Editor’s note: the attached video includes graphic footage of surgery.

For nearly 15 years, saline implants were the only option available to breast augmentation patients until the FDA re-approved silicone implants for cosmetic procedures in 2006. Although patients had limited choices, saline implants not only offered a track record of safety, but also the added benefit of flexibility, since they are not pre-filled.

Because they were deflated during insertion, doctors found they could utilize a variety of new techniques for inserting the implants that resulted in smaller incisions and less scarring. This meant that the scars could be placed in several areas; some more subtle or hidden than others.

Today, those techniques are available for all kind of implants — silicone as well as saline — and it’s important to know what kind of technique your surgeon will use, and the risk and benefit of each.

Inframammary: This incision is made where the breast comes together with the chest wall. A correctly placed incision means the scar is only visible when the patient is lying down.  One advantage to this approach is if the surgeon has to go back in to correct any complications, no other incisions need to be made. The breast tissue, muscle and implant are all accessible from this incision. A disadvantage to this incision site is placement; the surgeon must determine where the new crease will be, not where the old breast fell. Also, if the patient decides to either have the implants removed or go up a size, the old incision will be visible.

Periareolar: This incision is made around the bottom half of the areola. This incision is commonly used in patients receiving a breast augmentation and lift at the same time. It also allows the surgeon to work close to the breast, making placement of the implant easier. The main disadvantage to this type of incision is that muscles and connective tissue must be separated during surgery, and that causes additional discomfort during recovery. Also, since the entry point is so close to the areola, the risk of losing sensation is greater.

Transaxilary: The transaxilary incision leaves no scar on the breast itself but instead in the patient’s underarm. This technique allows for implant placement above or below the muscle, and usually results in fewer breast feeding complications for women who go on to become pregnant. However, this type of incision cannot be used with silicone implants, makes placement more difficult since the surgeon is farther from the breast, and complications have to be addressed with additional incisions, if needed.

With any of these techniques, and with any kind of implant, patients will experience soreness for two to three days as their body gets used to the change. Most patients are able to return to normal activity in a week.

A Los Angeles cosmetic surgeon is making it clear that what he does is only the beginning of your new and better body. The rest is up to you.

Dr. David Stoker of Marina Plastic Surgery Associates in Southern California is saying that people who try to get healthy before undergoing liposuction and stay healthy afterwards have the best long-term results.

He explains that a lifestyle of exercise and smart eating are the perfect fit for body contouring methods such as liposuction.

Liposuction is a procedure where fat is aspirated or suctioned through tiny incisions allowing the surgeon to contour areas of excess fat.

The procedure is very effective with high patient satisfaction.

This information is not new as these original findings were published in 2006 in Plastic and Reconstructive Surgery, the premiere journal in the specialty, by the plastic surgery group at the University Texas Southwestern Medical Center .

The researchers found that success in body contouring surgery was heavily dependent on the patients embracing positive lifestyle habits of proper diet and exercise for long – term success.

In more breast augmentation news, it seems another woman from England was part of a lawsuit, this time involving silicone implants.

Her case is finally closed after eleven years- and the compensation?  Less than four hundred American dollars.

She has called this an insult.

But based on recent medical findings, 56-year-old Shirley Hartley may be lucky to have been awarded anything.

Eleven years ago, Hartley took part in legal action against American implant manufacturer Dow Corning, stating that her silicone implants caused a severe reaction from her immune system.

Hartley had complained of chronic fatigue and burning sensations. She also claimed that her ill health has prevented her from holding a job – and even from being able to go for a walk.

It was back in 1998 that Hartley joined thousands of women from both Europe and America in pursuing a multi-billion dollar class action settlement from Dow Corning.

The settlement was granted, but before the women could receive full compensation, the company declared bankruptcy.

In the years since, more than 25 independent studies in both America and Europe have shown no conclusive evidence that silicone implants cause disease or any other serious health problems.

The findings come from sources that include the United States Institute of Medicine and the Medicines and Healthcare Products Regulatory Agency in the United Kingdom.

This controversy began as early as 1992, when silicone came under fire for supposedly causing cancer and other diseases.

As of today, the overwhelming amount of research has proven otherwise.  Based on this data the FDA reapproved silicone gel implants in 2006.

A recent study is showing a rising demand for cosmetic surgery among ethnic groups, with the Hispanic segment of the population taking the lead.

The American Society of Plastic Surgeons recently reported that while cosmetic surgery in the white population decreased by 3 percent in 2008, surgery in the Hispanic segment has increased by 19 percent.

More than 1.3 million Hispanics have had work done in the past year.

The most common procedure among this segment has been liposuction, with breast enlargement and nose reshaping next on the list.

A growing number of these procedures are intended to preserve ethnic features rather than change them.

The Rodeo Drive Rhinoplasty center in Beverly Hills, California, for example, who has a clientele that is less than half Caucasian, offers a service that includes an “ethnic” nose reshaping.

The study showed that the American cosmetic surgery industry took in more than $12 billion in 2007, which then decreased to $10 billion in 2008.

However, the study also noted that cosmetic surgery among African-Americans has increased by 10 percent this past year, and Asian-Americans are up by 5 percent.

Reasons for Breast Implants

The typical purposes of breast implants are:

•    Cosmetic – enhancement of the shape and size of the breast, making them look fuller and contributing to the woman’s self-confidence.
•    Reconstructive – to correct an inborn deformity or to reverse the aftermath of an operation like mastectomy.
•    Partial Reassignment – to complete one phase of a gender change operation (male to female).

Types of Breast Implants
One of the most critical decisions a patient needs to make before undergoing breast augmentation surgery is the fill you want for your implants.  Breast implants come in two primary types:

•    Silicone gel implants – use a silicone rubber shell that is filled with viscous gel also made of silicone. These implants are particular suitable, but not limited to, females with little breast tissue as well as for those undergoing breast reconstruction following a mastectomy. They demonstrate high stability (or form retention) property, thus less prone to rippling. Silicone implants are only available to women age 22 and older,

•    Saline implants – use elastic polymer shell made of silicone and is filled with sterilized saline liquid. Although good to excellent results may be anticipated, saline implants are more prone to visually and tactilely noticeable problems such as wrinkling or rippling. You must be at least 18 years of age to get saline implants.

Risks of Breast Implants
Both types of implants are approved by the FDA, but surgeries involving implants carry a unique risk outside of those from the surgery itself. Saline implants can deflate, while silicone implants can rupture and leak out into the area surrounding the implant. Both types of implants can also lead to capsular contracture, a complication that can be very painful and distort the appearance of the breast. These complications often result in the removal of the implant.

Before deciding to undergo surgery, it is pertinent to understand all the options and risks of getting implants.  Be sure to consult with a board-certified plastic surgeon, who can help you decide on the best option for your body type and desired results.

Cohesive gel implants have been used for 10 years in Europe but are still unproven in U.S. clinical trials. However, this new breast implant technology has shown some qualities that may make them preferable over saline filled or silicone gel implants in future breast augmentation surgeries.  According to some experts, due to the thick layer of gel, cohesive gel implants are:

•    More durable

•    Less prone to rippling and leaking
•    Not likely to collapse or fold
•    Better at retaining form and stability, enabling the shape of the implant to remain the same in any position

Despite these advantages, cohesive gel implants do not shift or change shape once they are inserted, and all cohesive gel implants are the same teardrop shape that may not appeal to all women. Cohesive gel implants also feel firmer than older types of implants. Other risks include rotation, which can distort the shape of the breast, and possible fracturing, which is possible given the “solid” nature of the implants.

Cohesive gel breast implants, though, are not for everybody.  In the United States, women who are found to have certain medical health problems (a prior check up is mandatory) are not eligible for such implants. Aside from this, the FDA imposes a precondition that patients who receive these implants are required to commit and submit to a follow-up period of 10 years. In addition, not all plastic surgeons in the U.S. can perform cohesive gel implants. Only those who have been approved for participation by silicone gel manufacturers (under FDA scrutiny) in the adjunct study can do it.

Notwithstanding the potential of cohesive gel breast implants to make improve the size and shape of the breasts, one should be aware of all the advantages and disadvantages of this new cosmetic technology. It is important to research all the possible results and risks before deciding to get cohesive gel breast implants.

However, with the wide array of breast implants available in the market, implant selection cannot be a do-it-yourself matter; it takes an expert to choose the best type, size, and shape of implants for a particular patient. Breast implants are categorized by surface type (smooth; textured), profile (protrusion distance), size/volume (typical ranges: 120-850 cc), shape (round; other shape), filler (silicone; saline), and material (implant innards).

Significance of Implant Placement

•    Subglandular – the breast implant is above the chest muscles and under the breast tissue.
•    Partial submuscular – the implant is partially under the pectoral and other chest muscles and under the breast tissue.
•    Full submuscular – the implant is under the muscles of the pectoral and chest areas.

Factors Affecting Breast Implant Selection
•    Filler –there are two primary types of breast implants: silicone-filled and saline-filled. Saline implants are more likely to cause problems such as rippling, wrinkling, and noticeable to the eye or touch.
•    Surface type – textured surfaces lessen the likelihood of capsular contraction, but may look unsightly because the texture may show through the skin when a subglandular placement method is used.
•    Shape, profile, and volume – breast-line goals and implant placement affect the way a breast implant will look. For example, a partial or full submuscular placement can make a contoured breast shape look more rounded.
•    Thickness – depending on placement, implant thickness may or may not be an issue.

What to Consider with Silicone Breast Implants
Silicone is a chemical compound formed by the mixture of silicon, hydrogen, carbon, and oxygen. Silicone with middle (as contrasted with low and high) molecular weight form gels, and the silicone gel is used as filler in breast implant.

Although the use of silicone gel implants is approved by the US Food and Drugs Administration (FDA), there have been isolated (but considered inconclusive by authorities) reports of illness attributed to silicone gel, such as: connective tissue disorder (CTD), change in nipple sensation, breast pain, hardening of the area around the implant, implant rupture, and the need for additional surgery. FDA studies disclose that majority of women using silicone implant have satisfactory experience with it.

No matter which type, size, or shape of breast implants you choose, you should be aware of the risks associated with both the surgery and the existing implants, including scarring, infection, implant rupture, and capsular contracture, an abnormal response that occurs when the woman’s immune system reacts to the breast implant. Complications from breast implants can result in reoperation.