There are over 1000 different implants available to patients for breast augmentation. These implants are available from Allergan, Mentor, Sientra and Ideal Implant. Most of the implants we use in our practice are the Natrelle implants made by Allergan. We have used thousands of these implants over the last 10 years for our cosmetic and reconstructive patients. The brand of implant used is more determined by surgeon preference than anything. There is no one implant that is better than the others. Patients will sometimes express that they would prefer a specific brand because a friend or family member has them and we are always happy to accommodate.
Implant Size: Silicone implants range from 100-800cc’s, and saline implants range from 100-960cc’s. For our cosmetic patients the implants we use most commonly are between 350-500cc’s. Many of our patients come in looking to go from an A to a C, or a B to a “full C” or “small D,” and with this range of implants we usually see patients change by about 2 cup sizes Our patients having breast reconstruction usually require larger implants to meet their goals. This is because their entire breast volume is determined by their implant size, whereas the cup size in our cosmetic patients is a combination of breast tissue and the implant.
Silicone Vs Saline: Most of the implants placed around the world each year are silicone. In our practice, about 95% of patients choose to have their augmentation with silicone implants. The main pros and cons are listed below.
Silicone Pros: In general, most patients who have had both implants say that their silicone implants gave a more natural look and feel.
Silicone Cons: These implants are typically more expensive than saline devices.
Saline Pros: Again, they are less expensive than silicone implants. The other benefit is that if they leak it is easy to tell since the entire breast will deflate (sometimes in as little as one day). With silicone implants the only way to know if there is a leak is with breast imaging (mammogram, ultrasound or MRI) or surgery.
Saline Cons: Patients often tell us that they can see or feel the “bag” through their skin. Although this can happen with silicone, we see it more commonly with silicone. Patients also frequently report that their breasts feel firmer with saline and that they can feel the saline slosh around when they move.
Implant Profile: Profile refers to how much an implant sticks up off the chest. Generally speaking, implants are available in low, low plus, moderate, moderate plus, high, and extra high profile. For our patients having their first breast surgery we most commonly use moderate profile implants to achieve the “natural” look that so many of our patients want. For patients having a second surgery, and for patients looking for a more dramatic look, we will often use high profile implants. We commonly use high and extra high-profile implants for our breast reconstruction patients. This is because they don’t have breast tissue on top of their implants so they usually require a more projecting implant to get the result they want.
Round vs shaped implants: Round implants are the most commonly used devices in the United States. In our practice, about 95% of all the implants we place are round. Shaped implants became popular years ago as a means to help provide a more natural look. However, we find that by choosing the right size and profile, we can achieve a natural look for most patients.
Smooth vs Textured: Most of the implants we use are smooth devices. The main reason to use a textured implant is when patients prefer a shaped device. In these cases, the texture is needed so that the shaped device doesn’t rotate and result in a distorted breast shape. Textured implants are being used much less frequently now because of the association between texturing and BIA-ALCL. This rare form of lymphoma occurs within the scar tissue surrounding textured devices. Although the risk is very small, we prefer to use only smooth devices to eliminate the possibility of it occurring.
How do we help patients select the right implants? During our consultations we start by finding out what the patient’s goals are. We will review photos and get a sense for what their preferences are. We then take measurements to find out what range of implants will fit. Using that information, we can then use our Vectra 3D imaging system to show patients what they would look like with a range of implant sizes and profiles. This really helps our patients feel confident that they will get the look they are going for. Based on all of this information, we select 3-4 implants to have available for the day of surgery. During the case, we will create pockets for the implants and then use “sizers” to see how each of these implants fits. We then choose the implant that actually gives the patient the look we talked about during their consult. By going through these steps, we ensure that patients end up with the size and look they were going for.