How to Choose Breast Implants

Breast Augmentation

With the plethora of options available to patients regarding breast implants, it is not surprising there is much confusion regarding how to choose a breast implant for an augmentation or augmentation mastopexy. Below are some rules of thumb to help patients better navigate this decision.

1.Textured no more

Textured shaped implant used to be all the rage but now we are living in a smooth round world. Texturing has fallen from favor when an association with an extremely rare soft tissue lymphoma, called Breast Implant Associated Anaplastic Large Cell Lymphoma (Bi-ALCL) was found. These implants may still be available outside the country so it is imperative for patients seeking care abroad, to ensure they select a smooth round implant for their surgeries.

2. Highly Cohesive Gel

Nowadays, most implants are made with a highly cohesive silicone gel inside the elastomer silicone shell. This cohesiveness means the gel will not leak out of the implant if the shell ruptures. It also means the implants are “form-stable” and will retain their shape once inside the body. In early versions of implants, the gel was not as cohesive, and ruptured implants could leak silicone, resulting in silicone granulomas in the axilla and soft tissues adjacent to the implant. The drawback of a more cohesive silicone gel is a stiffer implant, but this formulation keeps getting tweaked with newer generations of implants to obtain the best combination of cohesiveness and feel.

An early generation non-cohesive silicone gel implant on the left side vs a highly cohesive form stable implant on the right

3. Saline Implants have a Role

Saline implants may not be as sought after as their silicone counterparts, but they still are a good alternative in the right patient. For patients that are younger with plenty of breast tissue to cover the implant when placed in a dual plane, this is an excellent option. Benefits of the saline implant is the lack of surveillance needed for ruptures. Silicone implant augmented patients are recommended to undergo MRI evaluation of the implants every 3-5 years to ensure the implants are intact. The saline implants will simply deflate, with the saline being absorbed in the body. They are also useful in patients with slight asymmetries as the fill volume can be tailored differently for each side. They are also more cost effective. They may be slightly more palpable on the lateral pole of the breast with the feel of a water balloon so plenty of overlying breast tissue is a must for a good augmentation result.

Saline Breast Implant with visible fill valve

4. Choosing a Profile

Implants come in different profiles or projections with wider and less projecting implants called moderate profile devices and narrower and more projecting implants termed high profile devices. In general, patients desiring a modest increase in size are better served with moderate profile devices in the 200-275 cc range. For patients interested in more voluptuous augmentations, higher profile devices are recommended in the 300+ cc range.

5. Avoid a Capsule

All breast implants form a capsule around them once they are implanted. This is a thin layer of tissue that surrounds the implant. As long as the capsule remains thin, the implants will be remain soft. However, in a few cases, the capsule become thick and hard, resulting in a hard implant feel. This is called capsular contracture. In addition, this hard capsule may cause the implant to migrate from its initial position. In severe capsules, the breasts may also become painful.

Several different causes of capsular contracture have been hypothesized, including: contamination of the implant when placed in the body, postoperative bleeding, and over vs under the pectoralis muscle placement. For this reason, multiple techniques have been developed to limit this complication. Among these are: funnels to place the implants through small incisions without touching the implant itself, antibiotic irrigation of the implant and cavity, systemic antibiotics, and meticulous hemostatic techniques, and meshes to cover the implant and affect capsular formation. With the right combination of techniques, this complication can be averted.

Armed with this information, patients can make better decisions regarding their breast implants. Please visit us at Thomassen Plastic Surgery to help you make the right decision for you.

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