Why do saline implants deflate

The salt water is absorbed by the body. When a silicone implant ruptures, the gel leaks out more slowly because it's thicker, so it may take you longer to realize that the implant has ruptured, or you may not realize it at all. Silicone gel is not absorbed into the body. The liquid silicone gel implants sold in the United States prior to are more likely to leak beyond the capsule of scar tissue surrounding the implant if a rupture occurs.

The liquid silicone gel can spread to other parts of the body, such as the lymph nodes or the lungs. Your body may react to the silicone by forming more scar tissue, which might be uncomfortable or cause a distorted breast shape.

In relatively rare cases, lumps called silicone granulomas can form in the arm, armpit, chest area, or elsewhere in the body. Starting in , the silicone implants sold in the United States have had thicker shells and a more cohesive gel filler.

Signs that your silicone implant has ruptured can include changes in breast shape and size, and increasing pain, firmness, and swelling over a period of weeks. Exact data can be tough to determine for implant construction changes over time, and many people choose to have breast lifts or change to silicone implants without having deflated so exact numbers are impossible to come by.

One upside of saline implants is that if the implants does break and deflate you know it. The result is not subtle for that breast will shrink in size, get softer, and likely hang a bit looser than the other breast. Also when implants deflate it is common to feel the irregularities and folds in the implants once it is mostly empty of the saline.

Sometimes the empty implant even feels like it is pocking you and feels very different than when full and intact. The saline in your implant is regular IV fluid, and your body absorbs the slat water over time and you just pee it out like you would an IV solution.

Most implant deflations are a small pin hole that may have occurred from a small edge fold in the implant that made it rub against itself over the years and a hole occurred. A less frequent type of deflation occurs at the valve which is the part of the implant used to fill it with saline at the time of surgery. These valve leaks can lead to partial deflations, or changes in the breast size that take many weeks to occur. So once you and your surgeon know your implant on one side has deflated what should you do?

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B, E, H Immediately post-deflation cc from the right and cc from the left. C, F, I Eighteen months postoperative removal and neosubpectoral placement of Mentor Mentor, Minneapolis, MN textured cc moderate plus silicone implants, vertical mastopexy, and 60 cc of fat grafting to each side. J Intraoperative view demonstrating the immediate on-table result, as well as the explanted saline implants and corresponding capsules.

A subset of 10 patients underwent 3D imaging at three time points: at the initial consult Time 1 , immediately after deflation Time 2 , and 3 weeks after deflation Time 3.

Using the Sculptor Vectra, Canfield, Fairfield, NJ program, breast landmarks were placed by hand, rather than by the computer automated landmarks, on the following landmarks: sternal notch, clavicles, nipples, apex of the areola, lateral inframammary fold IMF , medial IMF, and IMF at the breast meridian.

In order to eliminate the intra-observer variability of placing the breast landmarks, these landmarks were placed at three separate times, and the average of these values were recorded. To calculate volumes, the Analysis program Vectra, Canfield, Fairfield, NJ was used because, unlike the Sculptor measurement of volume, the Analysis program takes into account chest and abdominal wall irregularities. For patient 5, the Vectra-calculated volume difference was mL and On average, the breast volume increases These patients showed an average This year-old woman was initially treated 11 years ago with bilateral augmentation mastopexy using cc smooth round saline implants.

She subsequently developed macromastia with asymmetry of lower pole mass. Additionally, she has widened nipple areolar complexes NACs bilaterally. B, E, H Immediately after deflation. We first began preoperative saline deflation in —publishing select cases starting in —as a method to determine whether an additional implant or mastopexy only is necessary in revisional breast surgery.

Many women with saline implants may eventually seek revisional breast surgery. A common challenge in secondary aesthetic breast surgery is determining the true volume of the breast parenchyma versus that of the implant.

Accurate assessment of parenchymal volume is important in determining whether the patient needs additional volume another implant or less volume reduction in conjunction with a mastopexy. A distinct advantage of saline implants is they can be deflated preoperatively to determine the true parenchymal volume. This was described by Fischman 8 in He deflated the implants right before surgery to facilitate preoperative marking.

In Zaworski's 9 reply, he noted a cm upward migration of the NAC after removal or deflation of subglandular saline implants. His algorithm was to remove the deflated saline implants months prior to definitive mastopexy to allow the skin to contract.

We started our saline deflation in , but were unaware that others would publish their experience in Handel 10 described postoperative saline deflation after secondary augmentation mastopexy in order to decrease tension and improve circulation to skin flaps to avoid a complication.

However, the duration of deflation, or the quantitative volumetric and shape changes that occur in the interim, have never been previously described. After reviewing our 3D imaging data, we were able to quantify the clinical phenomenon of elastic breast recoil. Breast volume appears to increase on average While this increase occurs in both the upper and lower pole, in some patients it is most noticeable from the basal view Figure 5 and Supplementary Videos 2 and 3.

A possible explanation for this is shortening of the suspensory ligaments that have previously been stretched by the implant, with resultant expansion of the gland back towards its pre-augmented volume.

Another explanation could be that after the implant is deflated, the pressure from the implant onto the parenchyma decreases. This drop in the parenchymal interstitial pressure allows fluid to reenter the interstitial tissue, much like a sponge absorbing water, to fill in the dead space left after implant deflation.

Three-dimensional imaging of a year-old woman who underwent the deflation process. This gland recovery is most noticeable in the basal view. The red arrow indicates the lower pole of the breast. A Before deflation. B Immediately post-deflation. Note the soft tissue irregularities in the lower pole skin immediately after deflation red arrow. C Three weeks post-deflation. These lower pole soft tissue irregularities red arrow have resolved by 3 weeks. For example, if the revisional plan included removal of the existing saline implants, replacement with a smaller silicone implant, and a vertical mastopexy, there are several considerations.

Using a smaller silicone implant will not elongate the sternal notch-to-nipple distance as much as a larger implant. The addition of a vertical mastopexy will further shorten the notch-to-nipple distance. The safe way to approach this would be to make conservative vertical mastopexy markings in the preoperative area and then, after the smaller implants are in place, perform a simulated stapled mastopexy and adjust the nipple height intraoperatively.

However, despite this careful tailoring, the nipples may still end up too high. Just as in breast reduction, when weight is removed from the breast, the nipples elevate.

In breast augmentation, weight is added, and the nipples lower. When a larger implant is replaced with a smaller one, the breast is unweighted, and the nipples elevate. This concept of unweighting the breast has previously been described. We always offer deflation for patients with saline implants before the size change to smaller implants.

It allows the patient to participate in the decision making of how large they want to be. If they want to downsize, it can be difficult for the patient to visualize and describe how much smaller they would like to be, and deflating the saline implant allows the patient to see how much of their own breast tissue they have to start with.

For patients with silicone implants, we offer a staged approach of explantation then revisional surgery in two instances. First, if there is uncertainty as to the need for mastopexy, we find that a staged approach helps clarify the need for mastopexy.

Second, we believe that when there is extracapsular silicone rupture, a staged approach after complete capsulectomy and removal of extravasated silicone allows the unstable soft tissue envelope to normalize. A period of waiting allows the blood supply to the breast to recover, which puts the patient at a lower risk for ischemic complications. The silicone implants are removed in the first operation which is analogous to in-office saline implant deflation , and 3 weeks afterwards we bring them back for final preoperative planning.

The revisional surgery is performed 1 week later. Therefore, our staged approach is the same for both silicone and saline implants. We find this elastic breast recoil occurs in patients who have had both silicone explantation and saline deflation, and waiting until this recoil has occurred clarifies preoperative revisional planning.

One weakness of this study is the small sample size. The percentage of new revisional breast patients requiring preoperative saline deflation is small, and all of these patients seen in our practice undergo imaging at these three time points. We suspect that there has been and will be fewer women with saline implants requiring revision due to the increased popularity of silicone implants.

We only acquired the 3D imaging system in December , and since then have been imaging all of our patients requiring deflation. In addition, we did not have a non-deflation control group. We are continuing to accrue patients into our study and plan to reanalyze our data in the future to see if our results are statistically significant. Furthermore, the deflation volumes are approximate, as the values are measured by looking at the values in the suction canister.

One further consideration for future studies is to remove this aspirated fluid and measure this more accurately in a beaker or weigh the saline. Another weakness is that there is a degree of variability in the measurements depending on where the breast landmarks are placed by hand. However, we attempted to minimize this variability by taking several measurements and reporting the average.