Dr. Patti Flint

Breast Implant Conundrums: How do you know which implant is right for you?

Breast augmentation was originally performed in the 1960’s. Last year over 300,000 women in the US opted to undergo the procedure. Much has changed about this operation since its development over half a century ago, not the least of which are the implants themselves. If you are considering breast augmentation and are confused about implant options, this article will provide some useful information.

In broad strokes, there are two major types of implants on the market. Saline and silicone. Both have been around since implants were first made. Saline implants have a silicone outer shell, and salt water is placed on the inside at the time of insertion to fill them. They can be filled past their recommended volume, but should not be under-filled which leads to wrinkling and early failure. Silicone implants have gone through many generations. Currently, all silicone implants on the market have cohesive gel inside, which means that if the outer silicone shell breaks, the very thick silicone gel inside is much less likely to ooze out into surrounding tissue.

Much has been made in the press about the “gummy bear” implant. These implants are filled with highly cohesive gel. To my hand, they feel quite firm. Evidently many women that choose them feel that way also. In a study that included over 2000 patients that had these implants, when asked about the softness of their breasts, 86% checked the box that said their breasts felt much firmer than a natural breast. For me, that is not a plus. Many gummy bear implants are shaped, also called tear drop or anatomic. This design feature was supposed to improve breast shape, however when 1500 board certified plastic surgeons voted electronically from the audience at a conference while being shown pre and post-operative photographs of patients with round or shaped implants, 52% of the time, the majority of surgeons were wrong when selecting whether or not the patient had shaped implants. Evidently, the shaped implants did not result in an obvious shape benefit.

All shaped implants are textured, meaning rough on their surface. There are different processes for adding texture, but one of the goals of texturing is to decrease the incidence of scar tissue (capsular contracture) that can develop around an implant. The second goal is to prevent movement because if your shaped implant turns sideways in the pocket, that is about the only time you can tell it is shaped…and not in a good way. Unfortunately, in spite of texturing, some shaped implants do rotate, necessitating a return to the operating room to upright them. Some do develop capsular contracture which can be painful and require additional surgery. Textured implants are also associated with a very rare lymphoma called ALCL. Data is still being collected, but over 500 cases of this cancer have been reported worldwide. The incidence is felt to be between 1 in 2000 to 1 in 5000 women with implants. As of yet, no case has ever been reported in a woman that had only had smooth implants.

As you can probably tell, I prefer smooth, round, cohesive gel (not highly cohesive) breast implants. To summarize why, the textured, shaped, highly cohesive implants were supposed to decrease capsular contracture and provide shape benefits. However, current data shows neither happened. Also, they feel firmer, they are more expensive, and now they are associated with a rare form of cancer. I am not sure why they remain popular. I do believe that in breast reconstruction following breast cancer treatment they offer advantages in the aesthetic results, but this does not carry through for cosmetic patients.

Ask your board certified plastic surgeon which breast implant is right for you and why they feel that way. Selecting the appropriate breast implant at the first surgery can help ensure you enjoy your results for a very long time.

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