Saline implants can be ordered in both smooth, round as well as anatomical textured implants. We prefer not to use anatomical textured implants due to risk of rotational deformity, which may be inevitable over time. Even a five degree rotational shift of the anatomical or shaped implant can lead to an obvious deformity externally for a distraught patient. Due to the unpredictable nature of the rotational deformities, we have not used anatomical implants in over a decade. Las Vegas breast implants specialist Dr. Linder believes that placing saline, smooth implants that are round, behind the muscle leads to a natural-looking appearance. This is due to the effacement of the upper pole of the bags from the upper pectoralis major muscle. Absolute proper positioning of the implant is required in order to reduce this rounding upper pole fake appearance.
Saline implants are often placed through the periareolar approach. The incision is made underneath the nipple areolar complex from approximately the five o'clock to seven o'clock position. It is then opened with a 15-blade under general anesthesia. The dissection is carried down through the glandular tissue to the fascia overlying the pectoralis major muscle, which is split laterally. Subpectoral dissection is then performed under direct headlight visualization. The parasternal and lateral inframammary attachments of the pectoralis major muscle must be completely released in order to allow the implant to position correctly. Dissection should be carried along the parasternal muscle, releasing the infraclavicular attachments of the pectoralis muscle. Lateral dissection is carried beyond the pectoralis major and minor muscle. Patients who desire more cleavage should be limited to lateral dissection so the implants can then be vector forced to the midline.
Saline implants are filled safety under sterile technique, which involves a three-way, fill-tube system placed directly into the IV tubing within the saline bag. This is performed so that the saline remains sterile from the bag into the implant itself.
Deep layer closure includes closing the fascia, the deep layer of fat, or glandular tissue over the muscle. Dr. Linder usually does not close the muscle directly in that scar heals together on its own, which has never been a problem with thousands of breast augmentation surgeries performed. The deep layers are closed with absorbable sutures and the subcuticular is closed with a non-absorbable suture which is usually removed within 14 days. In general, high profile, Style 68 implants are normally used, which reduces visibility and rippling due to a rounder shaped bag. These implants also reduce lateral displacement and lateral fullness, and allow women to have a more tapered and thin appearance, not the matronly appearance that is often seen with the Style 68 low profile implant. Dr. Linder believes the low profile implants have been shown to be too wide and the AP projection is not often enough.
Saline implants are very useful in patients with thicker chest walls and good ample amounts of breast tissue, because the rippling on the side is hidden by the lateral breast tissue. Silicone implants are useful for ectomorphic or thin women with minimal amounts of breast tissue, especially on the lateral breast. Although the implants are placed in the dual plane or subpectoral along the medial two-thirds of the pocket, the lateral third of the implant is normally only covered by breast tissue; this is where visibility and palpability of the bag edge is most common. Silicone implants are excellent for very thin women who have minimal breast tissue. High profile silicone cohesive gels are one of the best implants to reduce palpability and visibility of the implant edges.