26 Sep Breast Implants

Among the most exciting changes in plastic surgery have been the development and widespread use of different types of implants used in breast augmentation. These additions have helped plastic surgeons achieve excellent cosmetic results in nearly all patients. Today, there are more implant choices available than ever and so more to talk about with your plastic surgeon!

A recent survey of plastic surgeons in the US and in Europe has revealed that saline, or salt water filled breast implants are the implant most commonly used in the United States and in Europe, silicone gel breast implants are more commonly used for cosmetic breast surgery. The commonest shape of implant used both in the US and Europe is the round implant by an overwhelming majority and few surgeons still use breast shaped, or “anatomical” implants. Anatomical implants were more frequently used in the past as they were thought to provide a better shape for patients but over time, these implants have been associated with more complications than the simple round breast implant. Anatomical breast implants had also been textured on their surface to keep them in proper position and this textured surface has been implicate in the very rare BIAL, or breast implant associated lymphoma. To date, there has never been a case of BIAL associated with a smooth surfaced breast implant.

Breast Implant Shapes

Along the way in the development of different shapes of breast implants, manufacturers have varied the width and projection of implants to solve issues some patients have in terms of the width of their chest. The ideal shaped breasts create a space in the center of the chest where the breasts come together near the midline. They don’t need to touch but there should be some relation to each other. The ideal breast shape also includes fullness on the side where the breast comes to fall at the edge of the chest but no further. Additionally, the ideal breast shape includes fullness of the upper portion of the breast because this is the part of the breast that is exposed. Breasts should also have good projection, where the breasts stick out from the chest. Both projection and fullness of the upper pole create a sense of youth and vitality.

For round shaped implants, manufacturers have varied the width and the projection of the implants. For example, there are wider implants with less projection and on the other end of the spectrum, narrower implants with more projection. Some patients with wider chests can have a better and more natural breast shape with a wider breast implant that has less projection. And some patients with a narrower chest night also have a better shape with a narrower breast implant that has more projection.

Most patients are best served with an implant that’s in the middle of these extremes. These are round shaped implants with good projection that also have enough width so that the extend towards the middle and the sides of the chest. That way patients have the best of both worlds.

It’s What’s Inside

Implants are constructed as a shell of solid silicone rubber on the outside and the shell is filled with either saline (salt water) or silicone gel. The shell is similar, in concept to a balloon in terms of its flexibility but the shell is very strong and can withstand very high pressures and not deflate. But it is what is inside that can affect how the implant feels and appears. In patients with smaller breasts that have less tissue covering the implant, there is a higher chance to be able to feel the implant or to feel or see waves. This is termed “rippling” and is more common with saline filled breast implants. Silicone gel filled implants have a lower chance for this rippling effect.

Recent Developments

The basic silicone gel breast implant that is still in use today was one of the first implants to be placed on the market 65 years ago. There are three breast implant manufacturers that produce FDA approved gel implants in the US today. They use different names for their products but the implants are basically the same product. The last two years have seen the release of silicone gel breast implants that have a denser gel fill and each company also has their own names for these more dense gel products. The manufacturers state that these thicker gel filled implants have more fullness in the upper part of the breast and that there is a lower chance for rippling than with the basic gel fill. Both of these claims still await independent scientific proof.

The choice of implants is best discussed thoroughly with a plastic surgeon that can listen to a patient’s needs, both in terms of shape and size and is open to discuss the pluses and minuses of each type of implant.