Summary: Whether you’re trying to decide if breast augmentation is right for you or already window shopping for new dresses to fit your new soon-to-be figure, it’s worth noting that there are a number of different options at your disposal. While your primary consideration may be between silicone or saline implants, there are also procedural considerations to be made that can have a big impact on the results of your augmentation. To help you make this decision, five of the top implant options are reviewed here.
Saline implants are the FDA required implant choice for patients under 22 years of age. They have been around for decades and can produce excellent results. Benefits of saline implants include that the surgeon fills them up during surgery so subtle asymmetries can be addressed and adjustments for the “look” you want can be made. In addition, saline implants don’t require MRI exams to determine if they are intact since deflations are easy to diagnose clinically without fancy studies.
In my practice, 95% of patients over 22 choose silicone gel because they want the most natural “feel” and 5% choose saline just because they feel “safer” with them. The biggest downside to saline implants is the ability to feel or even see wrinkles and ripples especially along the lower outer portion of the implant especially in thin patients or those with minimal breast tissue.
2. Silicone Gel
Silicone gel implants have evolved significantly since 1991 when the old leaky ones were removed from the market. Modern gels are made of materials that are cohesive to minimize the risks of leakage. They feel softer and more natural than saline and come in a wide range of profile styles to create the many different “looks” that are desired by patients.
Shaped implants are a great option in post-mastectomy breast reconstruction but are of limited use in breast augmentation. Women who want a fuller upper pole generally need some form of higher profile round implant and those who desire a more natural look actually have been shown to be better served by lower profile rounds than shaped implants.
All shaped implants require a textured surface to hopefully prevent rotation and asymmetry but this doesn’t always work and sometimes they “stick” in the wrong position requiring more revision surgery than when rounds are used. If you’re having trouble seeing the difference between round and shaped silicone implants, remember that rounds can look just as natural as any shaped implant if they are in the moderate to moderate plus profile styles.
4. Implant Placement & Incision Choice
Major clinical studies have demonstrated that the best incision for implant placement is in the inframammary crease as this approach is associated with the lowest risk of hard scar (capsular contracture) forming around the implant which can ruin a result and require revision surgery. The highest risk of CC is in the armpit and the next highest is through the areola as both of these incisions appear to expose the implants to bacteria which is thought to promote scar formation. The implant placement under the pec muscle is also better because it allows for better mammography, is associated with lower rates of capsular contracture, helps the implants stay up higher in a better location over the long term, and they feel more natural because they are covered by more healthy tissue.
5. Choosing Your Surgeon
Please be sure that your surgeon is Board Certified in Plastic Surgery (not “Cosmetic Surgery” as this is not recognized by the American Board of Medical Specialties). He/she should be a specialist in breast augmentation surgery doing well over 100 augmentations each year to have maximal experience with all different kinds of starting points. They should operate in an Accredited and Licensed surgery center and anesthesia doctors provide the safest anesthesia.
The doctor should closely listen to your desires and will help you to mutually select the optimal implant for you based on your unique body, its measurements, and the “look” you are trying to achieve. Finally, the rate of revision surgery should be close to zero to give you the best chance of needing only one operation. Price should be factored in after all of the above issues have been evaluated.