The ABCs of Saline and Silicone Gel Breast Implants
Here are 5 basic questons to answer before you choose an implant:
- What fill?
- What size?
- What shape?
- What surface?
- What Profile / Projection?
1. Breast Implant Fill – Saline or Silicone?
Women today have options in breast implant fill. The first implants were filled with silicone gel. As breast implants evolved, saline (salt water) became an accepted alternative fill to silicone. Silicone can look and feel more like a real breast. Whether filled with silicone or salt water, the shell of both types is made of a firmer, silicone elastomer.
In 1992, FDA Commissioner David Kessler decided that the safety of silicone breast implants had not been established. The FDA then removed silicone breast implants from the market. Since 1992, silicone gel-filled implants have been available only to breast reconstruction patients and patients undergoing breast revision surgery. In order to receive silicone implants, women must be enrolled in clinical trials.
The current ban on silicone implants may soon be lifted.
2. Breast Implant Size – What is right for you?
How big your breasts going to be after surgery depend on primarily two size issues:
1) How big are you now?
2) What size implant will you choose? Your doctor will discuss other non-size factors.
Methods of choosing implant size.
Don’t choose your own cc volume. Most patients may not understand all of the variables (ribcage size, chest shape, existing breast volume) that will dictate what a given implant size will do for them. Your plastic surgeon has years of training and experience to rely helping you decide on the right size implant and fill. Choose the right Breast Implant from among the manufacturer’s specifications, with your Surgeon to create a fit and size that is custom to your body type.
3. Breast Implant Shape – Round or Anatomical / Teardrop
Now that you have the right size picked out, do you want round or anatomical (also known as shaped or “tear drop”) breast implants? Anatomical implants are meant to mimic the slope of a natural breast. However, a round implant when not lying down, takes on basically the same shape.
What’s natural looking? Round implants, placed under the muscle may have a more natural appearance than shaped/contour implants which can appear somewhat elongated in appearance in some women. Shaped implants tend to remain stationary, so they stay in the same place. When a woman lies down, round implants on the other hand, settle back evenly, like normal breasts. When a woman stands up, the saline goes to the bottom of the implants because of gravity, and the implants assume a natural teardrop shape anyway.
These are all terms used to describe an implant that is manufactured to be pre-shaped. Unlike a round implant, a “shaped” implant by design has a top and a bottom (it is tear drop shaped). These have a textured surface to avoid the implant flipping, leaving the implant upside down and misshapen in appearance. (This can be corrected but it is not a usual occurrence.) Unlike round implants, a teardrop implant will maintain the same shape lying down, which can appear unnatural in some women.
4. Breast Implant Surface -Textured Surface or Smooth Surface.
You’ve picked out a round or anatomical implant. You can choose a smooth surface breast implant or a textured surface breast implant.
Why do some implants have textured surfaces? All types of solutions have been attempted for decades to prevent scar tissue from becoming unacceptably hard around the breast implant. The body causes scar tissue to form around any foreign object in the body. The formation of scar tissue is known as capsular contracture when it becomes painful or unacceptably firm. Textured surface implants are an attempt to solve this problem. By adding a textured surface, manufacturers hope to prevent scar tissue fibers from lying down uniformly.
According to a number of studies, a textured surface is not likely to reduce the risk of capsular contracture but other studies do find a reduction in contracture. Ask your doctor what his or her experience has been and what is best for you. Unfortunately, the same characteristics of a textured surface that may cause the scar tissue to form erratically around the textured implant. This may cause the implant to appear rippled in appearance. Furthermore, textured implants often have thicker shells and may be firmer in appearance and palpability.
Smooth Surface Implants.
Most breast implants have a smooth surface. Since there is little consensus on whether textured implants will actually reduce the rate of contracture significantly enough to warrant other potential disadvantages discussed above, many doctors prefer to use smooth, round implants. Most often, implants are placed under the muscle in order to potentially reduce the incidence of capsular contracture.
5. Breast Implant Profile – Low, Moderate, High, or Moderate Plus.
Until recently, most patients never discussed profile with their plastic surgeons. If you chose a certain size implant, you would receive a determined amount of forward projection from that size implant. Now, you can choose an implant size and, if you like, have that size implant stick out more, or less than the base diameter would usually dictate. This works well for certain body types. Note the different heights below. For a woman with a very narrow frame, a moderate or low profile implant might result in a desired size, but may be too wide and carry the implant too far to the cleavage and underarm. By using a high profile implant, this patient can get the larger implant he/she desires. By the same token, a wide framed patient may find that in order to adequately cover the natural diameter of their breast size, the desired implant would have far too much projection. A low or moderate profile might work better. Your plastic surgeon can help you choose.
Low Profile Implants.
These breast implants have less projection per measurement of base diameter than a moderate profile breast implant.
Moderate(Medium) Profile Implants.
This breast implant profile is the “normal” profile.
High Profile Implants.
These breast implants have more projection per measurement of base diameter than a moderate profile breast implant. An added benefit of the high profile is that in order to create the profile, the side wall of the implant has more height, which may reduce visible rippling.
Moderate Plus Profile.
Both saline and silicone also includes this profile that is between moderate and high profile(limited).