Posted on July 10, 2019
By: Dr. Asaf Yalif
Breast augmentation is one of the most common plastic surgical procedures performed today. When our Atlanta, GA patients come in for consultation some have done a lot of research about implants and some have done none. Today’s blog will talk about the implants that are available and will help you start to figure out which may be right for you.
There are currently 3 FDA approved companies providing breast implants in the USA. The FDA also recommends that every device placed, whether silicone or saline, be exchanged after approximately 10-15 years. This means the device is not permanent! Please keep that in mind as you think about breast augmentation, as you will likely need a breast revision exchange or two during your lifetime.
Breast implants come in 2 main varieties based on what is on the inside of the implant. These are silicone and saline. In fact, there are different kinds of silicones in different kinds of silicone implants but let’s not muddy the waters yet. In general terms the outer shells of both silicone and saline implants are the same. They come in smooth and textured types.
Saline implants have been around a long time and are very safe. They are round. They are delivered sterile and filled with air. Because they come “empty” they can be placed through smaller incisions than silicone implants, which come pre-filled. Also, because we can adjust the implant volume during the operation these implants add some variability. This means that if your native breasts have a mild asymmetry we can address that with the implants being filled with different volumes. So it allows variability in the volume while we are doing the operation.
Saline implants are closed after achieving the desired volume with a small valve built into the implant. Saline implants come in several sizes (width) and projections (amount the implant pushes the breast forward).
The silicone inside the implant is a gel polymer of varying thickness. This variability in thickness is what creates the difference between the “gummy bear” implants of today, and the older implants. They come in both round and anatomic types. The more cohesive gels are more solid so they tend to be less reactive and when they do leak, they don’t tend to leak “far” like older implants, which occasionally leaked and created extensive granulomas or even leaked into the local lymph nodes. This thicker gel tends to stay put, like a gummy bear. That being said thicker gels are less soft so there is a trade-off – the more solid the implant the less soft it feels.
They come in round and shaped/anatomic types. The anatomic implants have the thicker, more cohesive gel in them so that they can maintain their shape at all times. They look and have the shape of a natural mound, with an upper slope leading to a rounder bottom. The anatomic implants are all textured, to help reduce the risk of the implant rotating inside the pocket. If you think about it it’s ok for a round implant to rotate, because it’s round! But if an anatomic/shaped implant flips upside down it could look quite asymmetric. The texturing is meant to help prevent this rotation.
Dr. Yalif uses the anatomic implants to help patients who have very little definition to their breast shape. By using a device that has a shape the breast will mold to the shape of the implant. So, not uncommonly in small-breasted women we will utilize these implants. Also we use them in breast reconstruction. Lastly we recommend these for patients wanting a “natural” shape to the breast. It does take a bit more technical skill to place the implant properly, but Dr. Yalif uses them frequently and has attended additional training in utilizing anatomic implants to make sure he is performing the most dynamic and up to date techniques.
Like saline implants, silicone implants also come in a variety of widths and projections and varying cohesivities (which is why there are so many options!).
Both saline and silicone implants come in smooth and textured types. All anatomic implants come textured. There are theoretical advantages to texturing, including less motion/rotation of the implant (ideal for the shaped/anatomic) and lower incidence of capsular contracture. These can be very useful in revision work.
We use anatomic implants and textured round implants after a thorough discussion with our patients about the risks and benefits. And often the benefits do outweigh the risks! We just want to make sure you make an informed decision before placing any device. You can read more about textured implants and other breast implant considerations in this related blog post.
There’s the rub, right! We recommend coming in for a consultation with a board-certified plastic surgeon and actually placing the different devices in your hands. Touch them, look at them, and play with them! In this way you get to evaluate the device in person and we can discuss all of the options for you based on your current breast shape and your desired breast outcome. With so many devices available it is best to lay your eyes, and your hands on some.
This is just a brief blog and there is much to discuss. We’ve including a link to a scientific article here, Aesthetic Surgery Journal, Volume 38, Issue 1, January 2018, Pages 38–48
As a triple board-certified plastic surgeon, I make sure to spend significant time with you to help you realize your goals in breast augmentation and understand your breast implant choice. With my years of experience and technical expertise, I know that I am more than capable of providing you with a result that exceeds your expectations.
Renew your look with expert, personalized treatment from Dr. Y. Begin the planning process with a one-on-one plastic surgery consultation in Alpharetta or Atlanta, Georgia. We are excited to welcome you to Y Plastic Surgery!