Chest insertions is a general term referring to surgical prosthetics placed beneath the skin and muscle of the chest wall. These devices are most commonly associated with breast implants, used for both breast augmentation and post-mastectomy reconstruction. Implants are also used to enhance or correct the contour of the male chest, known as pectoral implants.
Types and Materials of Implants
Chest prosthetics are primarily categorized by the material used to fill the outer silicone shell. The two main types are saline implants, which are filled with a sterile salt water solution, and silicone implants, containing a cohesive silicone gel. Saline-filled devices offer the advantage of being inserted empty and then filled, requiring a smaller incision for placement. Silicone gel implants are pre-filled and are often preferred because their texture closely mimics the feel of natural breast tissue.
Silicone implants are differentiated by the cohesiveness of the internal gel, with some highly cohesive types referred to as “gummy bear” implants. These form-stable implants maintain their shape even if the shell is compromised. The outer shell can be smooth or textured; smooth implants move freely, while textured surfaces encourage tissue adherence and minimize rotation.
Implants also come in two general shapes: round and anatomical, often called teardrop. Round implants have a uniform curvature, offering maximum fullness, especially in the upper part of the breast. Anatomical implants are designed to mimic the natural slope of the breast, being thinner at the top and gradually fuller toward the bottom. If an anatomical implant rotates, it can distort the breast’s appearance and may require corrective surgery, a risk that round implants do not carry due to their symmetrical shape.
Primary Reasons for Placement
Implants are placed in the chest for a variety of reasons, broadly divided into aesthetic and reconstructive purposes. The most frequent application is aesthetic augmentation, where the goal is to increase the size or improve the shape and contour of the breasts. This procedure is common for individuals seeking a change in their appearance or to restore volume lost due to factors like pregnancy or weight fluctuation.
Reconstructive surgery often involves the placement of breast implants following a mastectomy, most commonly due to breast cancer. This aims to restore the shape of the breast mound lost during the removal of breast tissue. Implants may also be used to correct congenital differences in the chest wall, such as the absence of chest muscle tissue seen in conditions like Poland syndrome.
For men, chest implants are specifically designed to be solid, contoured pieces of silicone, distinct from the gel-filled breast implants. These pectoral implants are used for aesthetic enhancement, creating the appearance of greater muscle definition that may not be achievable through exercise alone. They are also employed in reconstructive cases to correct asymmetry or underdevelopment of the pectoral muscles.
Surgical Placement Techniques
Implant placement involves selecting the incision location and determining the implant’s position relative to the chest muscles. Surgeons utilize several common entry points, with the inframammary fold—the crease beneath the breast—being one of the most frequent choices. The incision is often well-camouflaged in this natural fold. Other options include the periareolar incision, made along the edge of the areola, and the transaxillary incision, which is placed in the armpit.
The plane of placement refers to the layer of tissue where the implant pocket is created. Subglandular placement puts the implant behind the breast tissue and in front of the pectoral muscle, often resulting in a simpler procedure and quicker recovery. The alternative is submuscular placement, where the implant sits partially or entirely beneath the large pectoral muscle.
Placing the implant under the muscle provides a thicker layer of tissue coverage, which can be advantageous for thinner patients to minimize the visibility of the implant’s edges, known as rippling. A dual-plane technique, which is a hybrid approach, places the top portion of the implant under the muscle and the bottom portion under the glandular tissue. This can offer the benefits of both techniques, providing coverage while still allowing for natural lower pole fullness.
Long-Term Considerations and Safety
Chest implants are not considered lifetime devices and will likely require replacement surgery. While individual longevity varies, many implants show signs of wear or failure after 10 to 15 years. Regular follow-up with a medical professional is recommended to monitor the integrity of the implants over time.
For silicone implants, the Food and Drug Administration advises periodic imaging, such as an MRI, to screen for silent rupture, as a gel leak may not be immediately obvious. A common long-term complication is capsular contracture, which occurs when the scar tissue capsule that naturally forms around the implant tightens and hardens. This condition can lead to pain, firmness, and distortion of the breast shape, sometimes requiring surgical correction.
Another systemic concern is Breast Implant Illness (BII), which describes symptoms reported by some individuals, including fatigue, joint pain, and cognitive issues. While research is ongoing, the FDA recognizes BII as a potential complication associated with both saline and silicone implants. A rare but serious complication is Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), a type of immune system cancer that forms in the fluid or scar tissue capsule surrounding the implant. Current data suggest BIA-ALCL is primarily linked to implants with a textured surface, with the risk being virtually zero for smooth-shelled implants.