Silicone breast implants are used in the majority of breast augmentations that are now being performed. In fact, in 2012 they constituted 72% of the total number of breast implants used for breast enlargement with the remaining 28% being saline. In my practice, due to my firm evidence based convictions on the superiority of silicone implants over the saline ones, nearly 99% of my patients choose the silicone ones.

This preponderance of silicone implants being placed in breast enlargements was “artificially” eliminated between 1992 and 2006 due to the federal government’s (FDA) restriction on their usage. As a result, during this period, women electing to have this surgery either had to accept the usage of saline implants for their breast augmentations or forgo the surgery. (There were some exceptions to this edict.) In the last year of the moratorium which was 2006, 81% of the implants used were saline ones.

As you might expect, virtually all women decided that a breast enlargement with saline breast implants was better than having no surgery at all. Clearly, the benefits from undergoing this surgery – such as more aesthetically pleasing and alluring breasts and appearance, improvements in self-esteem, confidence, in relationships with others and in one’s sex life – far outweighed the downsides associated with saline implants.

Why are silicone breast implants so popular and chosen by the majority of women?

The reason is that they simulate quite well the feel and consistency of the female breast. They are the gold standard of breast implants. Cosmetically, they are light years superior to the saline ones which many people characterize as feeling like water balloons. Additionally, you can actually feel the envelope of the saline implant which often presents firm, discrete edges – not a natural occurrence in the female breast and a not so subtle reminder of their presence. Particularly in thin skinned individuals and those with their implants placed above the muscle, these edges can often be felt and seen as ripples of the overlying skin.

Despite all of this, many women who have saline implants are extremely happy with their results which they consider to be very good. The following patient of mine with a 10 year follow-up is but one example:

At the age of 37, this patient decided to pursue a breast enlargement which she had been thinking about for a long period of time (Fig A, C and E). Because of the restriction on the usage of silicone breast implants for primary breast augmentations, she underwent the procedure with saline implants that were placed behind the muscle. That was 10 years ago. She has been very happy with her results and has had no problems including rippling, hardness (capsular contracture) or contour irregularities (Fig B, D and F).

A). Before breast augmentation

B). 10 years after breast augmentation

C). Before surgery – side view

D). After surgery – side view

E). Before surgery – side view

F). After surgery – side view

My examination revealed that her breasts were soft, the implants naturally mobile and that there was no rippling present. She did develop some laxity of the skin over time from gravity and age. The implants themselves could barely be felt.

This patient, like many others who have had breast augmentation with saline implants, demonstrates that despite the superiority of silicone breast implants, saline ones can still provide excellent aesthetic results.

If you would like additional information on breast augmentation surgery, on silicone or saline breast implants or on any other plastic surgery procedure that I perform, please feel free to contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

In my blog, Gummy Bear” Silicone Breast Implants Just Approved by the FDA for Usage, I shared with you the news that the FDA finally allowed widespread usage of these next generation silicone breast implants after over a 12 year wait. Also, rather than being referred to as “gummy bear” implants, they have now been given an official name, the Natrelle® 410 Highly Cohesive Anatomically Shaped Silicone-Filled Breast Implants – or Natrelle® 410, for short.

Is this an earth shattering event?

Has there been a recent increase in seismic activity or an unusual number of earthquakes subsequent to this announcement?

No, and of course not!

However, if you are considering having a breast augmentation or a mastopexy (breast lift) with implants, now you have one more option available to you. These Natrelle® 410 implants do have several advantages over the round highly cohesive silicone gel breast implant (as I noted in that post). There are also a few drawbacks.

These are anatomic shaped implants (tear drop in configuration) so if you are looking for a “push-up” look with a lot of roundness and fullness at the top of your breast, this style implant will not be for you. If you are also desiring to be disproportionately large, the same holds true – so go with the round silicone breast implants.

These Natrelle® 410 implants require far more precision in their selection and insertion than the round silicone implants (although I already am very precise and meticulous as regards the round silicone gel implants). In fact, this is such a crucial issue that that any plastic surgeon desiring to offer these implants must obtain certification for their usage.

And guess what?

I have completed the certification program and am fully certified to offer and use these Natrelle® 410 implants.

Finally, these new implants are substantially more expensive than the round silicone gel breast implants. Consequently, this will translate into a significant premium to the cost of undergoing a breast augmentation if you opt for using them. This additional expense to the procedure will vary among plastic surgeons, but it could be in the range of $2000 – $3000 more.

If you would like additional information on the new Natrelle® 410 silicone breast implants or on breast augmentation surgery in general or if you would like to schedule your complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Natrelle® 410 Highly Cohesive Anatomically Shaped Silicone-Filled Breast Implants

After waiting years for approval of the widespread usage in the United States of the so called “gummy bear” silicone breast implants, the U.S. Food and Drug Administration (FDA) yesterday finally announced their formal approval to the manufacturer of this implant, Allergan, Inc. This implant will be officially known by the marketing name Natrelle® 410 Highly Cohesive Anatomically Shaped Silicone-Filled Breast Implants or Natrelle® 410 for short.

Or “gummy bear” implant if all this is too technical!

This breast implant has undergone the most rigorous scientific research for years and that has also included numerous clinical studies. Additionally, it has already been used worldwide for 20 years including in Canada and Europe. What has been learned is that women love them overwhelmingly (and so do men!). In fact, the satisfaction rate in those who have them is 96.5%, which even exceeds the already extremely high rate of satisfaction associated with the silicone breast implants that we have been using.

There are a few characteristics that make this silicone breast implant unique – and its formal name says it all. It is an anatomically shaped implant in the form of a tear drop or wedge compared to the round implants which have been used for decades. It also consist of a silicone gel that is highly cohesive – it sticks together to a very high degree, far greater than any other previous breast implant. Consequently, it maintains its intended anatomic tear drop shape for a more natural look but still has somewhat of a soft feel. Additionally and importantly, there has not been noted to be any silicone gel migration from the implant at 7 years.

This gummy bear implant also has the advantage of staying in place versus what can happen at times with the round breast implants. This is a double-edged sword in some ways, though. A well trained experienced plastic surgeon can place it precisely where it is desired allowing for even greater control of shape and other factors. There isn’t the so called “dropping” effect that many people have heard about with the round implants (though this doesn’t really occur either). Conversely, if the insertion is not performed skillfully, the results may reflect this.

Because of how this implant is constituted, the associated risks of rippling or wrinkling are virtually non-existent – at less than 1% at 7 years in primary breast augmentations. This is less than that of the “present” day round silicone breast implants and light years better than that associated with the saline breast implants.

This style 410 silicone breast implant is intended for usage in breast augmentation, breast reconstruction and breast revision surgery with the additional FDA stipulation that a woman must be at least 22 years of age. It will also not be for everyone who wants silicone breast implants. In fact, it may end up be a niche type choice partially because the results will be more “natural” in appearance which is not what many women are looking for (though many are as well!). The round implants that we are presently using provide that more popular appearance of considerable fullness – that round, push-up bra look.

And then there is the cost… It will be priced higher than the round silicone breast implants.

Once these Natrelle® 410 implants become physically available within the next week or so, I will be offering them as another silicone breast implant option.

For more information on the newly introduced Natrelle® 410 silicone breast implants, on breast augmentation surgery in general or on any other plastic surgery procedure that I perform, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

For a woman who has undergone breast augmentation surgery or even a breast lift with an enlargement, it is not necessarily one and done with regard to the implants. That is, there is a substantial likelihood that those aren’t the last pair of implants that she is going to have in her lifetime.

Why?

First of all, breast implants are not permanent medical devices and will not last forever if given long enough. At some point in time, they will either need to be replaced (implant exchange) or removed due to rupture or loss of integrity. It has been my experience that most women, even those in their 70’s, elect to have new implants put back in again rather than have them removed permanently. They just don’t want to be walking around without “breasts”.

This is not the only reason for changing out breast implants, a type of breast revision surgery. Some of the other reasons that women choose or need to obtain new implants include:

1) a desire to change their breast size – usually going bigger; rarely do they elect to go smaller
2) switching their type of implant from saline to silicone; the reverse, going from silicone to saline is extremely rare
3) a desire to alter the shape and projection of their breasts such as going to a higher profile implant to obtain more projection
4) to replace very old implants with newer but similar ones
5) to treat hardness or irregularities that have developed around the implants such as significant capsular contracture
6) development of infection (exceedingly rare)

This breast revision surgery is typically associated with minimal initial postoperative discomfort and is a far easier and more pleasant experience than the initial breast augmentation or breast lift with implants. I have found this to be almost universally true in my practice over more than 25 years.

The following patient of mine exemplifies a few of the reasons why women electively decide to pursue breast implant exchange surgery. At age 18 she underwent a breast augmentation that involved the submuscular placement of smooth surfaced moderate profile saline breast implants with 240cc on the left and 265cc on the right (Fig A, C and E). This gave her the shape and “C” cup that she had wanted so that she was very happy with the results.

A) Breast augmentation with saline implants – prior to implant exchange

B) After breast implant exchange, going from saline to silicone

C) Before implant exchange – side view

D) After implant exchange – oblique view

E) Before implant exchange – side view

F) After implant exchange – side view

After several years and experiencing no problems whatsoever, she decided that she wanted her breasts to be even larger and to also switch to the much more natural feeling silicone breast implants. For her breast revision, she had placement of smooth surfaced ultra high profile silicone breast implants with 360cc on the left and 400cc on the right (Fig B, D and F). There was virtually no discomfort following surgery and she went back to work within a few days. The results were just what she had desired and she was extremely happy.

For more information regarding breast revision surgery, breast augmentation or on any other plastic surgery procedure that I perform, please contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

A French manufacturer of breast implants, Poly Implant Prosthese (PIP), has been in the news worldwide and for all the wrong reasons.

Inferior quality breast implants that break easily.
Usage of unauthorized, non-medical grade silicone in their silicone implants.
Poor quality control and manufacturing techniques.
Concern that their implants may be associated with an increased incidence of cancer.
And now there are allegations that a fuel additive, untested in any human trials, was used in these implants.

These issues show an egregious violation of standards, ethics and integrity. On top of this, European medical regulatory agencies and other government agencies failed to protect the consumer.

Women in numerous countries around the world who had these implants used for their breast enlargement are quite understandably in a panic. There may be hundreds of thousands of them.

What about American women? Do they have anything to worry about here? How many of these implants were used in the United States?

Fortunately, the answers to these questions are both easy and positive.

PIP sold only saline implants in the United States for a short period of time – between the end of 1996 and 2000. In their investigation of the company and its saline implants, the FDA (Federal Drug Administration) in 2000 cited numerous issues and concerns including quality control problems and the unacceptably high deflation rate. This led to PIP immediately withdrawing these implants from the United States market.

And now for even better news: No PIP silicone implants were ever legally sold or used in the United States. Therefore, despite the worldwide uproar and concerns about these disastrous PIP silicone breast implants, American women don’t have to worry about this issue because they were never available for implantation here.

If you would like to obtain information on silicone breast implants, breast augmentation surgery or for any other plastic surgery procedure that I perform, or to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

As a result of research and technological advancements, there have been fundamental improvements in the design and construction of silicone breast implants over the years. These have translated into breast implants filled with a cohesive gel (like taffy) that are stronger, far more durable and resistant to a multitude of forces and factors and which will last considerably longer compared to previous generations of implants. They will not, however, necessarily last forever.

In 2006, the FDA issued recommendations (not a mandate) that women who have silicone breast implants as a results of breast augmentation or breast reconstruction should have an MRI starting three years after their surgery and then every other year subsequently. However, there was no scientific data to support this approach. Given the considerable expenses (and inconvenience) incurred by having these MRI’s which may not even be covered by insurance, we need to consider whether the FDA’s recommendations are really a prudent and necessary.

Research conducted at the University of Michigan and published in the March 2011 issue of the Plastic and Reconstructive Surgery® journal provides some compelling answers to this issue. This research combined and analyzed 21 previous studies that assessed the ability of MRI’s to detect silicone breast implant rupture in order to arrive at their conclusions.

What they discovered was that the MRI’s overall were fairly accurate in detecting ruptured silicone breast implants. However, in certain situations their accuracy rate was extremely high. In fact, they discovered that in women who presented with symptoms related to their breast implants, the MRI’s were 14 times more likely to discern a rupture than in those women who had no symptoms. Thus, in women who were asymptomatic, they were far less helpful.

How can we use this information to formulate reasonable recommendations?

Given that silicone gel breast implants will last on average well in excess of 10 years, MRI’s are not a cost effective tool to screen for ruptured breast implants in otherwise asymptomatic women during this first decade. Instead, mammograms and/or ultrasounds should be performed. If evidence arises or there is a significant index of suspicion for rupture, an MRI can then be considered.

If you would like more information on silicone gel breast implants, breast augmentation, breast reconstruction or for any other plastic surgery procedure that I perform or to schedule a complimentary consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

The term “gummy bear” breast implants has been used in the public realm for several years now yet most people know little about them. What they have heard is that they are the latest type of silicone breast implant and something that they may just want to have for their breast augmentation or breast reconstruction.

You might have wondered: “Exactly what are these breast implants and why are they named after a candy?”

You may even be thinking: “Can I have them for my surgery?”

“Gummy bear” implants are a new generation of silicone breast implants that have some of the characteristics of the candy that they were nicknamed after – though they are not also edible! These implants differ from all earlier versions in that they are composed of a very highly cohesive and form-stable (maintains their shape) gel that resembles the candy though softer.

These 5th generation breast implants have been used elsewhere around the world for breast augmentations and reconstructions since the early 1990’s. They have been extensively researched for years including in large clinical trials but have not yet been cleared by the FDA (Federal Drug Administration) for usage here in the United States although approval may be imminent. (Note: Plastic surgeons here in the United States have been hearing this for several years now – and we are still waiting!)

These new silicone breast implants do offer at least a few advantages over the current cohesive silicone gel ones (as well as some disadvantages). They have been noted to be more durable and last longer and the potential of the silicone gel migrating elsewhere is close to zero. The risk of developing hardness around the implants known as capsular contracture has been found to be lower, around an incidence of 3% as compared to 5 – 10% or more with previous generations of silicone implants.

A definite disadvantage of these “gummy bear” implants is the cost which is expected to be significantly more expensive than those that are used now. Whether this difference is an additional several hundred dollars or much more is not known as of yet. Their increased cost will definitely have some effect on their popularity and selection. Ultimately, however, several factors will play a role in influencing each woman’s decision regarding which type of silicone breast implant is right for her.

For more information on silicone gel breast implants, breast augmentation surgery or for any other plastic surgery procedure that I perform or to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

For any breast procedure requiring the placement of breast implants, my patients are offered the option of using either silicone or saline implants. This would include women who are considering breast augmentation, breast lift with implants, breast implant exchange and breast reconstruction. I thoroughly discuss with them all the important and relevant information about these two types of implants such as appearance, feel, durability, aesthetics, rupture, risks and possible areas of concern. They also are able to touch and closely examine both the silicone and saline implants.

What have I found is the overwhelming majority of my patients select the silicone implants for both cosmetic and reconstructive procedures and they definitely don’t regret the choice. The aesthetic results and much higher level of satisfaction irrefutably support the substantially greater superiority of silicone implants as compared to the saline ones. This is true for both cosmetic and reconstructive procedures. In my practice it is quite rare now for a woman to opt for saline implants and when they do it is virtually always because they cost $1,000 less a pair which then makes the cosmetic surgery affordable.

This finding is consistent with the medical literature including research just published in the November issue of “Cancer”. This multicenter study examined and analyzed the responses obtained from 672 women who had post-mastectomy (for breast cancer) breast reconstruction utilizing either silicone or saline implants. The results revealed a statistically significant greater level of satisfaction in women who chose the silicone breast implants for their reconstruction as opposed to the saline ones.

So, if you are interesting in pursuing either a cosmetic or reconstructive breast procedure that involves the usage of breast implants and were initially leaning toward saline implants you may want to strongly reconsider.

For additional information on silicone or saline breast implants, breast augmentation, breast reconstruction or for any other plastic surgery procedure that I perform or to schedule a consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Replacing of a woman’s own implants for newer ones is referred to as breast implant exchange surgery which also is a category of breast revision surgery. The implants could have been originally placed for a breast augmentation, during a breast lift or in breast reconstruction.

There are several reasons why a woman would select this course of action with some of the most common ones being to:

1. change the size of the implant
2. alter the shape with regard to projection and width
3. change from saline to silicone implants or vice versa
4. replace an implant which has ruptured
5. change the implants as an incidental part of another breast issue such as drooping or capsular contracture

Usually the number one reason for a breast implant exchange is to obtain larger implants in order to have breasts that are significantly larger. Very uncommonly does a patient request going to a smaller size. In most of these situations, it is either because they were made excessively large initially by their surgeon or they gained a considerable amount of weight in the intervening period of time resulting in concomitant natural breast enlargement.

It is quite rare for my personal patients to desire different implant sizes and when they do, it is usually years later and often precipitated by another event such as an implant rupture. How is it that my implant exchange rate is very low? During my patient’s consultation, I listen carefully to their desires and concerns, take measurements, have them “try on” different implants as well as show them photographs of other patients that may be relevant for their situation. Finally, during surgery I will first use temporary “sizers” so as to precisely determine the perfect implant for them.

The relative proportions (profile) of the implant which affect the ultimate breast configuration, are also important. By explaining and offering different profile implants such moderate, high and super-high, my patients can realize the customized appearance they desire. For example, a patient who has a very narrow chest and wants a lot of projection but without excessive width, would benefit from a higher profile implant. A woman who is relatively broad, has a moderate amount of breast tissue and doesn’t want to be extremely large, would be better off with a moderate profile implant.

Finally, most of the patients that I see who have saline implants and are undergoing an exchange for whatever reason, switch to silicone implants. The reason is fairly obvious – they look and feel far more natural. Only in rare circumstances do they go from silicone to saline and it is never for aesthetic reasons.

For more information on breast implants, breast enlargement or any other plastic surgery procedure that I perform or to schedule a complimentary consultation, please contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

You must be thinking that there has to be a typo here. If anything, from all the news media palaver in the past, it is the opposite that must be true. Actually, this is the right question and it does have an unexpected answer.
Silicone breast implants have been subjected to more scrutiny and studies over the years than any other medical device. Several of these looked at any possible association of the long term presence of silicone breast implants with the development of breast cancer by evaluating large numbers of women over many years. The results were shocking but consistent: there is a statistically lower risk of developing breast cancer in women who have had these implants long term. This finding has been reconfirmed by many studies in diverse locations around the world.

The most recent research published in January 2009 in the International Journal of Cancer revealed the results of a epidemiological study of over 6200 Swedish and Danish women who had a mean duration of implantation of over 16.5 years with thirteen percent having them in excess of twenty five years. The findings identified a statistically significant reduction of risk of developing breast cancer of 27%. Previous studies conducted in the United States have shown decreased risks as high as 37 to 53%.

Why women with silicone breast implants have a lowered risk of developing breast cancer is unclear and has been the subject of much conjecture. However, this is fantastic news both for women who are considering a breast augmentation and those who already have silicone implants. When discussing breast enlargement with my patients, I try to put this all in perspective. I do not tell them that if they elect to have silicone breast implants, their risk for breast cancer may be decreased. Instead, I let them know that at a minimum there is no evidence that having silicone breast implants will increase their chances for developing breast cancer.

Steven H. Turkeltaub, M.D P.C.
Scottsdale and Phoenix, Arizona

If you have breast implants, don’t you wish that they would last forever? Although this would be wonderful, they are not lifetime devices and will probably need to be replaced sometime in the future. Many of my patients here in the Scottsdale, Glendale and the Phoenix area are under the impression that breast implants need to be replaced every ten years. Fortunately, this is not the case. The silicone gel implants manufactured today are much better than previous generations. There have been many technological and manufacturing improvements including a thicker and more durable outer shell that is virtually impermeable to any silicone migration.

They also are filled with a much more cohesive silicone gel. As a consequence, it is possible for many silicone gel breast implants to last 20 to 30 years or more. In an ongoing prospective scientific study overseen by one of the silicone implant manufacturers, Allergan, it was noted that there is a rupture rate of 2.7% at 4 years after breast enlargement surgery.

Saline breast implants deflate, on average, much earlier and at a significantly higher rate as compared to silicone implants. This has been borne out by my personal experience of over twenty years at the Arizona Center for Aesthetic Plastic Surgery. Textured saline implants do not fare nearly as well as the smooth surfaced ones.

There are many other factors that can influence the lifespan of the implants aside from whether they are silicone or saline. Some of these include the presence or absence of surface texturing, size of the implant, manufacturer of the implant, size and location of the incision for insertion, surgical technique, mammograms and trauma. Each one of these issues can be discussed in more detail during your consultation.

Breast enlargement is extremely rewarding for the vast majority of women who have had the procedure. Just realize that although the breast implants are generally quite durable, they typically will not last forever.

For much more information or to schedule a thorough consultation for a breast augmentation, breast lift with implants or other cosmetic procedures, you can contact Dr. Turkeltaub at 480-451-3000.

Smooth(left) and textured(right) silicone implants