Breast augmentation is
one most commonly performed cosmetic surgical procedure in America. If you or
someone you know is thinking about breast augmentation, it is essential to
answer several questions about which type of breast implants are right for you.
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.
What size?
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.
Lastly
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”?