Most implants are either behind the pectoral muscle (IMO, the best way to do 
with, along with an intra-umbilical insertion of the implant while it is deflated. 
Then filling it with saline,  once it is in place) or on top of the Pecs, under the 
original breast. The worst scenario is when the nipple has been severed and 
moved, and the full implant stuffed in there, without regard to blood flow, 
nerve connection integrity, or prevention of severing the ducts. Luckily, most 
duct separation with nipple removal, and replacement is done during 
Reductions, or when "repairing" either very asymmetrical breasts, or Tubular 
Breast. Of course, it is good to know what type of incision she received. I 
subareolar incision is more likely to cause nerve and duct problems. A "crease" 
implantation (where the implant incision is made under the breast fold) or the 
newer procedure, where the actual incision is made in the Navel, and the 
unfilled implant is pushed through the body, to the site under the breast. The 
Navel incision, although not as common (some call it the "stripper incision" 
because there is no tell tale incision in the areola or under the breast fold) is 
probably best for breastfeeding, as well as breast integrity. 

When a mother is really full with most Implants it kind of looks like two breasts, 
like a wide hill, with a smaller hill on top of it. (The smaller hill, on top, being 
her real breast.) The smaller, top "hill" contains most of the ductal tissue, and 
I always avoid using Compression ON the implant, itself. (The implant is like the 
larger, "foothill" that the smaller hill or breasts sits on.) It is kind of tricky to 
find other ducts, as in near the clavicle, or under the arm, without disrupting 
the implant, but it can be done. In most cases, the implant feels very different 
from the real breast and breast tissue. Breast tissue feels like....Tissue. The 
ducts are palpable, the breast softens during Ejection, ect. The Implant often 
feels hard, and not Compressible. Many women have scar tissue from the 
implants, and some have implants which have burst. Sometimes, with old 
implants you not only see two "breasts" on each side, but a little lump of stray 
Silicone, in odd places, with the older Implants. With the newer Saline 
Implants, any rupture of the Implant filling is Saline and is usually absorbed, so 
you won't feel it. Although the woman may still have scar tissue and 
Encapsulation, which makes the implant area VERY hard, and difficult to move. 

I have seen less breast enhancement in recent years, I am not sure why. I 
used to see many more than I do today. 

I always avoid  heavy Compression of the Implant, if possible. Finding actual 
breast tissue isn't all that difficult, if you visualize what is going on in her 
body. A good, real breast, on TOP of the implant, often with some tissue near 
the clavicle and under the arm, too. Compressing the breast, to help with flow, 
shouldn't be a problem, unless the woman complains of severe pain. Sometimes 
encapsulated implants rupture, and although this is not a huge problem 
(doctors often rupture the encapsulations in their offices, when seeing lots of 
scar tissue, using much more force than you would with normal Compression.) 
do be careful. With many woman, Compression can cause some normal 
discomfort, followed by relief. This isn't rupture, and is to be expected. 

The Implant itself often FEELS "engorged" but, if the actual breast tissue is 
soft and pliable, it is just what happens when foreign bodies are placed into a 
human being, and not indicative of actual "engorgement." As many Implants 
develop scar tissue, the implant site may often feel engorged, when, in 
actuality, the breast itself is fine. Feel the breast, to see what is going on. 
You may not be able to go on skin tautness, as many Implant recipients have 
nearly constant tight skin on the breast. Palpate the actual breast to 
determine if engorgement is occurring or not. Even in cases of Encapsulation, 
the nipple should not pull into the breast, if this is happening, there may be 
engorgement, which may necessitate GENTLE pumping for a few minutes to 
soften the breast. In many cases of Implant problems, the pump may actually 
be a gentler tool than the hand at expression, but every woman is different. 


Mary Jozwiak IBCLC, RLC, LLLL
Private Practice 

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