21 March, 2011

Breast Prostheses

What are they and what are they used?

breast prostheses are devices that are implanted in the breast or breasts of women mainly for two reasons: as an aesthetic breast augmentation for women who want to have larger breasts (80 % of cases), and to reconstruct the breast in those women who have had a breast removed for breast cancer suffer.

Showing a breast prosthesis
Some prostheses to adjust the volume of the filler material after the operation.

Types of prostheses

There are 3 basic types of breast implants: prosthesis filled with saline , prosthesis filled with silicone gel -filled and other alternative substances such as soybean oil .

Breast implants vary in shell surface (smooth or rough), shape (round or other shapes), the profile (which protrudes), volume (or size) and the thickness of the envelope.

The fundamental parts of a breast prosthesis are:

  • it wrap the outer casing

  • the filler

  • a patch covering the hole manufacturing.

Concerning the design of the wrapper, most prostheses have a single outer layer (shell itself), some have a double shell prosthesis (one inside the other). Regarding the filling material, some prostheses are manufactured with a fixed volume of filler material, others are filled during surgery and other to adjust the volume of the filler material after the operation.

In the prosthesis filled with silicone gel The term silicone refers to a family of organic silicon compounds related chemically derived from silica. In medicine, the silicone has been used extensively as small amounts of this substance can be found in prosthetic joints (knee, hip, etc..) Artificial heart valves and even the bottle nipples for babies. However, the medical use of the compound more liquid, polydimethyl siloxane, is done with breast implants that were developed for over 40 years.

What is the surgery?

The surgery, though it can be done with local anesthesia and sedation, it is preferable under anesthesia general. An incision is made ​​at the lower end of the nipple-areola, or in the groove under the breast or in the crease of the armpit and the prosthesis is inserted to place, well below the mammary gland itself or under the muscle the chest which is in turn under the gland. The choice of technique depends on the plastic surgeon's discretion. The hospital stay is usually 24 to 36 hours.

What complications can arise?

It is important to bear in mind that most women who have surgery of breast implants may experience local complications such as pain, capsular contracture (scar tissue formation around the prosthesis that tightens or squeezes) or the prosthesis rupture or deflation. In many cases require nonsurgical or surgical reinterventions to treat these complications.

Local complications of surgery for breast implants are therefore common and are the primary concern regarding the safety of the intervention. In addition, complications accumulate over the life of the prosthesis should also know, do not last a lifetime. Finally, the women received information on possible local complications of this surgery is essential to make the final decision to operate or not.

There is a long list of local complications of this type of intervention:

  • asymmetry of the breasts

  • pain of the same

  • Breast tissue atrophy

  • calcification or calcium deposits on the breasts

  • capsular contracture

  • chest wall deformity

  • delayed wound healing or keloid formation or large scars

  • extrusion of the prosthesis or output

  • galactorrhea or secretion of milk from the nipple

  • hematoma, granuloma or wound complication

  • infections

  • inflammation or irritation

  • malposition or displacement of the prosthesis

  • necrosis or tissue death

  • sensory changes in the breast or nipple

  • rupture of the prosthesis, or it will deflate or deflate

  • seroma

  • wrinkles or ripples in the skin

  • unsatisfactory aesthetic results by size or style, etc..

Of these, the most important because of their frequency and consequences are breast pain, capsular contracture referred to above, changes in sensation in the breast or nipple and rupture of the prosthesis or deflate or deflate it.

Some of these local complications require reoperation, and in some cases, removal of the prosthesis, with subsequent complications aesthetic (dimples and wrinkles or ripples in the skin, loosening or falling of the chest, etc.).. The frequency of these complications aesthetic stands at 12-14% at 5 years when the intervention is to increase breast size and 28-30% at 5 years when it's for breast reconstruction, with the average time to remove the prosthesis of 11.5 years.

Women should be subjected to multiple reoperations to improve the appearance of the breasts, remove the deflated prosthesis or repair broken or other local complications may end the process with a clearly unsatisfactory cosmetic result, with all that entails.

It has been found that one in four women with breast implants had local complications that required a reoperation during the first 5 years after implantation. Just as we saw that one of every 3 women who received breast implants to reconstruct her breasts needed to be reoperated within the next 5 years and 1 in 8 women who were operated for breast augmentation had to be reoperated within 5 years.

Are there any health risks caused by the prosthesis?

Some women living with breast implants have developed health problems that they think are related to the prosthesis, but the majority of medical and scientific studies have failed to demonstrate such an association. Most health concerns related to breast implants are believed caused by a reaction of the organism against foreign material such as silicone.

Of the various diseases that have tried to link with breast implants are two: the cancer breast and a rheumatological disease called connective tissue disease includes diseases such as rheumatoid arthritis , lupus erythematosus or scleroderma among others, or disorders (signs or symptoms) related.

Today we know that breast cancer is more common in women with breast implants compared with those who do not carry. Multiple scientific studies have confirmed so.

What seems clear is that breast implants may interfere with early detection of breast cancer in making and interpreting a mammogram . Compression of the breast during this test may cause rupture of the prosthesis or deflate it. The best test to detect this problem in silicone prosthesis is the nuclear magnetic resonance .

Several scientific studies have been unable to establish a clear cause-effect relationship between breast implants and connective tissue disease, so currently can not mention that breast implants cause these diseases.

Considerations before getting a breast prosthesis

  • Most women who get breast implants will experience some local complications that may require further medical or surgical treatment (reoperation or removal of the prosthesis). Breast implants do not last a lifetime. Often require long term monitoring and reoperations for treatment of complications.

  • To be considered a cosmetic treatment, not within the Social Security benefits in Spain so that intervention is not funded. Even many private insurers cover it. In case of need for reconstruction after breast cancer surgery is considered medical treatment and is funded by Social Security.

  • It is important to know the real possibilities of the outcome. No surgeon will provide absolute guarantees that the result will be similar to other women who have obtained a great success. The results of your particular case will depend on many individual factors such as general health (including age), the structure of the thorax, the shape and position of the breast and nipple, skin texture, healing capacity (which may be delayed in case of previous radiotherapy or chemotherapy, alcohol, snuff, drugs, etc..) tendency to bleed, prior breast surgery, skills and experience of the surgical team, the type of surgery and the type and size of the prostheses.

  • Many of the changes that occur in the breast following implantation of the prosthesis can be aesthetically undesirable and irreversible. With the subsequent removal of the prosthesis may appear dimples, wrinkles or loosening of the breasts, loss of breast tissue or other undesirable cosmetic changes.

  • Women with implants should follow the same program for early detection of breast cancer by mammography. There is a certain risk of breast implant rupture or deflate during this test.

  • Other risks targets are delayed detection of breast cancer and pain or discomfort that may be after surgery.

Despite the controversy, there is no scientific evidence linking silicone breast implants with various diseases like breast cancer or connective tissue.

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