There are numerous implant options available for women in San Diego who are considering breast augmentation surgery. There is a lot of information on the web which can be both confusing and misleading or even inaccurate for prospective breast augmentation patients.
From my decades experience as a plastic surgeon, I have taken away the guesswork for my patients and make my recommendations based upon science and experience.
There are two main types of breast implants – saline and silicone gel. Both types have a silicone shell; they differ only in what fills them. The only way to avoid silicone in any form is not to undergo breast augmentation using an implant.
Saline implants are slightly less expensive and allow the surgeon to adjust the final fill volume at the time of surgery. This becomes an issue when small discrepancies exist between the two breasts although breasts can never be duplicated due to multiple intrinsic although subtle differences which can be due to factors other than volume. These include chest wall abnormalities, spinal curvature, breast position and shape amongst others.
Saline implants have more rippling or “palpability” versus silicone gel implants. However, this becomes less of an issue when a patient has more breast tissue that covers an implant. Patients who are very thin and fit with little to no breast tissue are more likely to notice ripping with saline versus silicone gel implants.
Silicone gel implants are less palpable and demonstrate less rippling than saline implants. However, silicone implants may still cause rippling in especially thin patients. Palpability and rippling are generally more noticeable when either of these types of implants are placed above the muscle, just beneath the breast tissue called the subglandular or pre-pectoral position. The new silicone gel implants are not a liquid as in the older style silicone implants but are more like “gummy bears” (hence the name) which simulate normal breast tissue and maintain their shape even if a defect occurs in the shell due to a factory defect or trauma.
Breast implants have traditionally been round in shape. Implant manufacturers recently developed anatomic or tear drop shaped implants as they claimed these implants most closely resembled the breast shape. These silicone gel implants had preferentially more silicone in the lower pole or base
than the upper pole. However, it was also discovered that such implants had a higher reoperation or revision rate. This was due to the implants rotating in their pockets creating a visible and/or palpable deformity which required surgery to correct. Round implants, by contrast, are not asymmetric in shape and do not look distorted when they naturally move in their pockets. Anatomic implants are also more expensive than round implants as well.
Implants have also been customized based upon their width and projection. Patients with wider chests and breast diameters will often do well with so called moderate profile implants. Those women who are petite and have narrower chest walls and breast diameters are more often candidates for high profile implants which have narrow bases and slightly more projection.
The surface of breast implants have been designed to be either smooth or textured. Textured implants have a rough surface and were thought to reduce scarring around implants called capsular contracture when the implants were placed above the muscle in the subglandular space. However, it’s my experience and that of many plastic surgeons that capsular contracture is reduced most by placing the breast implants under the muscle called the submuscular or subpectoral placement. Furthermore, there are extremely rare cases of a cancer called ALCL or anaplastic large cell lymphoma which have been reported with textured implants.
In my practice, most patients will choose silicone breast implants today for breast augmentation surgery. I recommend smooth, round “gummy bear” implants in most cases. Moderate profile or high profile implants will be chosen based upon the patient’s anatomy and aesthetic goals. It’s preferable for patients to try on “sizers” at the consultation to determine the range of implants which meet their goals rather than depend upon some computer imaging system which can be misleading and inconsistent in predicting a patient’s outcome. Sterile sizers are also used at surgery to confirm the optimal implant size and style for each breast to create the ideal aesthetic outcome in every case.
Great plastic surgery is all about details and literally millimeters. With this careful, detailed, and thoughtful approach, patients can be confident that we make every effort to obtain the optimal aesthetic outcome in breast augmentation surgery for each of our patients.
Dr Chaffoo speaks with Health Beauty Life’s Patrick Dockry to discuss Breast Augmentation.