The Biggest Myths of Breast Implants
First performed in 1895, breast augmentation is arguably one of the most recognizable of all plastic surgery procedures. This distinction brings with it many myths, questions, and hearsay to the public discourse – some of which I’ll address below.
1. The more cohesive the silicone gel, the safer the implant.
Not necessarily! “Cohesive” means to hold together, and all silicone gels used in breast implants are cohesive. The gel is a semi-solid material so there is no “leakage” if the outer silicone shell ruptures. Part of the confusion started when the “gummy bear” implants were introduced, and referred to as “cohesive gel implants.” That sort of implied that the silicone in round implants was not cohesive. The correct term is “form-stable” because the gel is firmer in order to hold the shape. The gel in round implants is softer for a more natural feel.
Plus there are different ways to measure gel cohesiveness. These include elasticity (the gel’s ability to retain its shape), resistance to gelcompression fracture (which would cause permanent gel deformation), and gel-shell peel (the integration of the gel with shell as a cohesive unit). For round implants, Sientra HSC has the lowest elasticity but the highest resistance to gel fracture and gel-shell peel (which is good.) For the form-stable implants, Sientra HSC+ is highest across the board, with Mentor CPG having the lowest resistance to gel fracture and gel-shell peel.
2. Larger implants can be used to avoid having to do a breast lift.
Not always, and it can make sagging worse! The key here is to understand the difference between a low breast and a deflated breast, as occurs after childbearing and breast feeding. In that instance, an implant large enough to fill up the loose skin envelope can avoid the need for a lift, or enable a shorter scar technique to work.
If the breast and nipple position are low, a large implant will have the opposite of the intended effect, at least over time. Adding weight and volume to an already sagging breast will cause additional stretching and sagging.
3. Changing to larger implants will improve rippling.
Rippling is to some degree a feature of all implants, and when ripples are visible it is more related to thin tissue coverage over the implants. Submuscular placement offers coverage to the upper part of the implants, but not the outside and bottom. These are the parts of the tissue envelope that are holding the implant up, and often it is the weight of the implant that causes thinning – and reveals more ripples. It makes no sense to place even more stress with larger implants, but I have seen it suggested. Don’t do it!
4. Implants need to be changed every 10 years.
If this were true, the manufacturers would not offer a lifetime warranty, which all of them do. I have not been able to track down the source of this myth, but it is one of the most persistent misconceptions. It may relate to the fact that 10 years is a benchmark for data on implant performance, and previous generations of implant designs had a high replacement rate. Currently it appears that less than 1 in 5 will have their implants replaced within 10 years, including replacement for size preference change.
5. Massaging implants will prevent capsular contracture.
Some plastic surgeons even have videos demonstrating proper massage technique (also called displacement exercises) to move the implants around in order to prevent contracture, a hardening of the scar capsule that can lead to firmness and distortion of the breast. There is absolutely no credible evidence that massage works to prevent capsular contracture however. What does work is use of the Keller funnel for implant placement, antibiotic irrigation, and good surgical technique. Using this approach, our rate of contracture is less than 2%, which compares favorably to published data of 12-17%.
