Breast Implant Options

There are many different types of breast implants available for Arizona women considering breast augmentation. Women can choose between saline and silicone gel-filled implants. Some breast implants have smooth surfaces while others are textured. Additionally, there are different widths and projections available (low profile, moderate profile, moderate-plus profile, high profile), and some implants are round while others are shaped "anatomically." Below are answers to a few of the most common questions I hear about breast implants from Scottsdale and Phoenix breast augmentation patients.

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Should I choose saline or silicone implants?

Silicone implants have been available continuously since they were invented in the 1960's; however, their use was limited in the early 1990's due to fears that they caused autoimmune diseases. At that time, there was minimal data to prove or disprove these claims. As a result, a vast number of scientific studies were performed to answer the question: "Do silicone implants increase the risk of autoimmune diseases or breast cancer?" The answer has been a resounding NO! Silicone implants do NOT increase the risk of contracting these diseases.

Although it took the legal system and the FDA many years to catch up to science, silicone implants are now available to women having a first time breast augmentation. Interestingly, silicone implants were never completely off the US market. Across the US, including Phoenix and Scottsdale, silicone breast implants have always been available to women interested in breast augmentation if they needed an augmentation and breast lift at the same time, or if they needed breast reconstruction, or revision of a saline implant breast augmentation due to excess wrinkling of the skin or multiple deflations. You would think that if the implants were truly dangerous, nobody would have had access to them. Clearly, silicone implants do not, and never did, pose a risk of autoimmune disease or breast cancer.

The decision to use silicone or saline implants is a personal one, but the decision should be based on cost and personal preference – not due to a fear of silicone. The newest generation silicone implants are made of "cohesive silicone gel," which is not liquid silicone. Modern cohesive silicone gel implants are solid, like a soft gummy bear, and if they are cut in half the gel holds its shape and does not "go anywhere." Compared to saline implants, these cohesive silicone gel implants feel more like natural breast tissue, are less likely to produce visible rippling or wrinkling, and do not "deflate" like a saline implant if wear and tear produces a small hole in the outer covering of the implant over time.

In my opinion, cohesive silicone gel implants are a superior breast implant material. If asked by a friend or family member whether I would recommend saline or silicone, I would strongly recommend silicone for the best, most natural result. It is important to note that silicone implants, because they are a higher quality material, are more expensive than saline implants. This must be factored into the decision-making process. However, when the cost difference is worked out over the 10-15 year period the patient is likely to have their implants, the cost per year is much less than what most patients spend on coffee.

Which is better, a textured or smooth implant shell?

The outer covering of both saline and silicone breast implants is made of a silicone polymer "shell." The word "shell" can be confusing, because it is not hard like a seashell. The covering is soft and the word "shell" simply refers to the outer "bag" of the implant that holds the cohesive gel or the saline solution.

Some implants have a smooth shell, while others have a rough shell which is referred to as a "textured" shell. The advantage of a textured shell is a more predictable and stable implant position over time (because it adheres to the tissues like Velcro), as well as a theoretical decrease in the risk of capsular contracture. Capsular contracture is a condition in which the normal, paper thin scar tissue "capsule" which the body forms around a breast implant tightens, causing the implant to feel firmer than it should. Some studies have shown that having a textured implant reduces the risk of this problem.

The disadvantage of textured implants in the past was that the shell was thicker, thus making the implant edge easier to see and feel through the skin. Additionally, textured saline implants are associated with a higher deflation rate. Newer textured silicone implants have vastly improved shells which have, in my opinion, eliminated my concerns about rippling and implant palpability.

In the past, I felt that smooth implants provided the most advantages and had the fewest disadvantages. However, with recent advances in implant technology, my opinions have changed significantly (see my blog entries about my Stockholm experience). I now use textured implants on the majority of my patients for implant stability, lower risk of capsular contracture, and to eliminate the need for implant massage after surgery. I still use smooth implants on some patients (for example, when performing an implant exchange on someone with pre-existing smooth implants, or in certain cases when the shape of a particular smooth implant is advantageous for my patient).

Low, moderate, moderate-plus and high profile implants; which is right for me?

The "profile" of an implant refers to the width and projection of an implant. In other words, for a given implant volume, a wider implant will have a lower profile (it will stick out less), while a narrower implant will have a higher profile (it will stick out more). Thus, for each size of implant, there's a wider, flatter version (low profile), a narrower, more projected version (high profile), and implants in the "in-between" range (moderate and moderate-plus profiles). Different brands will have different parameters for each profile. For example, a moderate textured round silicone Sientra implant has more projection than a smooth moderate-plus silicone Mentor implant.

Implant size and profile should always be considered on an individual basis for each patient. The decision should be based on the patient's chest diameter, the width of the patient's breasts, skin elasticity, ribcage asymmetry and her goal size, among other factors. For each patient, there is a range of implants that will look natural. If too wide or too narrow an implant is used, or if too large or too small an implant is used, an unnatural result can occur.

My goal as an experienced board-certified plastic surgeon is to provide professional guidance to women considering breast augmentation. The objective is always to produce a natural and aesthetic final result, and within this range some patients prefer to remain relatively small breasted, while others prefer to be larger breasted.

In most patients with an average chest width, I find that as I get into larger size ranges, I am more inclined to use a somewhat higher profile implant while in lower sizes I use a more moderate profile implant to create a better base width diameter match. Obviously, this is adjusted for every patient to create the best final result.

Are anatomically-shaped implants better than round?

Some implants are round in shape. Others are designed to be fuller on the bottom and less full on top (a "teardrop" shape) to emulate the look of a natural breast. These are called "anatomical" implants.

I have used both types of implants. In the past, I preferred round implants as I felt they gave me a more aesthetic result. As I gained more experience with the newer anatomical shapes that came on the market in 2012 and 2013, I realized that these can be very beneficial for certain patients. If a patient requests a fuller upper breast, then a round implant will provide more of that appearance. However, if a patient wants a more gradual slope to the upper breast, or if they have extremely thin tissues which will not hide an implant well, I feel that anatomical implants can provide a significant advantage.

The concerns about anatomical implants rotating in the pocket are mostly due to surgeons that did not adhere to precise pocket dissection techniques. If the breast pocket is designed to the size of a textured anatomical implant, the risk of rotation is minimal. In a recent large study by Sientra of their anatomical implants, the rotation rate was 0%.

I always discuss the options of anatomical versus round implants with each of my patients and try to help them select the implant that will best suit their needs.

How can I be sure I will look natural after surgery?

Before I enter the operating room, I always have a plan regarding which implants will likely be selected for each patient. These are chosen using a combination of preoperative chest measurements, photos from the website selected by the patient, and the use of preoperative sizers tried in a special bra. Sometimes, patients require a different size or profile implant on each side if they have pre-existing asymmetry. The implants I think I will use are my starting point, but because I have my own operating room with a full consignment of multiple implant brands, shapes and sizes, I can choose the final implants based on what looks best during surgery.

With most breast augmentations I perform, I use implant "sizers" during surgery. These are different from the sizers I use in during the pre-operative exam. The surgical "sizers" are temporary implants that let me see exactly what the final implants will look like. My preoperative plan regarding a specific implant size and shape is usually correct. However, by using the sizers and checking my patients from multiple positions and angles, I maximize my ability to achieve the best size and symmetry possible. With anatomical implants, I do not generally use sizers as I do not want to stretch out my precise pocket dissection. These implants are pre-selected and pre-ordered. I also place anatomical implants with a Keller funnel to minimize manipulation once they are in the pockets.

Using intraoperative sizers adds a little extra operating time, and because of this, some surgeons skip this step. My feeling is that my patients will not remember if they were in the operating room for an extra few minutes, but they will be looking at the final results for the rest of their lives. I believe strongly that the extra time and effort spent to achieve the best shape and symmetry is well worth it.

Receive a cosmetic consultation, or call (602) 702-5380 to schedule a consultation with board-certified plastic surgeon Dr. Robert Cohen. He will be happy to answer any questions you may have about breast implants. Arizona patients as well as those patients coming from other states and countries trust Dr. Cohen, who offers surgery at his facility, conveniently located near Phoenix and Tempe.

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