Adjustable Breast Implants

All About Expandable Breast Implants

What are adjustable breast implants?

Adjustable (expandable) breast implants are just that – adjustable. Saline can be added to these implants post-operatively. This allows much more control over final size.

Are there different types of adjustable breast implants?

Yes. For example, Mentor’s Spectrum breast implant is filled with saline only. Other breast implants, such as the Spectra Adjustable or the Becker are double lumen breast implants containing gel in the outer lumen, and saline in the inner lumen.

Are adustable breast implants more expensive than non-adjustable implants?

Yes, they are more expensive by several hundred dollars.

Why would someone choose adjustable breast implants?

Women that have asymmetry, or breasts that are two different sizes, can benefit from adjustable breast implants. Since these implants can be adjusted post-operatively, the surgeon has the ability to make small or large changes after surgery. However, plastic surgeons, particularly those that are board-certified by the American Board of Plastic Surgery, have no problem correcting asymmetry using non-adjustable breast implants.

How long have adjustable breast implants been around?

Expandable breast implants were introduced in 1984. Becker Expandable implants were created by Dr. Hilton Becker in conjunction with Mentor. It was initially designed for use in breast reconstruction patients, but soon became popular with elective breast augmentation patients. The Becker Expandable is a breast implant consisting of two lumens. The inner lumen (shell) is saline-filled, and the outer lumen (shell) is filled with silicone.

Becker Expandable Breast Implants

Spectrum Expandable breast implants were introduced in mid 90’s and are composed of a silicone elastomer shell filled with saline. These implants come in both smooth and textured surfaces, as well as round and anatomical shapes. As with the Becker Expandable, a fill port is left in place so that saline can be added or removed from the implant post-operatively.

The silicone elastomer fill tube is inserted into the self-sealing valve at the time the implant is made. The implant volume can be adjusted postoperatively via the fill tube and injection dome. A connector system is used to join the preinserted fill tube to the injection dome.

What is the Spectra™ Adjustable breast implant?

Mentor’s Spectra™ Adjustable Gel Breast Implants offer all the advantages of a silicone gel breast implant with an adjustable saline inner-lumen that can be adjusted both intra- and post-operatively. By adding saline for increased projection, the soft feel of the gel does not change. These characteristics are unique in the market.

What happens at the time of initial implantation?

Your plastic surgeon will create a pocket for the implant in either the subglandular or submuscular plane. Once this is done, the deflated implant is placed in the submuscular space and saline is injected through the fill tube by a single syringe to the point where the implant takes up the slack skin. This usually does not exceed 1/3 of the total designated fill volume of the breast implant, depending upon the amount of skin available and the circulation of the skin. If the circulation appears to be compromised, no additional saline should be added at this state.

The injection dome is then attached to the fill tube using Mentor’s True-Lock connector system. The injection dome is then secured in a subcutaneous pocket adjacent to the device. (usually below the axilla/armpit). The surgeon should take care to tailor the tube length to the patient so that it will not kink or shorten as the implant expands.

Does saline have to always be added post-operatively?

No. Expandable breast implants can be filled and sealed at the time of surgery just like regular saline breast implants. Because adjustable breast implants are more expensive, there is really no point in getting them if post-operative size adjustment isn’t something you desire.

How long can I make adjustments in size?

Mentor recommends that the duration of volume adjustment not exceed six months as tissue adhesions may make it more difficult to remove the fill tube and/or compromise the integrity of the valve. Damage to the implant and/or leakage may result.

How many size adjustments can be made?

Two injection domes are supplied with each implant. The micro dome can withstand up to 10 injections. The standard dome can withstand up to 20 injections. The photos below show the injection dome beneath the skin.

Close-up of the injection dome

The injection dome is implanted underneath the skin, very superficially as the dome is more easily accessible and identifiable. Mentor recommends that the injection dome be placed no further than three inches away from the implant to avoid damage to the device during postoperative filling.

View of the dome underneath the skin

Will I be able to feel the injection dome?

Yes, you will be able to feel it, and you will be able to see it protruding underneath the skin. But remember, it is only temporary. You may experience some chafing of the skin at the site of the injection dome if your bra rubs against it. This is more of a minor irritation and annoyance than anything else.

It should be noted that there is a difference between the micro dome and the standard injection dome. The micro dome is smaller in diameter and shorter in height than the standard injection dome.

During the initial surgery, when the implant is inserted, how much saline is added?

At the time of placement, the implant should be filled with no less than the temporary recommended minimum volume, or with no more than the final recommended maximum volume. Underfilling the implant can cause it to crease, fold, wrinkle, or buckle. This can cause friction on the shell and make it prone to rupture. Likewise, overfilling the implant also increases the risk of rupture.

How is additional saline added postoperatively?

A syringe filled with sterile saline solution is inserted into the center of the dome and injected through the fill port into the breast implant.

Injection Area

How much saline is added during postoperative visits?

Up to 100cc can be added twice weekly, although it isn’t uncommon to have increments of 50cc’s added on a weekly basis. The amount of saline used in postoperative expansion sessions will depend upon each individual case.

Does it hurt to have saline added postoperatively?

You will obviously feel the needle, but aside from that, the injection of additional saline is not painful. Depending upon how much saline is added, you may experience soreness in the breast area for a few days.

Do expandable breast implants have to be placed over the muscle or under the muscle?

Like all other breast implants, expandable implants can be placed over the muscle, partially under the muscle, or in the “complete” submuscular position.

When is the injection dome and fill tube removed?

Once the desired volume is achieved, the fill tube and injection dome are removed through a small incision under local anesthetic. A small incision is made at the location of the injection dome. The surgeon makes sure to grasp behind the connector and remove the tube before taking out the injection dome, which prevents the tube from dislodging and retracting back into the pocket. Trace amounts of gel may appear on the tube during removal from the device. The connector should not be pulled while removing the tube as it may disconnect and subsequent deflation could occur. Slow and steady traction to remove the fill tube prevents damage to the implant and/or the self-sealing valve.

What are the risks involved with expandable breast implants?

Women receiving adjustable breast implants are monitored during the period of adjustment. Things like sloughing, necrosis, and poor wound healing. If any of these symptoms are exhibited, the implant should be reduced in volume by reversing the filling procedure and withdrawing fluid from the implant. If symptoms persist, the implant must be removed.

As with all breast implants, other risks apply.