Modern breast augmentation was first introduced in the 1960s with Drs Frank Gerow and Thomas Cronin inventing the first silicone breast implants. Today, breast augmentation is one of the most common forms of plastic surgery in the U.S, with over 193,073 procedures performed in 2020 alone*.
Breast augmentation has come a long way since its inception and the procedure has seen improvements made to its safety, materials, incision methods and aftercare.
*according to a statistics report from plasticsurgery.org.
Silicone Versus Saline: What's The Difference?
In the 1990s, silicone implants made headlines when ruptured implants were suspected to be linked to causes of autoimmune diseases. This prompted the FDA to ban the use of breast implants in the United States, with exceptions made for those undergoing breast reconstruction surgery. Following this ban, the only other choice was saline-filled implants, with the belief that they can be safely absorbed into the body in case of a leak.
Photo: SW1 Clinic
Silicone gel implants became one of the most widely-studied medical devices following the ban. However, after years of extensive clinical studies with long-term follow-up, it confirmed that there were no associations between silicone gel implants and any chronic autoimmune disease, and FDA lifted this ban; silicone gel-filled implants were reintroduced back in the U.S in 2006. Modern silicone implants can be described as having the texture of a gummy bear candy — it is widely believed that they are able to achieve the movement and natural look of breast tissue. Silicone is an inert polymer with no known allergies or sensitivities. The gel is also more viscous than saline, flowing and interacting differently to create a more natural look.
Saline-filled implants, on the other hand, are usually housed in a silicone shell that is inserted into the body before it is filled to a desired volume with the sterile solution. As the fluid has the consistency of water, the implant can sometimes be seen or felt when inserted under very thin skin—a phenomenon often referred to as "rippling" or "wrinkling".
Newer generation silicone gel like Progressive Gel Ultima possessed high elasticity and viscoelasticity deformation capability, making it feels softer and more adaptable as a gel. Therefore, allowing the implant to be stretched with force and yet have the ability to recover to its original shape without being ruptured.
Smooth, Textured or Smoothsilk/Silksurface?
Besides choosing the material the implant is made of, there is also the option of picking between a smooth, textured or SilkSurface/SmoothSilk implant. With smooth implants, the outer shell is usually not as thick as a textured shell is, making it softer.
A potential complication after breast augmentation surgery is capsular contracture, where the scar tissues that form around the implants harden and tighten, giving the implants an unnatural and stiff appearance. A study on smooth implants has shown that the likelihood experiencing capsular contracture can be anywhere from 6.5 percent to 50 percent*, while textured implants come in at around 4.5 percent**. For textured implants, the pebbled, rough texture holds its position well, making anatomically- or teardrop-shaped implants look more natural.
*Collis N, Coleman D, Foo ITH, Sharpe DT. Ten-Year Review of a Prospective Randomized Controlled Trial of Textured versus Smooth Subglandular Silicone Gel Breast Implants. Plast Reconstr Surg. 2000. doi:10.1097/00006534-200009040-00005Summary of Safety and Effectiveness Data. US Food Drug Adm. 2011:39. doi:10.1017/BO9781107415324.004
**Bengtson BP, Van Natta BW, Murphy DK, Slicton A, Maxwell GP. Style 410 highly cohesive silicone breast implant core study results at 3 years. Plast Reconstr Surg. 2007;120(7 SUPPL. 1):40-48. doi:10.1097/01.prs.0000286666.29101.11
Photo: SW1 Clinic
*based on studies conducted by Wong CH, Samuel M, Tan BK, Song C.; Malata CM, Feldberg L, Coleman DJ, Foo IT, Sharpe DT.; and Headon H, Kasem A, Mokbel K.
SilkSurface/SmoothSilk has a texture that is engineered to sit somewhere between smooth and textured and it has been proven to have less than 1 percent chance of causing capsular contracture*. SilkSurface/SmoothSilk surfaces have the added benefit of limiting chronic inflammatory complications by harmonising the cell activity involved in the inflammatory and fibrotic response**. In other words, the body doesn't react as severely to implants with SilkSurface/SmoothSilk textures. SilkSurface/SmoothSilk has also undergone clinical studies to measure bacterial growth, where they have shown significant advantage over other implant types when it comes to contamination***.
*Sforza M, Zaccheddu R, Alleruzzo A, et al. Preliminary 3-Year Evaluation of Experience with SilkSurface and VelvetSurface Motiva Silicone Breast Implants: A Single-Center Experience with 5813 Consecutive Breast Augmentation Cases. Aesthetic Surg J. 2018;38:S62-S73. doi:10.1093/asj/sjx150** Cappellano G, Ploner C, Lobenwein S, et al. Immunophenotypic characterization of human T cells after in vitro exposure to different silicone breast implant surfaces. PLoS One. 2018;13(2):1-14. doi:10.1371/journal.pone.0192108Nam S, Lee M, Shin BH, Elfeky B, Lee YU, Moon DH. Characterization of BellaGel SmoothFine ® Implant Surfaces and Correlation with Capsular Contracture. 2019:196-211. doi:10.4236/jbnb.2019.104012Pontes GH, Vargas Guerrero LA, Mendes Carneiro Filho FS, et al. Reduced Remodeling Biomarkers TissueExpression in Nanotextured Compared with Polyurethane Implants Capsules: A Study in Rats. Aesthetic Surg J. November 2020. doi:10.1093/asj/sjaa315***James GA, Boegli L, Hancock J, Bowersock L, Parker A, Kinney BM. Bacterial Adhesion and Biofilm Formation on Textured Breast Implant Shell Materials. Aesthetic Plast Surg. 2019;43(2):490-497. doi:10.1007/s00266-018-1234-7
Round, Teardrop Or Ergonomix?
The shape of the implant matters when it comes to the results you are trying to achieve.
Round implants allow you to achieve the highest projection, with complete fullness at the upper pole of the breast. Teardrop-shaped implants, however, are fuller at the base and are required to be inserted in a precise position. While the teardrop shape is perceived as more anatomically accurate when standing up, it's not natural when one is lying down, because that's not how regular breast tissue reacts with movement.
Ergonomix, the 6th generation type of implant, flows with the movement of breast tissue, which allows the implant to hold both a round shape when lying down and a teardrop shape when standing up— similar to how natural breasts behave to these movements.
A Well-Rounded Approach To Breast Augmentation
There’s also a shift in perspective towards plastic surgery, with rising demand for self-enhancement procedures for people seeking to feel and look good about themselves. According to localised data from SW1 Clinic, a medical clinic located at Paragon, women between the ages of 25 to 45 make up 80 percent of their clientele seeking breast augmentation. The main reasons for the procedure include lack of development of breasts, sagging due to breastfeeding, asymmetry or a desire to feel more confident.
Breast augmentation is a woman's choice for her body and recovery is key. Aftercare for breast augmentation used to be largely dependent on doctors and with variations. Today, there are new programmes in place to ensure that patients receive the same high-quality aftercare to walk them through their journey. One such programme is JOY by Motiva. According to the company, it takes a well-rounded approach towards breast augmentation and also offers the latest enhanced features of breast implant, Motiva Ergonomix2 as part of the programme. It also covers implant ruptures, capsular contracture* and everything under Motiva’s Extended Warranty of five years. There is also an option to reverse the procedure within two years** if you choose to opt under the Woman's Choice Program.
*Baker grades III and IV** Starting from the date of the breast augmentation surgery
As with all medical procedures, choosing to undergo breast augmentation is a huge decision to make and SW1 helps to support this decision-making process through consultations, and visualisation aids to ensure that patients are making an informed choice.
Photo: SW1 Clinic
To help patients envision the results post-surgery, SW1 Clinic uses the Vectra 3D Imaging Simulation which produces a 3D image showing how the breasts will look post surgery, according to the size, volume, shape and projection of the implants chosen.
Selected doctors such as Dr. Tan Ying Chien and Dr. Chia Hui Ling from SW1 Clinic offer the Motiva Minimal Scar programme. This allows them to achieve incisional scars as short as 2.5cm* while using a no-touch technology by using the Motiva Sleeve. A smaller incision means the scar is less visible and it's done on the natural crease of the breast.
*based on individual skin condition and size of implants
Myth Or Fact?
From left: Dr. Tan Ying Chien and Dr. Chia Hui Ling (Photo: SW1 Clinic)
Breast augmentation has come a really long way in terms of technology and the studies that have gone into ensuring the safety of implants and the procedure itself. Dr. Tan Ying Chien and Dr. Chia Hui Ling of SW1 Clinic address these common myths surrounding the procedure and how these myths don't hold up against modern medical advancements in the field of breast augmentation in 2022.
More painful than childbirth
"As with all invasive surgery, there would be some pain involved which would last for a few days, and the level of discomfort varies from person to person. However, based on our experience with our patients, they experience more of a muscle ache feeling and it generally lasts for the first few days after surgery.”
You must lie in bed for one week
“Although it is recommended to rest your body after invasive surgery, we will recommend our patients not to lie in bed all day. You can continue to carry on normal daily activities even after surgery.”
Difficult to hide from others
“If you choose the right size and placement for the implants, it is harder for others to know that you have undergone plastic surgery.”
It looks fake and other people would be able to tell.
“Majority of our patients seek for Motiva Ergonomix as it is created to look and feel like natural breasts, moving with the body as you stand or lie down.”
"The scars would be visible."
“As we are trained under the MinimalScar programme, which is available for JOY by Motiva, it is possible to carry out breast augmentation surgery with an incision scar as short as 2.5cm. These incisions are made under the breast crease, so that it would not be visible after it heals.”
As with all medical procedures, speak to a certified doctor who would be able to address any safety or medical concerns and tailor a program that meets your goals. Visit this website for more information.