In these sections we will present your various options in breast implants, including the available shapes, sizes, fillers and surface variances.  We will also cover the available implant placements.  It is very important to educate yourself regarding your options so that you are able to make a truly well-informed decision.

*It is very important to mention that TUBA patients are offered saline-filled breast implants only.  For this very reason we will not cover silicone gel-filled or cohesive silicone implants as much as we will be discussing  saline.  If you wish to have silicone gel-filled breast implants, you cannot choose the transumbilical method.  This would be like trying to squeeze a grapefruit through a straw.  It is practically impossible.  Your surgeon will usually insert a silicone gel-filled breast implant through an incision in the mammary fold or around the areola.

Status of Saline & Silicone-filled Breast Implants - Breast Implant Manufacturers
Saline-filled breast implants have been officially approved in the U.S. since May of 2002.  Only two companies, Inamed Corp. (formerly McGhan Medical) and Mentor Corp. were given this approval.  Although breast implants were available before the official approval date.  I, myself, first got saline breast implants in 1998.

Silicone breast implants are not yet approved in the U.S. however one manufacturer, Mentor Corp., received a pre-approval nod from the F.D.A. panel on April 16, 2005.  Inamed was not granted a recommendation on April 13, 2005.  Although this very well may have been a deficiency in paperwork as both implants are comparable.  Interesting to note is that Mentor's manufacturing process takes place within the United Sates, Inamed's in Costa Rica, making it easier for inspections to take place for Mentor.

Breast Implant Types Available in Transumbilical Breast Augmentation
Since you are opting for the transumbilical method, your surgeon will use a saline-filled breast implant.  Breast implant shells are manufactured from a very strong silicone elastomer which may be smooth or textured, depending, upon the model.  These implants are deflated of any air, rolled up and inserted into the navel, up into the track and into the proper placement under the breast mound or pectoral muscle.  The implant is then filled intra-operatively with a sterile saline solution.

The available shapes include include round, and contoured styles, otherwise known as tear drop or anatomical.  These implants are now available in low moderate, and high profile options.  The two most commonly used implants are round and smooth but come in moderate or high profile.   Please discuss with your surgeon at your consultation if he, or she, chooses to offer his patients different choices in projection.

Breast Implant Sizes 
Inamed's saline implants range in sizes of 120cc (with a maximum fill volume of 150cc) to 800cc (with a maximum fill volume of 850cc).  The most commonly used saline implant from McGhan is the McGhan Style 68 (smooth/round).  Although these implants are commonly overfilled to reach larger sizes and to lessen the chances of rippling.

Mentor offers a similar smooth, round implant (Mentor Style 1600) in sizes from 125cc (with a maximum volume of 150cc) to 700cc (with a maximum fill volume of 775cc).  These, too, are often overfilled to reach larger sizes and to lessen the chances of rippling.

High and low profile implants come in different sizes and have different optimum fill volumes so please check with your surgeon about the specifications that will suit your size frame and your desired end result.

Implant Placement
Breast implant placement is an issue which defines the general appearance of the breast.  The amount of pre-existing breast tissue is also a determining factor for implant placement.  The three placements are sub-glandular, sub-pectoral and full sub-muscular.

Breast implants can be placed above the muscle in a patient with adequate breast tissue.  This position is best when utilized by patients with larger breasts, which may sag slightly and also in patients who wish to have a more natural movement.  However, in breast implants which are overfilled to hinder the possibility of rippling, the implant can be palpable.  The implant's edges may be seen and felt in some patients with this placement.  In the sub-glandular position the implant is placed above the pectoralis major, yet beneath the natural glands of the breast.  This placement has a shorter recovery time than the next two due to no dissection of the patient's muscles.  Some surgeons believe the sub-glandular placement carries with it a higher incident of capsular contracture, or a painful hardening of the fibrous capsule around the implant.

Sub-pectoral placement is best for patients who wish to achieve a more natural look or who have little or no breast tissue, and/or have thin skin.  The placement does create an unnatural appearance when the pectoral muscles are utilized however, the trade off is thought to be a fair one by many.  The implant is placed under the pectoralis major muscle which fans from the arm and underneath the breast.  The pectoralis major covers approximately 2/3 of the breast implant to help hide the edges of the prosthesis in smaller breasted women.  This placement unfortunately carries with it a longer recovery time and possible implant displacement.  It is thought my some surgeons to help prohibit capsular contracture.

Full sub-muscular placement is not offered by many surgeons but is an option.  The implant is placed underneath the pectoralis major muscle as with the sub-pectoral placement but also covered with the use of the serratus muscles which reside at the side of the ribs and under the muscle fascia of the rectus abdominus of the abdomen.  It can offer support and an increased healing time, was well as an increased time for implant settling.  Some surgeons believe this placement has the least percentage of capsular contracture.

Breast Implant Fill/Overfill Volume 
Implant fill volumes are determined by the implant manufactures and are set as guidelines per implant size.  Let's say a McGhan smooth, round Style 68 comes in 480 cc size.  The implants lowest recommended fill amount would be 480 and it's highest recommended fill amount being 510cc.  These are set guidelines by the implant manufactures.  Many surgeons will fill more than the recommended fill amounts for a standard average about about a 30 to 50cc overfill.  This is thought to help prohibit rippling and assist in lengthening the implant's lifespan by disallowing folding of the prosthesis with each breath so that no weak areas are made via the creasing associated with this folding action.

Overfill amounts vary with each surgeon and also on a case by case basis.  Please discuss this with your surgeon to determine if he or she even practices overfilling the prosthesis.

Breast Implant Warranties 
Just as with your vehicles and DVD player having a warranty, as do your breast implants.  Both McGhan (Inamed) and Mentor have 2 warranty options each.  There are standard warranties, and extended warranties.  For more information, please see our Breast Implant Warranty Information Section.

Breast Implant Risks  
As with any surgery, risks, contraindications and complications are a possibility.  Although choosing a qualified and experienced surgeon can significantly reduce your chances of a negative experience--problems can arise.  TUBA can have just as many, if not a few less, possible complications than a standard incision breast augmentation surgery.

Although standard pre-operative blood tests and physical examinations can be ordered, negative reactions to anesthesia are inherent.  Although the chances are small, patients may experience allergic-type reactions which can range from getting a little nauseated to a life-threatening emergency. 

Post-surgical, non-anesthesia related complications may include infection, loss of nipple sensitivity (although with TUBA a .5% chance is possible, numbness of the breast envelope, irregular scar tissue, implant displacement, synmastia/symmastia, bottoming out, galactorrhea (lactation), calcifications, implant extrusion, implant deflation, future breastfeeding complications, rippling (palpability of the scalloped edges of the implant), thrombophlebitis (inflammation of an epigastric vein of the thorax) and general dissatisfaction.  Other surgical complications may include hematoma (or a collection of  blood within the tissues), seroma (fluid collection within the tissues) and thrombosis (clots lodged in a vessel).

Capsules made from collagen fibers naturally form around any foreign object that is placed in our body, in this case the foreign object is a silicone-shelled breast implant.  It is speculated that the capsule forms to shield the body from the foreign object by creating a fibrous wall of tissue in between the two.  It is also speculated that the tissue capsule prevents friction within the body cavity.  The key point here is that capsule formation is normal.  The tightening, or contraction, of this capsule, however, is when problems begin to surface.  This is called Capsular Contracture and is often the bane of the breast augmentation patient' existence.  Please see our Capsular Contracture Information Section for more on this complication.

Contraindications include women who are pregnant or nursing, those with terminal illnesses, patients with diabetes or wound healing disorders, and those who have allergies to silicone.  Please discuss the risks and complications with your surgeon for more information.

Silicone-induced Illnesses 
Perhaps you remember the silicone implant scare of the 1980's and early 1990's?  Silicone is any of the "various polymeric organic silicon compounds obtained as oils, greases, or plastics and used especially for water-resistant and heat-resistant lubricants, varnishes, binders, and electric insulators" (Merriam-Webster) It is also found in processed foods, cosmetics, medications and all sorts of products that you are exposed to and ingest on a daily basis.  It is also used to lubricate medical devices such as tubing, hypodermic needles and is found in the food industry as being used to lubricate blenders, frozen drink machines, piping, cooking utensils, and machines.

Silicones are synthetic polymers and are made by combining oxygen and silicon and in high temperatures and pressures can produce polydimethylsiloxane (PDMS).  The fluids are made from linear chains of PDMS whereas the gels are lightly crosslinked to give it a thicker cohesive-ness.  Although without a container such as a highly cross-linked silicone elastomer breast prosthesis the silicone gel takes on no shape of its own and is very vulnerable to gravity and momentum, if applicable.  The elastomer implant shells contain very little free PDMS so that it remains a solid.  However "like can not hold like" so the lower weighted molecular silicones leach through the elastomer shells - even with the presence of protective inner barriers.  Silicone gel bleed can cause local inflammation and granulomas.

Having said that, there is no conclusive evidence in any study by any major, respected organization that can establish a direct or indirect link of any connective tissue disease or cancer with silicone.  

Breast Implant Maintenance 
Although there is not the same amount of maintenance related to breast augmentation surgery as comparable to owning a vehicle, there is a particular type of upkeep which must be carried out to keep your breasts and general health in optimum order.  Although bacterial infections are most common within the first week or two, it can occur even within the first year of implantation.  Some surgeons suggest that you take a few antibiotics in the event you need dental work or experience excessive plaque or dental carries which must be dealt with.  Other incidents such as blood borne- infections and other type of bacterial intrusions can causes problems in the breasts around the mammary prosthesis.  Infections can cause extrusion and large amounts of pus to form, necessitating a removal surgery and a strict course of antibiotics such as Cipro or Levaquin.  In the event that a bacterial infection forms in the implant pocket, after the implants are removed the patient must wait several months before a replacement surgery.  In cases where an actual pocket bacterial infection is not present, capsular contracture can form after a problematic bacterial infection within the body.

Implant massage is also a step which many breast augmentation patients undertake every single day.  Manual massage of the implant and pocket keep the implant soft and mobile.  Without massage it is possible that your implants fibrous capsule may begin to contract and become very hard and painful.  Please discuss massage with your surgeon as not every surgeon instructs this type of exercise.

Mammograms and Breast Self-examinations
Having a mammogram every year as you get older and consistently examining your breasts every month at home are important steps in making an early diagnoses and increasing your chances of a full recovery, in the event of breast cancer or other irregularities.  Please see our section on Mammograms and Breast Self-examinations for more information.