A Patient’s Guide To Breast Implants
Breast augmentation surgery is an option for women who desire larger breasts or hope to restore volume sometimes lost after weight loss or childbearing. There are so many breast implant options available and factors to consider so this blog aims to provide any potential patients with a full guide to breast implants.
Silicone vs Saline Breast Implants
There are two types of breast implants: silicone and saline. They both have an outer silicone shell, and they both have pros and cons. At this stage, I like silicone gel implants.
These implants come pre-filled with silicone gel, which is similar to the feel of human fat. This makes them feel more realistic. All of today’s silicone gel implants are cohesive meaning that the gel sticks to itself and spreads less if there is a leak. Women must be 22 years of age or older to get a silicone breast implant as this is the FDA minimum approved age.
As I strive to give my patients the most natural results, silicone wins hands down since they have a softer and more natural feel. The gel in the implants gravitates toward the bottom of the breast giving a more gentle transition from the chest wall. For women with little natural breast tissue to camouflage an implant, silicone is the best tool we have. Even so, silicone is not always right for each patient and is not always my first choice.
Saline implants are filled with sterile salt water. The implants are inserted empty and filled once they’re in place. If a saline implant happens to rupture, it will deflate, but your body will safely absorb the saline. Saline breast implants are available to women age 18 and older, and any age for breast reconstruction. So when might saline be a better option?
1) The asymmetric patient: Silicone gel implants cannot have their volume adjusted. In a woman with asymmetric breasts, I will sometimes use two different implants. The volume of saline implants can be adjusted in surgery, offering more flexibility in a woman with asymmetric breasts.
2) The patient is trying to avoid a lift: Saline implants, particularly high profile, have more projection and fullness in the top of the breast. While this is less natural-looking, it elevates more loose skin and can sometimes minimize or avoid the need for a breast lift.
3) The patient who likes that “implanty look”: While most of my patients want to look as natural as possible, some patients like that “implanty” look. While less natural, some consider it sexier.
4) The apprehensive patient: Despite the safety studies that have been done, some patients continue to be anxious about silicone implants. It is important to me that I educate my patients about both options, but ultimately I want my patients to have the implant they are comfortable with.
5) Cost: On average, silicone gel implants cost about $1,000 more than saline implants.
Breast Implant Size
If you are considering undergoing a breast implant procedure, one of the most important decisions you’d make involves the size of the breast implant. Choosing the right implant size is critical to ensure that the outcome is what you wished for.
When determining the right breast implant size, many women think in terms of cup sizes only. But I think of implant size in width, projection, and patient size. A D-cup bra from one manufacturer may differ from a D-cup made by others. ABC is often subjective and inaccurate. CCs, or cubic centimeters, are a measure of volume, but there can be different shaped implants with the same CCs. For example, a 200 CC implant can be wide and flat or narrow and pointy. Because of this, it is first important to pick the right shape and then consider the goal volume.
During our consultation, I will consider the following factors before recommending the right implant size for your unique goals and needs:
- Your weight, height, breast, and chest dimensions
- Your skin elasticity
- Your desired breast size
- The amount of your existing natural breast tissue
- How athletically/physically active you are, how much do you workout
Textured or Smooth Implants
Textured or rough surface implants were created to minimize the risk of Capsular Contracture. The idea is that the rough surface breaks up the scar tissue. While evidence supports this for implants placed above the pectoral muscle, submuscular placement (which I prefer) does not benefit as much from texturing. I don’t like textured implants. I think they are more noticeable under the breast and the breast does not move as naturally. They have also recently been associated as the cause of a very rare tumor “ALCL”.
Breast Implant Shape
Some implants are shaped, such as teardrop or oval. To maintain their position in the body, these implants must be textured so that they stick inside the breast pocket. Occasionally they fail to stick and will rotate into an abnormal position. I think shaped implants are a good option for breast reconstruction when trying to match another breast, but I don’t favor them for cosmetic augmentation. I prefer a smooth round implant. If a round implant rotates around in the pocket it will not affect the appearance of the breast. All currently available silicone implants have a cohesive (sticky) gel. This means that the gel is most likely to stay put in the event of an implant leak or rupture.
Breast Implant Funnel
Most patients will never know it exists, but if you’re having a silicone gel breast augmentation with me, I will be using an implant funnel.
The breast implant funnel is like a very strong version of the pastry bag that bakers use to put decorative icing on cakes. We cut the tip to the appropriate size, wet the funnel which makes it slippery inside, put the silicone gel breast implant in the funnel, put the tip of the funnel in the incision, squeeze and the breast implant is in. So far I’ve been very pleased with this new tool. It has allowed me to make smaller incisions for larger implants; it reduces the length of the surgery and results in less touching of the implant. Less touching of the implant may decrease the risk of capsular contractue, a situation in which the scar tissue around the breast becomes firm.
Breast Implant Manufacturers
There are a few manufacturers currently FDA-approved to sell breast implants in the United States. Allergan (formerly Inamed), Mentor, and Sientra all make silicone gel implants. Sientra does not make saline but Allergan and Mentor do. A newer company makes the “Ideal” implant which is saline but has structure inside it to minimize visible rippling. If you ask each company they will assure you that their product is best. In my opinion, they all make excellent products and because they are all FDA-approved they have gone through extensive testing. While I offer them all to my patients, I always recommend that the patients go with the brand their surgeon is most comfortable with. For more information on how safe various types and manufacturers of breast implants are read our Breast Implant Safety Page.
Breastfeeding with Breast Implants
Breastfeeding with breast implants – is it possible? YES. It is possible to breastfeed with implants. However, the area of incision does matter. In surgeries where there were incisions through the areola, by definition, some of the milk ducts are cut. Even so, many are left intact so breastfeeding is often possible. In situations where there is a numbness to the nipple the reflex to let milk down can be altered.font? A patient planning to breastfeed may wish to consider an inframammary (in the fold beneath the breast) incision which is below the ductal breast tissue so it may have less impact on breastfeeding. There is also newer evidence that an inframammary incision may reduce the risk of scar tissue tightening (capsular contracture) around the breast in the future.
Each patient is different, so it is always good to be comfortable with alternatives to breastfeeding. Unfortunately, the only way to know is to try, but fortunately, most women are successful.
When Should I Change my Breast Implants?
Many patients have confusion about when a breast implant exchange is necessary. Some of the confusion is because plastic surgeons have differing opinions. Here I share my thoughts.
If you have a saline implant and you are doing well, look good, and are happy, then I see no need to replace it. Basically, if it’s not broken don’t fix it. While the leakage rate of saline implants starts to climb after 10 years, I have seen patients with saline implants placed more than 20 years ago who are doing just fine. If a saline implant leaks, it is usually quite evident as the salt water in the implant is absorbed by your body. Replacing them is usually a very quick surgery with little or no downtime.
I feel differently about silicone implants. The older generation of silicone implants had a climb in the rupture rate at about 10 years as well. When a silicone implant leaks the silicone usually stays in the implant pocket, so it can be difficult on examination to know if it has ruptured. An MRI is the best way to see if the implant is leaking. If you have a silicone gel implant manufactured before the 1990s or earlier I would recommend exchanging it now. In early generation implants the first sign of a leak is often capsular contracture. It is much easier to change a silicone implant before it leaks and certainly before a capsular contracture develops.
At the moment I still discuss the possibility of a silicone gel implant exchange with my patients at about 10-12 years. Allergan recommends replacement at 10 years. The other manufacturers have yet to weigh in. I am just starting to see some rupture being picked up on MRI at about 12 years so at present I think that 10- 12 years is reasonable.
The FDA currently recommends an MRI to evaluate the integrity of silicone gel implants 5 years after the initial surgery and every 2-3 years thereafter.
Removing Breast Implants
For patients wishing to have their implants out, with no silicone rupture, it is a short procedure and can often be done under local anesthesia. Why would a patient want to remove them?
- People change- I have known some of my earliest patients for 20 years now. Their lives have changed, their goals have changed and in some cases, their weight and natural breast volume have changed. For some, a return to au naturel is appealing.
- Tired of maintenance- implants require some lifelong surveillance and maintenance. No implants- no more maintenance.
- Age- I see older patients whose health has changed and who do not want the added possibility of future surgeries. No implants- no more worries.
While most of my patients will want to take their implants with them into the world beyond, you don’t have to. It’s your body, your goals, your life and implants don’t have to be forever.
Schedule a Consultation
To learn more about breast augmentation procedures, implant types, and implant placements, contact my practice to schedule a consultation at one of my three locations, covering patients in Maryland, North Virginia and Washington DC. With years of experience, we can create your ideal breasts. Call now for a consultation: 301-656-6398.
March 15, 2022 9:42 am