Choosing the Right Implant Type for You

How do you choose the right breast implant for your breast augmentation procedure? Well, first off, there are two basic types of implants to choose from: saline filled implants and cohesive silicone gel implants. Both implants have a solid silicone shell. There are also implants that are round in shape and those that are tear drop shaped. And, to confuse your decision process even more, there are shells that are smooth and those that are textured.

The original breast implant was invented and implanted in 1963. Silicone implants came to the market at that time followed by saline implants in 1968. Both have a long safety track record. The silicone implants used up until 1992 were filled with silicone oil. They were taken off the market because of concerns that the device could lead to connective tissue diseases. These fears were proven to be invalid, however, the devices did have issues with the silicone oil oozing out and spreading into tissues. In 2006, a highly cross-linked, non-oozing silicone gel implant was approved by the FDA. It is called the cohesive gel implant. It was studied for 14 years before receiving approval and is now the most popular breast implant in many parts of the country.

In our practice, we use primarily, round implants. I have found that in most patients the implants turn and rotate. With a round implant, the turning implant always assumes the proper shape. When the patient is upright, there is more implant volume on the bottom and less on the top. When the patient is lying down, the implant takes on a rounder shape. This dynamic shape change mimics what the real breast does. I have had the opportunity of removing shaped or tear dropped implants in patients and have found that because the implants rotate, the most projecting portion is sometimes along the wrong axis. This can produce an odd shape to the breast.

I also prefer smooth implants for the vast majority of our patients. There are some studies that indicate that textured implants may be beneficial in patients suffering from capsule contracture or abnormal hardening of the scar tissue around the implant. However, in my opinion, the textured shell feels thicker and less natural. As we have a very low capsule contracture rate, we think that the smoother shell implant gives an improved feel to the breast.

As we primarily use smooth walled round implants, the next question is which is better, saline or silicone? In my opinion both work well and it really comes down to evaluating the pros and cons of both and making a personal choice.

So lets compare the two. There are several issues to consider. First there is cost. Saline implants are less expensive than silicone implants by about $1200 per pair. Second, each implant has a warrantee provided by the manufacturer. This means that they will provide your surgeon with a new implant for you if it ever ruptures, at no cost. This does not mean that they will pay for your replacement surgery. They also provide the patient with a financial stipend if the implant breaks within the first 10 years. For saline implants, the manufacturer we use (Allergan) will pay the patient $1200 for saline implants ($2400 if the patient pays Allergan for their gold policy), or $3500 for silicone implants.

Third, as saline implants are put in deflated and then inflated once they are in the pocket, they require a smaller incision. I do not think this is a decisive issue as we prefer to completely hide the incision in the armpit for both saline and silicone implants. Thus the incision is hidden, it is not on the breast, and in most patients the scar virtually disappears.

The next two issues both come down to the same factor: how much breast tissue and body fat does the patient have? For the implant to look smooth and feel as breast like as possible, the surgeon would ideally like as much tissue covering the implant as possible. Both the saline and silicone implants have visible and sometimes palpable ripples along their edges. Silicone implants tend to have less rippling than saline. So in patients with very little breast tissue or very little body fat, the silicone implant tends to feel more natural and have less rippling. Finally, there is the feel of the implant. If the patient has a fair amount of tissue covering the implant, it will feel more breast like. However, in my opinion, I prefer the more natural feel that a silicone implant can provide.

Choosing what implant to go with for your breast augmentation is a personal choice. Being informed will help you be satisfied with what you and your surgeon decide upon.

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