If you’re considering breast augmentation, or if you need breast reconstruction after mastectomy, you may be wondering what type of breast implant is right for you. When you see a board-certified plastic surgeon for your initial consultation, they will assess your breast anatomy and discuss your aesthetic goals so they can make a recommendation for the type of implant and the augmentation techniques they will use during the procedure.
Breast implants vary by surface, shape and content. The surface can be textured or smooth. The form can be round or anatomical (also called “teardrop”). Content can be silicone or saline. There are pros and cons to each type, all of which should be discussed between you and your plastic surgeon.
SHAPE: ROUND VS ANATOMICAL (TEARDROP)
Implants can be round or anatomical in shape. Anatomical implants look like a teardrop, and were developed to mimic the natural look of the breast with a sloping top and a fuller bottom. Anatomical breast implants require the textured shell because movement would cause it to not look right aesthetically.
SURFACE: TEXTURED VS SMOOTH
All implants have an outer shell that is typically made of silicone. The shell can be smooth or textured. Years ago, textured implants became popular because early forms had a polyurethane covering with a spongy texture that was shown to significantly decrease the incidence of capsules, one of the most common breast implant issues. Later studies conducted on polyurethane connected the substance with liver cancer in rats, leading to the development of the textured silicone shell that is commonly used today.
Textured implants allow breast tissue to attach to the implant, reducing its likelihood of movement and migration. While their use is shown to reduce capsule incidence, it unfortunately increases the incidence of infection and malposition. Bacteria from infection anywhere in the body can seed into the tissue around the implant. If the implant shifts, it will be stuck wherever the tissue grows into it.
CONTENT: SALINE VS SILICONE
All breast implants are filled with a substance, either silicone or saline, in order to mimic a real breast. Silicone implants are usually pre-filled before insertion, while saline implants are inserted empty and then filled to the desired size. Silicone implants tend to feel more natural than saline, and don’t show rippling as much because it is a thicker substance.
Saline implants have higher instance of deflation and leakage than silicone, both from rupture and from the valve. However, if a leak occurs saline is safely eliminated from your body through urination, while silicone can migrate to other parts of your body (typically the lymph nodes in the armpit) and can make you sick in large amounts. Silicone that has leaked must be surgically removed, and because it usually forms small, hardened beads, it is difficult and time-consuming to remove it completely. One of the more recent silicone implants, commonly known as the “gummy bear” breast implant, have a more cohesive filling that holds its shape better when ruptured and doesn’t leak. These implants tend to feel firmer than others and are less malleable, requiring a larger incision.
For patients with asymmetrical breasts or who have undergone mastectomy of one breast, saline is sometimes a better option. When an individual’s breasts require different fill volumes, symmetry is achieved more easily when it can be adjusted and filled to the necessary amount during surgery.
BASE WIDTH, PROJECTION, PROFILE AND FILL VOLUME
The size of the widest part of the implant (the base width) is determined by the footprint of your natural breast/chest anatomy. The width should not exceed that of your natural breast otherwise it will look anatomically incorrect, bulging at the edges in a phenomenon commonly referred to as “double bubble.”
Breast implants can vary in projection and profile as well. Projection is how far forward it projects from the chest wall and is measured in centimeters or inches. Profile is determined collectively by the base width, projection and fill volume. Profile is categorized as low, moderate, high and extra high (with variations in manufacturer labeling). Generally, lower profile implants look more natural, while higher profile implants look fuller and rounder.
Fill volume is how much fill material the implant contains, and is measured in cubic centimeters (CCs). Although a cup size cannot be guaranteed due to the variation in bra manufacturer sizing, typically 150-200 ccs is equivalent to one cup size depending on all of your measurements.
A NOTE ABOUT BREAST IMPLANT ILLNESS
Years of research and peer-reviewed studies have shown that breast augmentation is a predominantly safe and effective procedure. However, recently textured implants have come under fire for their connection to Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), a type of cancer that develops in the tissue surrounding the implants. In fact, Allergan, a well-known pharmaceutical company manufacturing breast implants and other products used in the cosmetic surgery industry, just announced an FDA-requested recall of their textured implants and breast tissue expanders that have been connected to some of the cases.
Ongoing research is being conducted to determine what factors contribute to the development of breast implant illness. According to the American Society for Aesthetic Plastic Surgery, it is rare, highly-treatable, and has high cure rates. The American Society for Plastic Surgeons also notes that the industry’s current assessment of the 457 cases of BIA-ALCL shows that “to date, no purely smooth-implant case of BIA-ALCL has ever been reported in any series, registry, or case report with a detailed history.”
At Fuentes Cosmetic Surgery, we have recommended only smooth implants for a number of years and will continue to do so in light of the latest findings. For more information about breast augmentation surgery, visit our breast augmentation service page. Contact us here or call (631) 385-9377 to schedule a complimentary consultation.