Breast Implants

There are many considerations regarding breast implant shapes, sizes and types. Here is a quick review of the breast implant choices you have for your breast augmentation surgery.

Breast Implant Surface: Smooth or Textured

Smooth Breast Implants

Smooth breast implants have a smooth outer shell, are available only in round shapes and they have a thinner shell. Smooth breast implants are projected to last longer than their textured counterpart. Smooth breast implants have less rippling and provide a natural cleavage and wholesome look. The implant moves comfortably within the breast pocket created by the surgeon.

The two disadvantages of smooth breast implants include a higher incidence of capsular contracture, and the weight of the implant can stretch the pocket, which reduces the fullness to the upper part of the breast.

Textured Breast Implants

Textured breast implants are firmer than smooth breast implants and have a textured feel. Textured implants are designed to avoid capsular contracture. The textured breast implant hinders tissue from growing around and on the implant. Textured breast implants are found in both round and "teardrop" shapes, allowing the surgeon and client to choose a desired shape for the breasts.

Disadvantages to textured breast implants include discomfort to the surrounding tissue, and the tissue around the implants can pull on the breast implant and cause rippling and wrinkling.

Breast Implants Shapes and Sizes

Round

Round implants remain constant in their shape as long as they are not ruptured. They do not change shape and are made to appear smooth and textured. Round breast implants are less expensive than the anatomical design and can look less realistic than anatomical designs. The choice and results depend on the anatomy of the patient, the amount of tissue to work with, the plastic surgeon's experience and the placement.

The round implant is still the most popular choice for a couple of reasons. Round implants cost less than other shapes. Normal physical activity can cause the implant to rotate and with a round symmetrical implant, no change is visible in the appearance and shape of the breast.

Breast Implants: round breast implant (left) and contoured breast implant (right)

Shaped (anatomical)

The second most popular breast implant shape is the anatomical breast implant, which is more commonly called the "teardrop." Teardrop implants look more natural because they have more fullness at the bottom and less at the top of the breast area. They are intended to replicate the natural shape of real breasts. However, if the anatomical "teardrop" shaped implant rotates, it will be physically apparent. In cases of rotation, minor surgery might be needed to correct it.

Anatomical designs are primarily used for reconstruction purposes. Anatomical breast implants avail a more natural-looking breast, which is oval in shape. From a side view, they have more volume at the bottom and less at the top, like natural breasts. They come with a textured surface, which allows tissue adherence and helps to keep breast implant in place and from rotating.

Breast Implant Profile: How Far Does The Implant Protrude?

Remember to discuss all types, sizes and designs with your surgeon. The protrusion of the implant should appear somewhat natural for the most appealing and desired look, and will depend on the natural anatomy of each patient-height, weight, frame, figure, shape and breast tissue.

Breast Implant Size or Volume

Breast implant size typically ranges from 120 CCs (B-cup size) to 850 CCs (upward of DD-cup size).

Breast Implant Filler: Silicone Breast Implants or Saline Breast Implants

Silicone Gel Breast Implants

Silicone breast implants are filled with silicon gel, which is a thicker substance, therefore, it holds together more uniformly, while retaining the natural shape consistent with breast tissue. Silicone breast implants have a set volume, so they require larger incisions. When inserting, the doctor will make a large incision and will have various options for placement. Silicone gels consist of a silicone outer shell and are pre-filled with a silicone gel. Silicone-gels look and feel more like natural tissue. Read more about silicone breast implants, here.

Saline Breast Implants

The most common type of breast implant uses saline. Introduced by a French manufacturer in 1964, the saline breast implant has a silicone shell, but it is not filled with silicon gel; it is filled with a sterile saline, which is a saltwater mixture-much like the fluids already found in the human body.

Because of FDA limitations on silicone breast implant procedures, your only cosmetic choice might be saline breast implants, unless your surgery is reconstructive in nature.

Read more about saline breast implants on this directory.

Breast Implant Incisions

When considering a breast augmentation procedure, there are many decisions to be made in advance of the surgery including: breast implant filler, size and where the surgical incisions will be made. The "incision decision" is ultimately yours. For most women, scarring is a big concern. There are various benefits and drawbacks to each of the four incision options. To learn more about this visit our "techniques" section, which should be discussed in detail with your surgeon. Incision preference correlates to the type of breast implant you desire, as some incisions do not allow for the use of certain breast implants.

Many surgeons have a technique and incision preference they are most comfortable with performing. If you do not have a strong incision preference, it might be in your best interest to select the surgeon's preferred technique. Conversely, if you do have a strong incision preference, find a qualified surgeon who is comfortable and experienced performing the procedure you desire.

The four most common incisions for breast augmentation surgery are:

1. Inframammary Incision (crease or fold incision under breast)

The inframammary incision is a very popular surgical option for breast implant surgery and breast augmentation, particularly with silicone breast implants and certain reconstructive surgeries. This incision allows for placement of implants under muscles and glandular tissue, and women of childbearing age experience less difficulty breastfeeding after this type of incision.

2. Periareolar Incision (nipple incision)

Periareolar incisions are growing in popularity as one of the most common incision procedures used by surgeons to insert breast implants during breast augmentation. The periareolar incision is made around the edge of the nipple where it meets the surrounding breast tissue. There is a higher degree of difficulty breastfeeding after periareolar incision, and there is a higher probability for loss of sensation in the nipple area because of periareolar incisions and scarring.

3. Transaxillary Incision (transax or armpit incision)

The transaxillary incision is made under the arm in the armpit area, so that there are no scars in the breast area. It is possible to see the transaxillary scar when the arms are lifted, but the incisions are placed as inconspicuously as possible to limit the visibility of the breast implant scar.

4. TUBA Incision (belly button, navel, or transumbilical incision)

The transumbilical breast augmentation technique, also known as the TUBA method, is a less common option. The surgeon makes an incision in the patient's belly button or navel and creates a path to place the implants in the ideal area behind the breast tissue.

Breast Implants and the FDA

Saline breast implants are most the common used implants in the United States. The first saline breast implants were approved by the FDA in 2000.

Silicone gel implants have been on the market since 1962. Initially, they were silicone shells filled with a silicon gel, and the leading manufacturer was Dow Corning. In 1995, Dow Corning halted production and filed for bankruptcy after women filed 19,000 proclaiming to have a range of medical difficulties caused by the silicone gel.

These claims led to an FDA-imposed ban on the sale of silicone breast implants in 1992, which made it more difficult for women to get silicone breast augmentations. During this period, the FDA allowed women who met certain criteria to get silicone breast implants as a part of ongoing research on the safety of silicone implants.

In 2005, the FDA began to change its position, as a result of the research and study that had gone on in the intervening years. The FDA sent out letters to two silicone implant manufacturers, Mentor and Inamed (now Allergan), indicating that their silicone breast implants could be approved for use if the companies met certain conditions.

In 2006, after another year and a half of negotiation, the FDA reversed its previous decision and approved certain types of silicone gel breast implants. These breast implants were approved for use in breast augmentation surgeries in women who were at least 22 years old.

Today, the FDA has approved both leading manufacturers of silicone gel breast implants, Mentor Corporation and Allergan, imposing restrictions and limitations for breast reconstruction and cosmetic breast augmentation. It continues to monitor these breast implants to ensure they are safe in the long run.

Currently, there are types of saline and silicone breast implants that have received FDA approval. However, not every breast implant on the market is FDA-approved. If you have questions about which implants are approved, ask your breast augmentation surgeon.