Breast Implants in Malaysia

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Breast implants in Malaysia section, includes general infrmation about Breast implants Procedure, Breast implants Malaysia Local News, Breast implants Malaysia Surgeon Locator and other Breast implants related material.

Breast implants Procedure

A breast implant is a prosthesis used to enlarge the size of a woman's breasts.
The procedures of resizing or re-shaping a woman’s breast are also known as:
• Breast augmentation;
• Breast enlargement;
• Mammoplasty enlargement; or
• Augmentation mammoplasty.

Breast implant procedures are performed for the following clinical indications:
• To reconstruct the breast (for example: after a mastectomy)
• To correct genetic deformities (abnormalities that affect the shape and size of the breast)
• As part of male-to-female sex reassignment surgery.
In some countries health insurers will reimburse insertion of breast implants only for these indications. Non-clinical indications (the most common reasons) are cosmetic.

According to the American Society of Plastic Surgeons, breast augmentation is the most commonly performed cosmetic surgical procedure in the United States (In 2006, 329,000 breast augmentation procedures were performed in the U.S.).

There are two primary types of breast implants: saline-filled and silicone-gel-filled implants.
• Saline implants have a silicone elastomer shell filled with sterile saline liquid.
• Silicone gel implants have a silicone shell filled with a viscous silicone gel. There have been several alternative types of breast implants developed, such as polypropylene string or soy oil, but these are uncommon.

Some history
Implants have been used since 1895 to augment the size or shape of women's breasts. The earliest known implant was attempted by Czerny, using a woman's own adipose tissue (from a benign growth, on her back).
Until mid-1900s, a number of substances were tried, including ivory, glass balls, ground rubber, ox cartilage, Terylene wool, polyether foam sponge, polyethylene tape or strips forming a ball, polyester Silastic rubber, teflon-silicone prostheses and others. In recent history, various creams and medicaments have been used in attempts to increase bust size. Various synthetics were used throughout the 1950s and 1960s, including silicone injections, which an estimated 50,000 women received. Thomas Cronin and Frank Gerow, two Houston, Texas, plastic surgeons, developed the first silicone breast prosthesis with the Dow Corning Corporation in 1961. The first woman was implanted in 1962.
Development of silicone granulomas and hardening of the breasts were in some cases so severe that women needed to have mastectomies for treatment. Women sometimes seek medical treatment for complications up to 30 years after receiving this type of injection.

Procedure
The surgical procedure for breast augmentation takes approximately one to two hours. Variations in the procedure include the incision type, implant material, and implant pocket placement.

Incision types
Breast implants for augmentation may be placed via various types of incisions:

• Inframammary: an incision is placed below the breast in the infra-mammary fold (IMF). This incision is the most common approach and affords maximum access for precise dissection and placement of an implant. It is often the preferred technique for silicone gel implants due to the longer incisions required. This method can leave slightly more visible scars in smaller breasts which don't drape over the IMF.
• Periareolar: an incision is placed along the areolar border. This incision provides an optimal approach when adjustments to the IMF position or mastopexy (breast lift) procedures are planned. The incision is generally placed around the inferior half, or the medial half of the areola's circumference. Silicone gel implants can be difficult to place via this incision due to the length of incision required (~ 5cm) for access. As the scars from this method occur on the edge of the areola, they are often less visible than scars from inframammary incisions in women with lighter areolar pigment.
• Transaxillary: an incision is placed in the armpit and the dissection tunnels medially. This approach allows implants to be placed with no visible scars on the breast, but is more difficult to consistently achieve symmetry of the inferior implant position. Revisions of transaxillary-placed implants often require inframammary or periareolar incisions. Transaxillary procedures can be performed with or without an endoscope.
• Transumbilical (TUBA): a less common technique where an incision is placed in the navel and dissection tunnels superiorly. This approach enables implants to be placed with no visible scars on the breast, but makes appropriate dissection and implant placement more difficult. Transumbilical procedures may be performed bluntly or with an endoscope (tiny lighted camera) to assist dissection. This technique is not appropriate for placing silicone gel implants due to potential damage of the implant shell during blunt insertion.
• Transabdominoplasty (TABA): procedure similar to TUBA, where the implants are tunneled up from the abdomen into bluntly dissected pockets while a patient is simultaneously undergoing an abdominoplasty procedure.

Types of implants

Saline implants
Saline-filled breast implants were first manufactured in France in 1964, introduced by Arion with the goal of being surgically placed via smaller incisions. Current devices are manufactured with thicker, room temperature vulcanized (RTV) shells. These shells are made of silicone elastomer and the implants are filled with salt water after the implant is placed in the body. Since the implants are empty when they are surgically inserted, the scar is smaller than is necessary for silicone gel breast implants (which are filled with silicone before the surgery is performed). A single manufacturer (Poly Implant Prosthesis, France) produced a model of pre-filled saline implants which has been reported to have high failure rates in vivo.

Saline-filled implants are the most common implant used in the United States due to restrictions on silicone implants, but are rarely used in other countries. Good to excellent results may be obtained, but as compared to silicone gel implants, saline implants are more likely to cause cosmetic problems such as rippling, wrinkling, and be noticeable to the eye or the touch. Particularly for women with very little breast tissue, or for post-mastectomy reconstruction, plastic surgeons believe that silicone gel implants are the superior device. In patients with more breast tissue, however, saline implants can look very similar to silicone gel.

Silicone gel implants
Silicone implants are generally described in terms of five generations which segregate common characteristics of manufacturing techniques.

First generation Silicon Implants
The Cronin-Gerow implants were made of a silicone rubber envelope (or sac), filled with a thick, viscous silicone gel with a Dacron patch on the posterior shell. They were firm and had an anatomic "teardrop" shape.

Second generation Silicon Implants
In response to surgeons' requests for softer and more lifelike implants, breast implants were redesigned in the 1970s with thinner gel and thinner shells. These implants had a greater tendency to rupture and leak, or "bleed" silicone through the implant shell, and complications such as capsular contracture were quite common. It was predominantly implants of this generation that were involved in the class action-lawsuits against Dow-Corning and other manufacturers in the early 1990s.

Third & Fourth generation Silicon Implants
Third & fourth generation implants, from the mid 1980s, represented sequential advances in manufacturing principles with elastomer-coated shells to decrease gel bleed, and are filled with thicker, more cohesive gel. These implants are sold under restricted conditions in the U.S. and Canada, and are widely used in other countries. The increased cohesion of the gel filler reduces potential leakage of the gel compared to earlier devices. A variety of both round and tapered anatomic shapes are available. Anatomic shaped implants are uniformly textured to reduce rotation, while round devices are available in smooth or textured surfaces.

Fifth generation Silicon Implants
Evaluation of "gummy bear" or solid, high-cohesive, form-stable implants is in preliminary stages in the United States but these implants have been used since the mid 1990s in other countries. The semi-solid gel in these types of implants significantly reduces the possibility of silicone migration. Studies of these devices have shown significant potential improvements in safety and efficacy over the older implants with low rates of capsular contracture and rupture.

Implant pocket placement

The placement of implants is described in relation to the pectoralis major muscle.
• Subglandular: implant between the breast tissue and the pectoralis muscle. This position closely resembles the plane of normal breast tissue and is felt by many to achieve the most aesthetic results. The subglandular position in patients with thin soft-tissue coverage is most likely to show ripples or wrinkles of the underlying implant. Capsular contracture rates are also slightly higher with this approach.
• Subfascial: the implant is placed in the subglandular position, but underneath the fascia of the pectoralis muscle. The benefits of this technique are debated, but proponents believe the thin vascularized fascia may help with coverage and sustaining positioning of the implant.
• Subpectoral ("dual plane"): the implant is placed underneath the pectoralis major muscle after releasing the inferior muscular attachments. As a result, the implant is partially beneath the pectoralis in the upper pole, while the lower half of the implant is in the subglandular plane. This is the most common technique in North America and achieves maximal upper implant coverage while allowing expansion of the lower pole. Capsular contracture rates have been lower after widespread adoption of this technique.
• Submuscular: the implant is placed below the pectoralis without release of the inferior origin of the muscle. Total muscular coverage may be achieved by releasing the lateral chest wall muscles (seratus and/or pectoralis minor) and sewn to the pectoralis major. This technique is most commonly used for maximal coverage of implants used in breast reconstruction.

Recovery
Depending on the level of activity required, patients are generally able to return to work or school in approximately one week's time. Scars from a breast augmentation surgery will last six weeks or longer and usually begin to fade several months after surgery.

Systemic illness and disease
Since the early 1990s, a number of independent systemic comprehensive reviews have examined studies concerning links between silicone gel breast implants and systemic diseases. The consensus of these reviews is that there is no clear evidence of a causal link between the implantation of silicone breast implants and systemic disease.

Thousands of women claim that they have become ill from their implants. Complaints include neurological and rheumatological problems. Some studies have suggested that subjective and objective symptoms of women with implants may improve when their implants are removed.
Several studies have established that women who elect to undergo breast augmentation or other plastic surgery tend to be healthier and more affluent than the general population, prior to surgery and afterwards. For example, two large studies of plastic surgery patients found a decreased standardized mortality ratio in both breast implant and other plastic surgery patients, but an increased risk of respiratory cancer deaths in breast implant recipients compared to other forms of plastic surgery.
Another large study with long-term follow-up of nearly 25,000 Canadian women with implants reported, "Findings suggest that breast implants do not directly increase mortality in women."

While there is a general international consensus that silicone implants have not been shown to cause systemic illness, excluding the possibility that a small group of patients may become ill through (as yet) unknown mechanisms may prove difficult.

Complications
Local complications that may occur with breast implants include:
• Post-operative bleeding (hematoma);
• Fluid collections (seroma);
• Surgical site infection;
• Breast pain;
• Alterations in nipple sensation;
• Interference with breast feeding;
• Visible wrinkling;
• Asymmetric appearance;
• Wound dehiscence (with potential implant exposure);
• Thinning of the breast tissue;  and
• Synmastia (disruption of the natural plane between breasts).

Implant leaking, aging, and the need for re-operation
Breast implants do not last a lifetime. When saline breast implants break, they often deflate quickly and can be easily removed. Prospective studies of saline-filled breast implants approved by FDA in May 2000 showed rupture/deflation rates of 3-5% at 3 years and 7-10% at 5 years for augmentation patients.

Manufacturers are required to inform women that the implants are not necessarily permanent devices and that most recipients will likely need additional surgery to replace or remove their implants.
Rupture is one reason for re-operation.
Among the causes of rupture are:
• Damage during implantation or other procedures;
• Trauma to the chest; and
• Pressure of mammograms.
The age and design of the implant are also important factors in rupture, but estimating ruptures rates of contemporary devices has been difficult for a variety of reasons, particularly because implant designs have changed over time.

Implant break
When silicone implants break they rarely deflate, and the silicone from the implant can leak out into the intracapsular space around the implant. An intracapsular rupture can progress to outside of the capsule (extracapsular rupture), and both conditions are generally agreed to indicate the need for removal of the implant. Extracapsular silicone has the potential to migrate, but most clinical complications have appeared to be limited to the breast and axillae in the form of granulomas (inflammatory nodules) and axillary lymphadenopathy (enlarged lymph glands in the armpit area). The specific risk and treatment of extracapsular silicone gel is still controversial. Plastic surgeons agree that it is difficult to remove, but there is disagreement about the health effects.

Scarring
All surgical procedures on the breast leave scars. Scar quality is determined by factors including a patient's ethnicity, tissue quality, wound tension, suture material, tissue trauma from surgery, smoking, and an individual’s propensity for favorable wound healing. While most breast augmentation incisions heal well, a rate of 6-7% of unfavorable scarring was reported for primary augmentation patients in US-FDA clinical trials.

Chronic pain and changes in nipple and breast sensitivity
Feeling in the nipple and breast can change after implant surgery. Changes include intense sensitivity, chronic breast pain, and no feeling in the nipple or breast for months or years after surgery.
This altered sensitivity can be temporary or permanent and may affect sexual response or the ability to nurse a baby.

Implant extrusion and tissue necrosis
Compromise of blood supply as a result of surgical procedures may lead to skin loss or breast tissue necrosis (death). Unstable or weakened tissue covering may result in subsequent extrusion of the breast implant through the skin. Implant extrusion and tissue necrosis are rare in breast augmentation patients, but may occur in up to 1-2% of reconstruction patients using implants. Surgery needed to correct this can result in unacceptable scarring or breast tissue loss. Procedures which combine simultaneous breast augmentation with mastopexy (breast lift) techniques carry higher rates of implant loss or wound breakdown than either procedure alone.

Cancer screening with patients who underwent implant surgery
The presence of radio-opaque breast implants may interfere with the sensitivity of screening mammography. Specialized radiographic techniques where the implant is manually displaced (Eklund views) may improve this somewhat, but approximately 1/3 of the breast is still not adequately visualized with a resultant increase in false-negative mammograms.

Repair or revision surgery
Regardless of the type of implant, it is likely that women with implants will need to have one or more additional surgeries (re-operations) over the course of their lives. Most common indications for re-operations include:
• Major or minor complications;
• Capsular contracture treatment; and
• Replacement of ruptured/deflated implants.
Re-operation rates are predictably more frequent in breast reconstruction cases due to the dramatic changes in the soft-tissue envelope and anatomical breast borders after mastetcomy.
Breast cancer patients also frequently undergo staged procedures for reconstruction of the nipple-areola complex (NAC) and symmetry procedures on the opposite breast.

It is assumed that re-operation rates in cosmetic cases can be improved by more carefully matching individual patients' soft-tissue characteristics to the type and size of implants used.

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