from the tissue, which is believed to harbor high levels of bacteria that can potentially increase the risk of complication.

Advocates of this new implant technique believe it works well for patients with small breasts and limited amounts of fats and tissue who want to achieve a smooth and natural-looking bust after breast augmentation surgery.

But for those who want to further minimize the risk of implant visibility, the submuscular implant placement is still the best technique.