The decision to having a breast augmentation performed is accompanied by many decisions. One of these is to decide on which type of implant to have inserted into your breasts: Silicone or Saline. Another is what size and which shape should be inserted: high profile, moderate profile, or low profile. The question of whether to insert the implant under or above the muscle has been discussed in another blog article.
The decision to the type of implant you should have is really a personal one and should be based on the knowledge of how the implant will affect you. What are the types and shapes of implants? Will it be in your budget? Will it cause rippling? Will it cause capsule contraction? Will it rupture easily? Will it leave you with a small or large scar? These are questions we want to discuss in this article.
What are the types of implants?
There are two basic types of implants. Silicone implants include regular silicone implants and silicone gel implants, also called gummy implants or gummies. Many people still believe that silicone implants will cause problems to their bodies such as autoimmune diseases. Studies have proven that even the older implants didn’t cause them, nor do any of the newer implants.
Most surgeons prefer the gummies because they are made of a cohesive gel, have a more natural feel once in the breasts, have a more rounder look to the breasts, and are preferred by most women. The older silicone implants are not used anymore due to prior fears and problems. In addition, they “leaked” silicone into the surrounding tissues, which caused many of the problems associated with the old silicone implants.
The gel inside gummies doesn’t leak. You can actually cut the implant in two and the gel will not leak out. However, if the implant ruptured slightly while inside the breasts, this rupture may not be noticeable to you. If it ruptures significantly, you would know.
The other type of implant is the saline implant. These are inserted into the breasts through smaller incisions (3 cm with saline vs 5 cm with silicone) because they are inflated when inside the breasts. Silicone gel implants come already filled with silicone gel and thus need larger incisions.
Saline implants are basically a bag of water and usually don’t have the natural feel as silicone implants. In addition, when they rupture, it is very noticeable. Although the saline leaking out causes no harm, it results in the appearance of a flat breast that is very noticeable.
What are the Different shapes of the implants?
Implants come either round or in a teardrop form, and they come with various heights, called profiles. The rounder implants and higher profile implants are preferred by most patients, for a more beautiful breast is a rounder breast.
Teardrop implants are said to give the breasts more upper breast fullness. However, if you have adequate tissue in the upper part of your chest, this is not really significant for most patients. Teardrop implants are mostly used for reconstructive surgeries, such as after mastectomy for breast cancer. However, some surgeons prefer them.
A major problem with the teardrop implants is that they may twist around and give the breast an abnormal shape. Thus, the dissection must be extremely accurate in order for the implant to lie precisely in a vertical fashion. While healing, they must stay in that precise position too, so they are not used as much for regular breast augmentation. In addition, teardrop forms are more expensive than round implants.
Round implants come in different heights or projections. This is also called the profile of the implant, i.e. the profile as viewed from the side. High profile has more projection forward (height) while moderate to low profile implants have lower heights. However, with lower height you also get wider widths, so you can’t have very large implants placed if you go with the lower profiles.
Most women prefer more projection of their breasts versus wider breasts. If too wide, the implants tend to project out to their chest sides too much. Thus, when they walk or run, their upper arms tend to hit the implants hanging over the sides of the chest, which is very uncomfortable and undesirable for most women.
Silicone or saline implants can be inserted in anyone 22 years old or older. Thus, if you are 18 to 21 years old, you can only have saline implants. If that’s the case, you have a choice of waiting until you are 22 years old, or you can get saline implants now, and then change them later when you’re older if you desire.
What size is best for me?
Size of the breasts is totally a personal choice. We always let the patient choose what size of implant she desires to give her the look she wants. We have a lot of implant “sizers” that she can try-on and then choose the one that she prefers.
Choosing a size can be a challenge for some women. They may bring photos of other women who had implants placed and they like the look of their augmentation that was done. The problem with these is that you don’t know how much breast tissue the woman had prior to the implant: a lot or a little? In addition, you don’t know how tall the woman is. A tall woman needs a larger implant and a shorter woman a smaller implant to balance her body properly.
Bottom-line it’s better for the patient to try-on some different sizes and look at herself in a mirror with a T-shirt on. Like picking the right size of a dress, she can pick the size that she prefers. Then, we place the implants of her choosing. Patients are more satisfied with this method rather than the physician just choosing the size that he/she thinks is best.
Will it be in your budget?
Saline implants are less expensive than silicone implants. However, because they are hopefully a once in a lifetime investment, most women prefer to get the best implant, which is the silicone implant. Teardrop implants are much more expensive than the round implants.
In addition, if you want very large breasts, you can get them special ordered and these are very expensive. Normally implants go to a maximum volume of 800 cc. Any more than this would require a special order.
Other considerations are in what facility you will have the implants placed, and anesthesia. Some surgeons only use hospitals to do their surgeries, which could tack on extra fees. In addition, the type of anesthesia used can also tack on extra expenses.
At our office, we do the procedure in our accredited Surgi-center, so costs are less for the facility. In addition, we have three types of anesthetics: tumescent (or local) allowing you to be awake during the procedure, twilight with tumescent, or general with tumescent. The price increases the more anesthesia you need, as do potential complications from the anesthesia. However, some women don’t want to feel or know anything while doing the surgery, so the latter may be better for them, although more expensive.
Will the implant cause rippling?
Rippling is a potential problem for all implants, especially in women who are very thin and don’t have good fat coverage of the implants. A rippled appearance of the implants occurs primarily when the woman leans forward and she sees scalloped lines along the sides of the implants, mostly on the sides but they can be seen on the inner areas in some women.
Saline implants cause more rippling than silicone because they are just a bag of water and have no form or substance to them internally. Silicone implants have much less chance of rippling because they are a gel and have substance within the implants that keeps the breast fuller and thus with less noticeable rippling.
This problem of rippling is a major decision point for most women as to whether they want saline versus silicone. When rippling is demonstrated to them by using five fingers pressed into the sides of the breasts, they usually say, “I don’t want that”, and decide on silicone implants as their preference.
Will it cause capsule contraction?
Capsule contraction can occur with either implant. Initially it was thought that saline implants cause less contractions, but now it is becoming more apparent that silicone may cause less contraction than saline. The jury is still out.
When implants are placed, your body produces a membrane around the implant, called a capsule. This membrane must maintain its softness to give the breasts a softer natural feel. We recommend that patients do massages to their breasts and also take certain meds and supplements to help keep them soft. If the membrane becomes inflamed for whatever reason, the inflammation can lead to scar tissue formation within the membrane.
If excess scar tissue develops in the membrane, the tissue becomes very hard when you feel it. In addition, the scar can contract bringing the rest of the tissue with it, resulting in deformities of the shape of the breasts. Most of the time, when this happens, the only ultimate solution to correcting this is to do surgery to remove the capsule and replace the implants.
Will it rupture easily?
Neither silicone or saline implants ruptures easily normally. A significant amount of pressure is needed in order to rupture the implants. For instance, a severe auto accident with the seat belt severely compressing the implant rapidly can cause rupture. A very forceful compression of the breasts, such as when a mammogram is performed, can occasionally cause a rupture.
Rarely there is a manufacture defect to the implant and the implant can rupture without any trauma. The incidence of such rupture is quoted by the manufacturer to be 1 time in 100 implants per year. In such a case, usually the manufacturer will pay a certain amount for just the implants for replacement, but not the costs of the surgeon nor the Surgi-center.
When saline implants rupture, the saline leaks out and thus the breasts are no longer full. They revert back to their former shape or even smaller, which is obvious to the woman. When silicone implants rupture, the appearance may not be noticeable since the gel stays inside, thus the shape stays the same. However, if the rupture is significant, any silicone exposed to the tissues can cause a reaction to occur within the breasts that results in inflammatory fluid to accumulate within the breasts, resulting in an enlargement of the breast with the rupture. This is called a seroma and can be very painful to the patient.
Treatment for a rupture regardless of the type of implant is surgery to remove the old implant and replacement with another. Many women take this opportunity to change the size of their implant to either a larger size, a smaller size, or different sizes due to imbalances in the size of one breast to another.
Will it leave a large scar?
Most surgeons place the scar for implant insertion near the lower fold of the breasts, called the inframammary fold (IMF). The scar for saline implants is around 3 cm, and the one for silicone is 5 cm. Silicone needs a slightly larger scar since they must be inserted prefilled, while saline implants are inserted deflated and inflated within the breasts.
The IMF scar is an ideal place to put the scar. It is usually not noticeable when standing or sitting on frontal view for it is hidden in the fold as the breasts drop. It also allows for the best dissection of the breast pocket that needs to be performed when placing the implants. There are other areas that can receive scars for implant insertion, and these are discussed in another blog article.
To choose the right implant for you requires a consideration of all these factors. We want you to be satisfied and happy about your results from your breast augmentation. Thus, we discuss all of these with you so you can make an informed consent for the choice of the implant best for you. Of course, coming in for the consultation is your next step in getting the beautiful breasts that you want.