Types of Breast Implants?

Breast implant choices typically boil down to smooth or textured, shaped or round, saline or silicone. Our goal is to have a natural appearance and decrease the need for a second operation as much as possible. If you are the type of person that likes to read the end of the book first, for most patients in my practice (95%) the current answer is “round-smooth-silicone gel” But let’s look in more detail:

Smooth vs textured:

There was a silicone implant available in the 80’s called the “MEME” implant that was covered with polyurethane. This had a fuzzy outer surface and had a very low incidence of capsular contracture. But it was eventually taken off the market because the polyurethane was felt to be able to break down into a chemical that could potentially increase the risk of developing breast cancer. So implant companies with breast implants approved for use in the United States (Allergan , Mentor,and now Sientra) have offered silicone implants of both saline and silicone gel fill with a texture on the outer surface. This can be useful and necessary in a shaped implant (more about these in a minute) to help prevent turning or flipping of the implant. But it increases palpable and visible rippling and wrinkling when the tissues adhere to the implant. It has not been definitely shown to decrease capsular contracture (link to decreasing capsular contracture page). And there have been instances of late (after several years) bleeding around the implant when it is thought to have torn loose from the adherent tissues. So something else that might cause a problem without a strong benefit- for most patients then the vote is for smooth.

Shaped vs round

Shaped implants can mimic the natural shape of a woman’s breast and in some cases appear more natural. But these cases are typically either breast cancer reconstruction when no natural breast mound is present, or the rare breast augmentation patient who has little or no existing breast tissue and a “tight” skin envelope. I am excited to finally have available on the market the Allergan Natrelle Syle 410 breast implant, which has been just released by the FDA. I had the opportunity recently of being the first surgeon to use these implants at Winchester hospital. I used this in a breast cancer reconstruction patient whose shaped saline implant had deflated suddenly. The early results appear excellent. But it has to fit the pocket precisely, typically needs drains for 6-8 days and is more “finicky” to use. In the typical breast augmentation patient who has even a little breast tissue, we can obtain a nice and natural appearing result with a properly sized round implant. And if the round implant turns or flips it is still round. If a shaped implant turns or flips it usually means another operation. So for the typical breast augmentation patient a shaped implant is another factor that can potentially increase the risk of another operation. – for most breast augmentation patients then the vote is for

Shaped implants can mimic the natural shape of a woman’s breast and in some cases appear more natural. But these cases are typically either breast cancer reconstruction when no natural breast mound is present, or the rare breast augmentation patient who has little or no existing breast tissue and a “tight” skin envelope. I am excited to finally have available on the market the Allergan Natrelle Syle 410 breast implant, which has been just released by the FDA. I had the opportunity recently of being the first surgeon to use these implants at Winchester hospital. I used this in a breast cancer reconstruction patient whose shaped saline implant had deflated suddenly. The early results appear excellent. But it has to fit the pocket precisely, typically needs drains for 6-8 days and is more “finicky” to use. In the typical breast augmentation patient who has even a little breast tissue, we can obtain a nice and natural appearing result with a properly sized round implant. And if the round implant turns or flips it is still round. If a shaped implant turns or flips it usually means another operation. So for the typical breast augmentation patient a shaped implant is another factor that can potentially increase the risk of another operation. – for most breast augmentation patients then the vote is for round.

Silicone or Saline Breast Implants?

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Silicone Gel Implants

I have had the benefit of having been in practice before silicone gel implants were removed from the market, and was part of the national adjunct study on silicone breast implants as part of the research before they were released again in 2009 for general use in breast augmentation patients over the age of 21. Silicone has the advantage of feeling more natural, having less potential ripples and wrinkles, and being slightly lighter in weight and slightly under-filled and therefore more natural in appearance when compared to a same volume saline implant. It is harder to detect a rupture however. The FDA has recommended an MRI be obtained 3 years after surgery and every 2 years after, but an MRI has a 10% false negative rate- it tells us that there is a leak in 10 out of 100 women who do not have a leak and therefore could lead to unnecessary surgery. So most patients are not doing this. I was present when our national plastic surgery society (The American Society of Plastic Surgeons) met with a representative of the FDA in Denver in October of 2011 and the representative noted that this wasn’t a great test to recommend, but they did not have a good alternative. A plastic surgeon in our society has presented at our past three meetings with the use of high definition ultrasound, like the technique that is used to look at babies in the mother’s womb, and he feels that he is able to detect when a rupture has occurred in a silicone implant. So I think that this might be the direction that we are moving in. Then the question is “if the implants leak, is the silicone dangerous”. We didn’t have the answer in the past. But now we have more than 48 major studies combining millions of women with breast implants and we can state that there is no medical condition that happens more often in women with silicone gel implants. There are a few twists in the studies- a study in Canada found that women with silicone gel implants had a lower risk of breast cancer. But no one believes that placing an implant will decrease the risk of breast cancer. And a small study in Sweden seemed to show an increased risk of a rare type of brain tumor in women with silicone gel implants, but a single patient can affect the numbers and this was not reproduced in any of the many other studies. There have been some rare case reports of Anaplastic Large Cell Lymphoma (ALCL) in women with mainly texturized breast implants developing in the scar capsule next to the implant. But half of the women resolved with no further treatment simply by removing the implant, and the 28 reported cases are a small number of the millions and millions of women ( worldwide estimate is 5-10 million women who have had breast implants )who have had breast implants for reconstruction and for augmentation, so the FDA does not feel that this is a cause for alarm.

And the silicone gel implants have been cohesive since 2006- more like Jello than a fluid (see attached photos) Although even the cohesive and highly cohesive can leak, the silicone is typically contained within the scar tissue capsule that surrounds the implant.

Saline implants

Easier to tell if they have leaked. “Dr Hall I woke up this morning and my right breast is flat” But they tend to feel like a baggy filled with water. Patients who have had silicone changed to saline, often want to change back to silicone. People that have thinner tissues are more likely to see the ripples and wrinkles of the saline implant than those of a silicone implant. So for patients that have a high likelihood of needing needle breast biopsies, or who want the certainty of knowing if it has leaked, Saline implants are a choice. I have found that currently 95% of my breast augmentation patients are choosing silicone. The numbers around the world are similar. – so most patients vote for silicone.

Learn more about choosing your ideal breast implant size with Dr. Hall’s video blog, The Thoughtful Patient’s Guide!