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reduced significantly but it is still a bit under 10% over 10 years. Capsular contraction occurs when the body's fibrous tissue around the implant contracts. Any implant that is placed into the human body, whether it be a pacemaker, artificial hip or silicone breast implant, is walled off by a layer of fibrous tissue that the body forms around it. The body treats the implant as a foreign body and tries to wall it off. Fibrous tissue over time tends to contract and while this may have no impact on a metallic implant like an artificial hip it tends to squash and tighten around a soft implant such as a breast implant. This makes the breast implant feel hard and squeezes it into a sphere shape because that is the least surface area for implant volume. It can become painful and is the cause of most of the apparent breast implants gone wrong horror stories that show up in women's magazines. With the advent of texturing of the surface, the rate of capsular contraction has reduced from around 30% over 10 years to around 10% over 10 years. There are now also further innovations with breast implants whereby they are covered in polyurethane foam which reduces that contracture rate to probably only 1% over 10 years. An additional improvement in the use of the semi-solid filling is that the implants now have a shape and are referred to as form-stable, as compared to early first generation liquid silicone containing implants which just squash into any shape. Because they are form-stable and have shape, there are numerous different shapes available; round, anatomical, teardrop, made to suit many different patients' body habitus. Therefore the combined advantages of the above improvements, namely cohesive gel to stop leakage and give shape and surface texturing to stop contracture, implants are much safer and useable in a much wider range of patients. They are still not perfect however and there is a small incidence of contractures, rotations, ruptures, infections and other lesser known problems. No implant can be regarded as lifelong and they will always require some type of maintenance, replacement and/or revision. The combined affect of all these small problems and the limited life of the implant mean that approximately a third of patients will have revisionary surgery. In the context of breast reconstruction for breast cancer, it is for the above reasons that most Plastic and Reconstructive Surgeons would prefer a tissue reconstruction as in the long term they have less problems. There are many situations however when the patient has no other spare tissue to use and the only way to get sufficient volume for a reconstructed breast is by the use of implants. In this context, despite implant misgivings, they are relatively safe and offer the only practical solution to reconstruct the breast. For cosmetic breast enlargement there are new technologies on the horizon that may negate the need for implants. These new operations combine the use of a pre-operative vacuum pump called Brava which is worn for about three weeks prior to a fat grafting operation. The early results from these surgeries are very encouraging. Stuart McNicoll is the Senior Consultant Plastic & Reconstructive Surgeon at Tristram Clinic, Hamilton. He also works part-time at Waikato Hospital. He has been practicing for many years with a strong interest in cosmetic and reconstructive breast surgery. Photo of a Silicon Spill SILICONE? WHAT IS Silicone is a polymer of silicone dioxide meaning long chains of these molecules. When they are in short chains they form oils and when they become longer they become gels, rubbers and eventually virtually solid which we all know as the common glass in windows. The intermediate length chains of this molecule form flexible rubbery substances that we all know could be used to seal a window. Silicone oils are used as lubricants and in many cosmetics. It has long been known that silicone is very unreactive in the human body compared to most substances. It can sit there for many years with no apparent tissue reaction. A breast implant made of silicone rubber and silicone gels can therefore be likened to a modified soft form of glass.