BREAST ENLARGEMENT / ENHANCEMENT: CREATE A CUSTOMIZED BREAST SHAPE
In general, shaped implants in the past, such as anatomical implants or the Style 468 Anatomical McGhan Implants, Dr. Linder no longer favors. The problems with those implants are they can shift and rotate which will therefore lead to a severe deformity in appearance of the chest as well as increased scar tissue can form around these anatomical implants. Natural or teardrop implants or anatomical implants have rotational deformity over time and can lead to very severe deformities, including poor cleavage, sternal deformities and just an abnormal appearance to the breasts. Even a 5 degree rotation or shift to the breast implant can cause an abnormal disfigurement to the breast area. The only way to truly fix this is by removing those implants, performing an open capsulotomy and/or capsulectomy if necessary and replace them with round implants. As a result, in creating a customized breast shape, Dr. Linder only uses round implants. The majority of the time high profile implants are used, either silicone or saline. The advantage of the high profile implants are that they are not as wide as the moderate or moderate plus profile implants and thereby they give more of a tapered appearance with more fullness with AP projection. Because the implants are placed in the dual plane or subpectorally, the implants have a more natural slope under the muscle. In fact, CT scans have been shown with implants placed, both the anatomical and/or round, behind the muscle and do not show a significant slope difference between the two. Round implants obviously do not have any rotational deformity problems as they are round.
Silicone versus saline is significant of course in terms of softness, and visibility of the implants along the side of the breasts. Patients who are ectomorphic (very thin build) should possibly undergo silicone gel augmentation in the dual plane in order to reduce visibility and rippling of the bag along the side of the chest. They also may have less fullness and less of the unnatural appearance that may be associated with round implants.
Saline implants are very useful for endomorphic, barrel chest patients, or patients who have very thick muscles. Saline implants will actually enhance fullness in the upper pole, especially with women who have loss fullness associated with breast feeding, postpartum women who have involutional upper pole atrophy with complete loss of fullness associated with pregnancy. Therefore, breast enlargement and breast enhancement can allow patients to create a customized breast shape, but only to a certain extent. Again, we only use round implants because they must avoid rotational deformities that can be significantly found with teardrop or anatomical shaped implants.
The reconstructive breast cancer implants are often wider-based and those can also rotate and create a very severe deformity. Those, in my opinion, wide-based anatomical implants, should be used only in cancer reconstruction. In patients who we have seen for cosmetic purposes, the majority of them have had horrible rotational disfigurement.