Toronto Breast Implants – Undesirable Aspects

A discussion should take place concerning the multiple potential undesirable aspects of breast implants, such as palpability, rippling, distortion, malposition, device failure (leaks, saline, or silicone gel), and capsular contracture. Potential effects on nipple sensation and breast-feeding should be included. Asymmetries, enlargement of the areola, and prominence of veins may occur postoperatively, and pointing this out to patients before surgery may obviate a source of patient dissatisfaction.

1. If you can feel your ribs with your finger, beneath the breast or at the side of your breast, you will be able to feel the edge of your implant beneath your breast and at the side of your breast.
2. Currently manufactured Toronto breast implants that strive to achieve durability of the shell have a thicker shell to prolong the life of your implant, and a thicker shell may be easier for you to feel.
3. If feeling an edge of an implant shell could be a problem for you, do not have an augmentation.
4. We cannot change the quality or thickness of your tissues. If you are thin or have very little breast tissue, you will be more likely to feel your implant.
5. The larger your implant, the worse your breast will look over time. A larger implant will stretch your tissues over time and will cause more tissue-thinning and sagging than a smaller implant. Your tissues do not improve with age, and they will be less able to support the additional weight of any implant, especially a larger implant.
6. Any implant, if filled adequately to prevent collapse and possible folding of the shell when you stand, will feel firmer than a normal breast, regardless of the filler material. If the implant shell folds, it could fail sooner and require you to have a reoperation sooner.
7. If you want a totally natural breast, you should not have a breast augmentation.

In the past, rates of capsular contracture were reported to be higher with silicone gel implants than with saline implants. Whether this trend continues with newer gel implants remains to be shown.
In breasts that do not exhibit capsular contracture, saline breast implants may have an increased incidence of both palpable and visual irregularities as compared with silicone gel breast implants. This is particularly true in the subglandular position in the patient who does not have a lot of soft-tissue cover. Both saline and gel breast implants may leak. Leak rates for silicone gel implants are difficult to determine. This is because most gel leaks are contained within the capsule surrounding the implant, and the breast may not appear to lose volume or have a palpable change. Many such leaks are diagnosed inadvertently as a secondary observation during other breast procedures. Such leaks may also be discovered by either mammography or magnetic resonance imaging. The various reported rates of leak have ranged from 1 to 7 percent. Implant deflation with leaking saline is almost always noticed by the patient, and reoperation is more likely than with the often subtle clinical changes of silicone gel leakage.

Envelope: Smooth versus Textured

Texturing of the silicone shell of breast implants was developed as an attempt to decrease the rate of capsular contracture. There is evidence that, in the subglandular position, the capsular contracture rate for textured implants is less than the rate for smooth-walled implants. This benefit may disappear in the submuscular position. Potential negatives of the textured surface are an increase in rippling or wrinkling and palpability. This is particularly true in the subglandular position.

There are strong advocates for both round and shaped or “anatomical” implants. Success in the use of either type depends on the absence of capsular contracture, the impact of which will not be mitigated by the shape of the implant used. A submuscular round implant may have the tendency to increase upper pole fullness, particularly in patients with certain body types, such as those with shortened vertical thoracic dimensions. Advocates of round Toronto breast implants point out that, in the absence of capsular contracture, a round implant becomes a teardrop anatomically in the body from gravitational effects. Additional issues that impact this situation include fill volumes of different implant types and the degree of added firmness, with overfilled implants or possible device failure associated with underfilled saline implants. Shaped implants carry the extra burden of precision with placement, as distortion and malposition may be apparent, with the intrinsic form of the implant producing an abnormal appearance against the overlying breast. This is particularly true in the subglandular position.

Implant Size

The properties of a breast may be determined primarily by whatever component of the breast occupies volumetrically the largest percentage of the breast. Therefore, implant size is important in the decision-making process to both accomplish patient satisfaction and minimize the requirement for secondary surgery. Choosing larger breast implants is associated with an increased risk of skin stretching, implant visibility and palpability, and implant ptosis. Reoperation for a change of implant size is common; therefore, taking the time to assess this factor with the patient preoperatively is very important.