Which implants are FDA approved?
There are three manufactures of breast implants that have FDA approval in the United States: Allergan, Mentor, and Sientra. Although there are other brands of breast implants in other countries, the United States has the largest and strictest regulatory process for FDA approval, and only these three companies can legally sell breast implants in the United States. The largest breast implant available in the US is 800 cc.
Silicone or Saline?
Saline implants are FDA approved for anyone over the age of 18. They have a silicone shell and are filled with salt-water. If they accidentally rupture, your body will easily resorb this fluid and the implant will deflate, giving you a “flat tire”.
The advantages of saline implants are that they can be placed through slightly smaller incisions, they can be used in younger women, and they contain salt-water that your body can resorb. In the event of a deflation, you will know within a day that the implant has ruptured.
The disadvantages of saline implants are that they look and feel slightly less natural than silicone implants. Particularly in thin women, saline implants can sometimes be associated with visible or palpable rippling.
Silicone implants are FDA approved in women over the age of 22. The newest generation of implants is filled with form-stable silicone, sometimes referred to as a “gummy bear” implant. It has a feel similar to a very fresh gummy bear or gumdrop, and could actually be “sliced” without leaking.
The advantages of silicone implants are that they look and feel extremely natural, even in thin women, particularly when they are placed below the pectoralis major muscle. They move more like regular breasts compared to saline implants.
The disadvantages of silicone implants are that they require slightly larger incisions for placement, as compared to saline implants. It is also harder to detect implant rupture because the silicone is not absorbed like the saline. The FDA has advised that women with silicone implants undergo MRI surveillance of their implants 3 years the original surgery, and then every 2 years to monitor the integrity of the implants.
If silicone, what kind?
If you opt to have silicone implants, there are a few further choices you must make. Do you want round implants or "tear-drop" (anatomic) implants? And do you want low, medium, or high profile implants? And what about gummy bear implants?
Round or Tear-Drop?
The most common choice of breast implants are round. The main advantage of round implants is that they have no particular radial orientation, so even if they shift or rotate over time, the result will not be noticeable. Round implants are semi-spherical in shape, which is regarded either as an advantage or a disadvantage, depending on the desired look, as they tend to create more fullness on the upper part of the breasts.
The alternative to round implants is anatomic-shaped, or "tear-drop" shaped, implants. The advantage of tear-drop breast implants is that they resemble the actual physiologic shape of a real human breast, with a gently downsloping upper pole and a fuller lower pole (in other words, like the shape of a tear drop). Women who want a very subtle, natural look are sometimes drawn toward this type of implant. The main disadvantage here is that in situations where rotation of the implant occurs over time, a second surgery may be required to correct the implant position.
High or low profile?
Breast implants come in low-profile, regular-profile, or high-profile types. Profile refers to how high the implant sits above your body, with low-profile implants staying the closest, and high-profile implants sticking out the most. Those who want more prominent cleavage or a fuller look should opt for higher profile implants, while those who prefer a more subtle look should opt for lower profile implants.
Regular silicone or gummy bear breast implants?
Although "gummy bear" or highly cohesive breast implants have received a lot of attention-- some of which undoubtedly comes from their catchy nickname-- standard silicone implants remain more popular overall and in my practice.
Gummy bear implants are made with a highly cohesive form of silicone that is form-stable, meaning that even if the implant ruptures, it will not spill or leak. Women with gummy bear implants report that they feel slightly firmer.
Textured or smooth?
There is no universal opinion among plastic surgeons regarding whether textured or smooth implants are superior. There is some data to suggest that the rate of capsular contracture is lower with textured implants.
The size of the breast implants you choose is one of the decisions that women think about the most.
Before committing to a particular size, discuss your ideal look with your surgeon, "try on" a variety of implants inside your bra, and listen to your surgeon's advice about what size implants your body will safely accommodate. Many patients bring in photos of breasts that they like, but it is not possible to make one woman’s breasts look like another’s!
It is important to remember that not every breast can accommodate every implant. The best size range for your individual anatomy depends on the base width of your breast, your skin pinch thickness at the top and bottom of your breast, your tissue elasticity, and other factors that may be unique to you.
When considering breast augmentation, I advise all women to see a board-certified plastic surgeon with verifiable credentials. Ask questions, read about the procedure in advance, have realistic expectations, and choose long-term quality over seductive advertising or cheap prices.
Dr. Bash doesn’t post before and after photos of her patients on the internet. This is for patient privacy, safety, and just makes good sense. Do you really want your photos out there “forever”?