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Breast Augmentation with Breast Implants - Saline & Silicone

What Types of Breast Implants Are Available for Breast Augmentation?

There have been varying viewpoints throughout the years about the best kind of implant to use for Breast Augmentation, and health controversies about one kind of implant that dominated news reports in the 1990's. Many women who were interested in having fuller breasts were fearful to do so because of these reports. The following describes the different kinds of implants that are available, and addresses some of the concerns regarding differences between breast implant fill material, shape, surface texture, size, manufacture, and use of implants.

Breast Implant Fill Material:

Although all breast implants do have a solid silicone shell (bag), they are filled with different substances such as:

Saline Breast Implant
While there are a number of implants available for Breast Augmentation, currently the most commonly used is the saline breast implant.

The saline implant has an exterior sack made of solid silicone, which is filled with a sterile saline solution — like the salt-water solution that is administered for intravenous fluids. One of the advantages of this solution is its safety. Should the implant for some reason leak, the saline just gets absorbed by your body, as would the intravenous fluids used during, and after surgery. Yet another advantage of the saline implants is a very low infection rate, which is usually less than one to two percent.

Another advantage of the saline implant is that it is filled with fluid after being inserted in the breast, therefore requiring only a small incision. This is in contrast to silicone implants which are pre-filled. Also, because saline implants are filled after insertion, their final volume can be adjusted making it easier to correct for existing breast asymmetry.

Unlike other types of implants such as silicone implants, there are not restrictions on the use of saline breast implants; and women do not need to enter any specific national breast study to be eligible for their implantation, as they do for the implantation of Silicone Implants.

Widespread media reports that saline-filled implants can contract fungal contamination were discredited when it was learned that the Canadian laboratory that released this finding relied heavily on implants that had been mailed. As such, there was no guarantee of sterility in the transport of these implants.

There are two main disadvantages of saline breast implants, when compared to those filled with silicone. Because of the liquid nature of saline, saline filled implants tend to have a higher incidence of rippling, or the ability to be felt. Although rippling occurs in all saline implants, filling them according to the manufacturer’s recommendations, submuscular placement of implants, and the existence of thicker breast skin and tissue minimizes a person’s ability to see or feel rippling of saline implants. Because silicone gel has a thicker consistency, it tends to ripple much less, but sometimes happens nonetheless.

The second potential disadvantage of saline implants compared to silicone breast implants is the difference in how they feel to the touch. Outside of the body, silicone implants have a more natural consistency. In reality, this difference becomes less noticeable when implants are felt underneath the breast and muscle tissue.

Silicone Breast Implants
These are implants that are filled with a silicone gel. More than 1.5 million American women currently have silicone breast implants. Some people feel that the silicone implant results in a more natural appearing breast. However, about 15 years ago, the safety of these implants was questioned in numerous media reports, and through the filing of numerous lawsuits again the implant manufacturers. Numerous afflictions, including autoimmune diseases and hardening of the breasts, were attributed to the leakage of silicone into the bodies of women who had these implants.

The facts of the matter about silicone breast implants have been published by the Food and Drug Administration FDA:

"In January 1992, the FDA called for a voluntary moratorium—a delay on the use of these implants—until new safety information could be thoroughly reviewed. The moratorium was not intended to "ban" the implants, but instead to allow time to review the new safety information. In April 1992, the agency decided that no PMA yet submitted contained sufficient safety and effectiveness data to support approval. However, access to these silicone gel-filled breast implants would continue for women enrolled in certain clinical studies. In the years that followed that decision, thousands of women filed lawsuits against the manufacturers of silicone gel-filled implants, claiming the devices had caused serious ailments, such as connective tissue diseases, neurological diseases, and cancer. Consumer groups repeatedly filed petitions urging more studies on the implants. But many women said they were pleased with their implants, including cancer patients who had pleaded for the opportunity to choose silicone gel-filled implants for reconstruction. In January 2004—contrary to the recommendation of the agency's advisory panel—the FDA determined that the new silicone gel-filled breast implant PMA was "not approvable" at that time. This meant that the implants were not approved for marketing pending additional information, but that women would continue to have limited access to them by enrolling in clinical studies."
Therefore, at this point only women who are enrolled in long-term clinical studies are allowed to have silicone breast implants. To be considered for these studies, a woman must need implants for breast reconstruction, for repair of breast asymmetry or ptosis, or to have been among those that have developed severe rippling with saline implants. Those who have Lupus, Scleroderma, autoimmune diseases, or diseases that hinder wound healing are excluded from the study.

The main disadvantage of silicone breast implants is that their rupture is less easily detected than with the rupture of saline implants. When a saline implant ruptures, the saline gets absorbed by the body, making the breast go flat, which can be easily recognized by a woman. On the other hand, because silicone gel mostly stays within the breast tissue and does not get absorbed, there is usually no noted reduction in breast size after rupture of silicone implants. Tools to detect rupture of silicone implants include Mammograms and Magnetic Resonance Imaging (MRI). Also, the clean up and complete removal of the leaked silicone gel is difficult. Finally, although there are several studies that attest to the safety of silicone, the controversy about the safety of silicone implants remains.

Cohesive Gel Implants
Cohesive gel implants are silicone implants that are filled with a thicker silicone gel that holds its shape and form like a "gummy bear." If you cut into a standard gel implant, the liquid silicone gel escapes from the implant shell. In contrast, when you cut into a cohesive gel implant, the implant itself maintains its shape and integrity. These shaped implants are designed with a focus upon a natural look, rather than for enlargement. Furthermore, gummy bear implants maintain their shape in an upright position that decreases the incidence of folding of the implant shell or rippling. If a cohesive gel implant ruptures, it maintains both its shape and integrity.

One disadvantage of cohesive gel implants is that they require a slightly larger incision for insertion. Because of this, insertion is usually performed through an incision in the fold under the breast, or occasionally through an incision around the areola. Cohesive gel implants are very difficult to insert through an incision in the armpit. Finally, gummy bear implants were approved in late 2006 by the FDA for use in the United States, but their use is limited to certain age, and patient require strict follow-up with MRI to look for silent rupture.

You can learn more about your options about "new gel implants" by visiting the Allergan's web site: www.breastimplantstoday.com

PIP Implants
PIP implants are breast implants manufactured in France by Poly Implant Prostheses, and, until recently, imported by PIP/USA. PIP implants are saline but, unlike other saline implants, they are pre-filled.  They are not currently approved by the FDA for use in the United States.

Soybean oil-filled Implants
Soy oil-filled implants provide a material less dense than silicone gel, or saline solution, to allow for better visualization of mammograms in the presence of implants. The goal was also to achieve a material of similar safety to saline to allow clearing once the implants eventually fail and leak. These implants are not approved by the FDA for use in the United States.

Expandable Implants
The Spectrum implants introduced by Mentor Corporation are expandable and can be filled anywhere from 25cc to 140cc depending on the initial size of the implant itself. They come with a small remote port that is placed over the outer chest rib cage. They can be filled over weeks to months to let the patient decide exactly on the size. The advantages are the flexibility and range of fill size and the ability to change it after surgery. The disadvantages are that it requires a second surgery to remove the port from the chest wall. There is also a higher infection rate with a remote port and that these implants are costlier than standard implants.

Do Implants Come in Different Shapes?
Yes. There are various shapes to implants – including Round, Teardrop — or "Anatomic" as well as a variety of Implant Profiles.

As a general rule, Round implants are wider, provide greater cleavage, and fill in the upper portion of the breast. However, the Teardrop or "Anatomic" implants might be best for women who are seeking fullness mostly in the lower breast. Although Teardrop, or Anatomical implants, were previously more popular, several studies have demonstrated that when a woman is standing, a Round implant takes on a Teardrop shape. The main disadvantage of Teardrop implants is that they do not emphasize the cleavage; and because they have a long shape, if they rotate and tilt onto their side, they can appear odd, or unattractive.

Recently, several manufacturers have introduced a variety of implant profiles from low to high profile. While round profile implants are usually wider and flatter, high profile implants are narrower and taller, resulting in a more pronounced looking breast.

Do Implants Have Different Surface Consistencies?
Yes. A woman can choose between Textured implants, or Smooth implants. Textured implants have a rougher surface. The textured implant’s primary advantage is that it has a much lower incidence of Capsular Contracture, or hardening of the breast capsule. When implants are placed over the muscle, the incidence of Capsular Contracture with smooth implants is approximately thirty percent compared to seven percent for textured. The incidence of Capsular Contracture becomes the same (seven percent) when either implant is placed under the muscle. Some surgeons feel that textured implants are more palpable and do ripple more, but the differences are not documented in large clinical studies. Considering this information, Smooth Implants are preferable, unless the patient has had Capsular Contracture in the past.

Implant Manufacturers & Warranties

There are only two FDA-approved implant manufacturers in the United States:
Inamed Corporation, which is now a subsidiary of the Allergan Corporation, offers a lifetime warranty replacement of all implants as well as $1,200 towards the cost of replacement of deflated implants for 10 years.

Mentor Corporation offers the same implant replacement policy and 5 years warranty for replacement cost. Mentor does offer an extended ten-year warranty for an additional fee.

Implant size
Both implant manufacturers have implants from 125cc to 850cc volume. Larger implants are not currently being manufactured by either company. The specific volume or size of the implant does not guarantee a bra size; as final breast size also depends on the original size and shape of the breast.

Implant use
Although the implants that we have discussed are usually for cosmetic Breast Augmentation, they are also used for breast reconstruction after the post-mastectomy chest wall skin has been stretched out to several sizes larger that the intended breast sizes, with a breast implant tissue expander.

During your consultation with Dr. Younai he reviews your treatment options and choices of different breast implants, including pros and cons of each implant and procedure, potential risks and complications, recovery course, pre and post operative instructions, and esthetic outcomes. You will also have an opportunity to "touch and feel" different types of saline or silicone breast implants. There are also many before-and-after pictures and high resolution images of breast augmentation available in our photo gallery.

Dr. Younai is a board certified plastic surgeon who receives patients at the California Center for Plastic Surgery from the Northern as well as the Southern California region. Some of these cities include Beverly Hills, Los Angeles, Santa Monica, Hollywood, Burbank, Sherman Oaks, Encino, Calabasas, Woodland Hills, Thousand Oaks, Westlake Village, Pasadena, Glendale, Valencia, Palmdale, Fresno, and Oxnard.

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Dr. Sean Younai
is a Board Certified Cosmetic Plastic Surgeon, who practices in Encino, Los Angeles, Southern California.
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