Starting your aesthetic journey is a learning process that requires a lot of research. Not only do you need to narrow down your provider options, but you also have to think about what type of procedure will provide the outcome you desire. Take, for instance, augmentation mammaplasty (a.k.a. breast augmentation). Generally speaking, there are three types of breast augmentation: breast implants, fat transfer, and a combination of the two.
If you are interested in breast implants or hybrid breast augmentation (which combines implants with fat transfer), part of your consultation and pre-op process will involve deciding on what type of implant is best for you. It’s not just about size — you and your plastic surgeon will also discuss material, shape, and texture.
The vocabulary can be confusing, but you don’t need a medical degree to sort it all out. To break down the terminology and what should factor into your decision-making process, we tapped the man who quite literally wrote the book on implants, Gregory Buford, MD, a Colorado-based board certified plastic and reconstructive surgeon and author of The Boob Job Bible: Your Ultimate Guide To Breast Surgery. Read on for a masterclass on breast implants.
Types of Breast Implants
Once you’ve established that you are a candidate for breast implants, the next step is choose the material from which the implant is made. “The two main types of breast implants currently available in the United States are those filled with saline and those filled with silicone gel,” Dr. Buford notes. Here’s how they differ:
Silicone Gel Breast Implants
- What: A silicone outer shell that is filled with silicone gel.
- Pros: Used in both primary and secondary (read: revision) breast augmentation and reconstructive surgeries, Dr. Buford says silicone breast implants are the most popular in the U.S. “They not only look and feel more natural, but they also move more naturally, giving a far more optimal appearance,” he explains. At his practice, he specifically uses Allergan’s Natrelle INSPIRA™ implants because he likes the “individual styles, sizes, and gel structure that Allergan has.”
- Cons: Dr. Buford notes that saline implants are not approved by the U.S. Food and Drug Administration (FDA) for people under the age of 22, and they can be more expensive. In the event of a rupture, the danger of silicone implants is that they do not reabsorb into the body. The so-called ‘silent rupture’ requires an MRI scan to diagnose. Additionally, inserting this type of implant requires a larger incision, which may factor into the decision-making process for some.
Saline Breast Implants
- What: A silicone outer shell that is filled with saline (i.e. saltwater).
- Pros: Unlike silicone gel implants, saline-filled implants are FDA-approved for patients 18 and older. Another advantage? “They can be preferentially filled with a range of fluid (saltwater), which allows better customization of size,” Dr. Buford adds. Because they aren’t pre-filled, a smaller incision is needed. “This allows them to be rolled (like a cigar) into a much smaller profile and inserted through a much smaller incision,” he notes. If saline implants rupture, the saltwater is harmless and reabsorbed by the body.
- Cons: Rupturing is a big concern for many breast implant patients, and, if a saline implant ruptures, Dr. Buford says it will leave you “with what we lovingly refer to as the ‘flat tire’ look.” The breast will have a visible deflated appearance that requires surgery to correct. Additionally, saline implants can have a wrinkled or rippled appearance under thinner skin.
Breast Implant Shape
Now that you know the difference between silicone- and saline-filled implants, it’s time to talk about shape. “There are really only two different shapes of implants: round and anatomic (a.k.a. teardrop),” Dr. Buford says. This impacts the profile of the breast once the implant is inserted.
Round Breast Implants
- What: Round implants are circular and have a uniform circumference.
- Pros: In the event of a rotation, the round shape does not appear to have moved the same way a teardrop might. Round implants can be filled with silicone or saline and housed in a textured or smooth casing.
- Cons: There are few notable cons to round-shaped breast implants. Depending on their aesthetic goals, some patients may express dissatisfaction based on individual preference.
Teardrop Breast Implants
- What: Anatomic or teardrop breast implants have more volume at the bottom.
- Pros: Because teardrop breast implants are tapered, they theoretically better mimic the shape of a natural breast. To minimize the risk of rotation and asymmetry, they have a textured exterior (more on that below).
- Cons: “The early buzz of anatomic implants was that they would give a more natural result,” Dr. Buford recalls. The theory, however, did not bear out. “When blinded observers compared results, this was not the case,” he says. Instead, “the big disadvantage of the teardrop-shaped implants is their ability to rotate,” Dr. Buford notes. In order to maintain the shape, teardrop implants can only be saline-filled.
Breast Implant Texture
As we started to discuss above, the texture of the implant also matters. Implant texture refers to how the outer shell feels (think: smooth or textured). There are pros and cons to both:
Smooth Breast Implants
- What: The exterior of the implant has no texture.
- Pros: Without any texture to the shell, the implant may have a softer look. Without the texture to lock it in, smooth implants can move around more freely, which allows it to feel more natural.
- Cons: This style can be more prone to inflammation around the implant and may not be the right fit depending on your medical history. Additionally, there is more of a chance of rotation, though it’s not usually very noticeable in round-shaped implants.
Textured Breast Implants
- What: The shell has a rough exterior that is comparable to sandpaper.
- Pros: “Texturing is thought to potentially reduce the risk for capsular contracture, but it is also used when the implant is shaped — instead of round — to avoid rotation,” Dr. Buford explains.
- Cons: For the implant to have a textured exterior, it requires a thicker shell that may lead to a less natural-looking appearance. Additionally, you may remember the recall involving textured implants from a couple years ago. “These implants have been tied to the risk for a very rare cancer called anaplastic large cell lymphoma (ALCL) — a form of Non-Hodgkin's Lymphoma,” Dr. Buford notes. For these reasons, he prefers smooth implants.
So, you’ve got a good sense of breast implant filling, shape, and texture. Here are the remaining factors for you to think about:
Cubic centimeters (a.k.a. CC) is the sizing system for implant volume. Implants usually begin at 100 CC and can go up to 800 CC, depending on the manufacturer. To help you visualize this, it is estimated that 150 CC to 200 CC equals a full cup size — though it is important to remember that the way an implant looks ultimately depends on the patient’s measurements. This is why surgeons tend to focus less on specific sizes and more on look and feel. Because no two breasts are the same (think of them as sisters, not twins), implant sizes can be mixed and matched to create a more symmetrical appearance.
Not to be confused with size, the profile or dimension of the implant will dictate the protrusion of the breast. “Given the same amount of volume, we have implants that are wider and flatter and we have implants that are narrower and more projectes,” Dr. Buford explains. “[This allows] for even further customization of a specific look for your patients.” A lower profile implant, for example, will only protrude a little, whereas the high profile option will appear fuller. While that’s the general rule, the exact outcome depends on the individual's anatomy — meaning the size and shape of the chest wall and breast envelope.
“Most plastic surgeons these days are placing implants through either a periareolar or an inframammary approach incision,” Dr. Buford explains. The former involves incisions around the areola, while the latter goes through the base of the breast. The size and nature of the incisions will depend on the type of implant used. Silicone gel implants tend to require larger incisions than their saline counterparts because they are pre-filled. Regardless, good scar care should minimize the appearance of postoperative marks.
4. Shelf Life
What does Dr. Buford believe is the biggest misconception about breast implants for patients and providers alike? “That you need to change out all breast implants every 10 years,” he says. While observing the implants for possible rupture is part of long-term post-op maintenance, implant replacement does not happen on one set timeline. “At 10 years, there is an increased risk for complications associated with implants,” he admits. “But, if it ain't broke, don't fix it.”
All plastic surgery is personal, and breast augmentation with implants is no exception. As Dr. Buford explains, your ‘after’ will be more impacted by your ‘before’ than by the implant itself. “Your tissue quality, degree of symmetry (or lack thereof), and the overall appearance of your breasts are far more important than the specific style of implant used,” he shares. Consider that all the more reason to ensure you find a plastic surgeon who understands your aesthetic goals.
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