Breast Implants

Breast Implant Surface: Smooth or Textured

Smooth Breast Implants

Smooth breast implants have a smooth outer shell. Smooth breast implants are only available in round shape 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. Also, the weight of the implant may stretch the pocket reducing the fullness to the upper part of the breast.

Textured Breast Implants

Textured breast implants are more firm than smooth breast implants and have a different, 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 "tear drop" shaped implants, 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 also the tissue around the implants can pull on the breast implant and cause rippling and wrinkling.

Smooth Breast Implants Vs Textured Breast Implants

There is an unresolved ongoing debate over smooth vs textured breast implants. Both have their own advantages and disadvantages and the debate is left up to the patient's personal preference and the surgeon's ability to perform either.

Breast Implants Shapes and Sizes

Breast Implant Shape: Round or Shaped

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 alternative, 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.

Anatomical designs are primarily used for reconstruction purposes. Anatomical breast implants avail a more natural looking breast, which look oval in shape. From a side-view, these appear to have more volume at the bottom and less at the top, like natural breasts. Because there is a concern that the anatomical breast may rotate, flip or turn in the breast pocket; they come with a textured surface, which allows tissue adherence and helps to keep breast implant in place and from rotating.

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

Breast Implant Profile: How Far Does The Implant Protrude?

Remember to discuss all types, sizes and designs with your surgeon for the best outcome. The protrusion of the implant should appear somewhat natural for the most appealing and desired look. These factors depend on the original anatomy of each patient (height, weight, frame, figure, shape and breast tissue). If breast implants are placed in the body properly, there should be minimum recovery time or discomfort after surgery. The intention is for the patient to feel better about her appearance after the surgery, which requires a realistic approach to having breast implant surgery in the first place.

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: Saline Breast Implants or Silicone Breast Implants

Silicon Gel Breast Implants

Silicone gel implants have been on the market since 1962. Initially, these breast implants were silicone shells filled with a silicone gel and the leading manufacturer was Dow Corning. In 1995, Dow Corning halted production and filed for bankruptcy after 19,000 lawsuits filed by women who proclaimed to have a range of medical difficulties caused by the silicone gel. This caused The Food and Drug Administration to become involved. Today, the FDA has approved both leading manufacturers of silicone gel breast implants, Mentor Corporation and Allergan imposing some restrictions and limitations for breast reconstruction and cosmetic breast augmentation.

Saline Breast Implants

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

Saline breast implants were introduced using new materials and a favorable technique requiring smaller incisions to insert the empty implant, and then fill with saline solution once placed in the chest cavity. The saline solution is pre-determined and pre-measured in CCs to fill the pre-selected saline implant size.

Saline breast implants are more popular and considered safer. If a saline breast implant ruptures, the body will absorb the saline and flush it out of the body via urination, eventually. In addition, should a saline breast implant rupture or break, they are easier to replace and remove than silicone gel breast implants. Saline breast implants are more likely to cause rippling and wrinkling of the skin, because the solution is not as thick.

The FDA has approved saline breast implants for unrestricted use in breast enlargement, reconstructive and enhancement surgeries.

Per the introduction of saline breast implants, they were only made available in round shapes, now there are other, more natural looking shapes. The round implant is still the most popular choice for a couple of reasons. Round implants still cost less than other shapes. In addition, breast implant rotation is not uncommon after surgery. Normal physical activity can cause the implant to rotate and with a round implant that is symmetrical, there is not visible change in the appearance of the breast and shape in comparison to other implant shapes, like the anatomical implant.

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 and visible. In such cases of rotation, minor surgery may be needed to correct it.

Due to FDA limitations on silicone breast implant procedures, your only cosmetic choice may be saline breast implants, unless your surgery is reconstructive in nature.

Silicone Breast Implants vs. Saline Breast Implants

Silicone breast implants are filled with silicon gel that 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 size and will have various options for placement. Silicone-gels consist of a silicone outer shell and are pre-filled with a silicone gel rather than saline. Silicone-gels may look and feel more like natural tissue.

Saline breast implants are filled with saltwater-like, saline solution, similar to the fluid that makes up a majority of the human body, creating a firmer feel. Saline breast implants have a flexible volume, which is thinner in substance, and can be adjusted by the surgeon. Surgeons create a smaller incision size with various options for incision placement. Saline breast implants consist of a silicone shell, filled with saline during surgery. Saline-filled have been criticized for feeling hard or unnatural, although improved surgical techniques have lessened these complaints.

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 and size and where the surgical incisions will be made for implant placement. The "incision decision" is ultimately that of the person undergoing the surgery. The biggest concern is scarring, for most women. There are various benefits and drawbacks to each of the four incision options, which should be discussed in detail with your surgeon. Incision preference will also correlate to the type of breast implant that you desire, as some incisions do not allow for the use of certain breast implants.

The experience and level of skill can determine the location of breast implant incisions. Many surgeons have a technique and incision preference they are most comfortable with performing. If you do not have a strong incision preference, it may 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.

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 sugeries.

The inframammary incision is made in the fold under the breast, making the scar relatively inconspicuous after surgery. The inframammary incision allows for placement of the implants both under the muscle and the glandular tissue. If there are any postoperative complications, the surgeon will typically be able to re-use the same inframammary incision without needing to make any additional incisions.

Scarring from inframammary incisions are less conspicuous than the scar from nipple incision. A major benefit of the inframammary option is that women of child-bearing ages experience less difficulty breastfeeding after breast augmentation. The inframammary incision bypasses the milk ducts, posing less risk of damage to those areas. This surgical option also does not require the protective sleeve when placing the breast implants.

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.

The scar from a periareolar incision is virtually invisible, as it blends well with the natural pigment and change in skin color, which is why women choose this procedure. In addition to being the most easily concealed incision, the periareolar option has several other benefits: The periareolar incision allows the surgeon to place implants under the muscle or under the glandular tissue, as with inframammary incisions (under the breast). Surgeons who are familiar with the performing breast implant surgery like periareolar incisions, because this procedure gives a surgeon the greatest degree of precision due to the close proximity of the incision to the treatment site. If postoperative complications should occur after the initial breast augmentation surgery, an additional incision will not typically be required. The surgeon can enter through the original incision, eliminating the risk of added scarring from corrective surgery. During breast augmentation surgery, the implant is rolled up into a protective sleeve before being inserted through the passage into the breast implant pocket. The protective sleeve prevents the implant from coming into contact with bacteria that could later cause a local infection. The sleeve is removed after the implant is correctly placed.

The risks associated with the periareolar incision: There is a higher degree of difficulty breastfeeding after surgery for women who have children after implant surgery. Also there is a higher probability for loss of sensation in the nipple area due to the periareolar incisions and scarring.

Transaxillary Incision (transax or armpit incision)

The transaxillary incision is another popular surgical option that can be used during breast augmentation. 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.

This procedure can be performed with or without an endoscope, which is a small surgical camera used to guide the breast implants into the most ideal location in the breast area. During the breast enhancement procedure, the doctor will make the transaxillary incision and create a channel from the armpit to the breast area to place the implant. Make sure your surgeon is familiar and comfortable with the transaxillary incision procedure. There is a greater is the risk with proper breast implant placement with this procedure, particularly if the surgeon is less experienced and because the surgeon is working further away from the actual surgical destination, leaving more possibility for error. When a surgeon is well-trained and experienced with the transaxillary technique, the risk of error in implant placement is very low. In addition, if there are postoperative complications that require a subsequent surgery, it is generally not possible to reuse the same transaxillary incision. During a corrective surgery, the surgeon will typically have to use the periareolar or inframammary technique, adding another scar from breast augmentation. Some studies have also shown that the transaxillary technique can cause a loss of nipple sensation after surgery. Transaxillary incisions are still a very popular choice among women.

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

The transumbilical breast augmentation technique, also known as the TUBA method, is a less common incision option during this type of cosmetic surgery. During the transumbilical technique the surgeon will make an incision in the patient's belly button or navel in order to insert the breast implants and create a path to place the implants in the ideal area behind the breast tissue.

The transumbilical incision leaves no trace or scars in the breast area and all other scars are hidden within the belly button area. This is may seem like a more extreme surgical option, the transumbilical technique is actually the least invasive of all breast augmentation incisions. Recovery time is also not as great with the transumbilical technique as some other methods, although the pain from the breast implant placement is the same after surgery.

The transumbilical procedure requires inflatable breast implants, since it is not possible to have a pre-filled implant guided through such a small incision into the breast area. During the transumbilical technique, the surgeon makes an incision in the belly button area and then creates a "V" shaped passage from the incision to each breast. In very rare cases, this can actually leave "V" shaped tracks on the patient's stomach area, however this is an uncommon complication of the transumbilical technique. After the passage has made from the transumbilical incision to each breast, the surgeon will use a small surgical camera called an endoscope to guide the implants into their pocket. Once the implant is in place, a small tube will be guided in to fill the breast implant to its predetermined volume. Lastly, the transumbilical incision will be closed.

The same incision cannot be used If there is a complication with the results and additional surgery is required. In the case of corrective surgery, the surgeon will have to make a periareolar or inframammary incision. The transumbilical technique also has the greatest risk of error because the incision is so far from the actual breast implant destination.

The periareolar and the inframammary techniques are the most popular ones, the first one being made around the nipple and the second one made within the natural fold of the breast. The transaxillary incision is made in the armpit area. The least common incision preference is the transumbilical incision, where incisions in the bellybutton are used to place the breast implants.