|Procedure||IMF approach||Periareolar approach incisions||Transaxillary approach|
|Placement of implants||Subglandular plane||Under chest muscle||Subfascial plane|
|Position||Implants are placed under the breast and over the muscle directly under the breast tissue||Implants are placed under the chest (pectoralis major) muscle||Implants are placed under a fascial layer overlying the pectoralis major muscle|
|Advantages||The most natural plane in which to place the implant as it replaces the actual breast tissue||Provides robust coverage and reduced palpability of the implant||
||Can lead to muscle weakness and potential animation deformity, where the implant can move when the chest muscle is activated||
|Recommended for||For patients with moderate to large breasts and/or thick chest skin||For patients who are thin with small breasts and thin chest skin||For patients with moderate to large breasts and/or thick chest skin|
BIA-ALCL is a rare peripheral lymphoma which was first discovered in 1997. To date, more than 300 cases of BIA-ALCL have been reported in the United States alone, mainly occurring in patients who received textured-surface breast implants. The incidence of BIA-ALCL ranges from 1 case per 4,000 implants to 1 case per 30,000. As it is relatively new, knowledge on this topic continues to evolve. It most commonly presents as a late peri-implant collection more than one year following the breast implant surgery. Other less common symptoms include a breast mass, enlargement of the axillary lymph nodes, with fever and fatigue. The average time from implant placement to onset of BIA-ALCL is 10.7 years. BIA-ALCL may affect patients with either silicone- or saline-filled implants. BIA-ALCL may be diagnosed on ultrasound or MRI scan, in conjunction with the use of image-guided needle fluid aspiration or biopsy.
Most cases of BIA-ALCL are considered localized and have an early-onset form and can be cured by implant removal and complete excision of the implant capsule. Regular surveillance examinations imaging investigations may be required. Patients with more advanced disease may require chemotherapy and/or radiotherapy. If you already have breast implants, the US FDA states: “There is no need to change your routine medical care and follow-up”. Additional screening or removal of implants is not required for asymptomatic women. The FDA continues to affirm that “BIA-ALCL is a very rare condition”. Should you experience any of the symptoms described above, do arrange for a consultation with your plastic surgeon.
As a result of an inflammatory, foreign-body reaction, the body develops a capsule around any implant placed inside. This can sometimes be hastened by a low-level infective process. When severe enough, in breast implants this capsule can lead to capsular contracture. Capsular contracture itself has different grades of severity and can be classified into 4 stages (Baker’s classification):
Stage 1: Breast is soft, and implant is not palpable
Stage 2: Breast is solid, and implant is palpable but not visible
Stage 3: Breast is solid, and implant is palpable and visible
Stage 4: Breast is deformed and painful and implant is palpable and visible
Placed well with meticulous technique, breast implants can last a lifetime with low risks of capsular contracture. However, if this does happen, the usual timeframe for symptomatic capsular contracture is 10 years. This can be severe and distressful, and capsule removal or replacement with implants or fat grafts can be done as treatment.
Breast augmentation can be done at any age once breasts are fully developed, which usually occurs by 18 years old. There is no age limit, though at a later age factors such medical suitability, skin quality, and breast ptosis must be considered.
Whether done using implants or fat grafting, breastfeeding is safe after breast augmentation.
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