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Implants

Breast Implants | Breast Augmentation Beverly Hills | Los Angeles

In the United States there are only two types of breast implants currently approved by the FDA for use in breast augmentation surgery: saline-filled and silicone gel-filled breast implants. The shell for both of these types of implants is made of the same silicone elastomer and it is impervious to tissue fluid, chemically and biologically non-reactive, non-irritant, non-carcinogenic, non-allergic, resistant to mechanical strain/wear and sterilizable. In fact, silicone is one of very few substances known to mankind that meets all of these requirements and it is not only used in breast implants, but also in numerous medications, syringes, heart valves, artificial joints, instruments and other medical devices. This is the reason why all modern breast implants, whether saline or silicone gel-filled, have an outer shell made of the same silicone elastomer. It is the filler material inside the breast implant shell that can be either saline (salt water) or silicone gel. Overall, there seems to be no best implant filler material when choosing between a saline- or silicone gel-filled breast implant since each implant type has its own unique advantages and disadvantages. Weighing the pros and cons of saline and silicone breast implants along with your own personal preferences is the best way to approach deciding which type of implant may be right for you.

Saline Breast ImplantsSaline breast implants are filled with salt water solution after their implantation inside of the breast which gives them several unique advantages in breast augmentation.First of all, because saline implants are manufactured “empty” and they are filled with saline after placement in the breast, they tend to require shorter length incisions for insertion that “pre-filled” silicone breast implants.  For the same reason, saline implants can allow for correction of mild breast volume asymmetries while the size of the pre-filled silicone implants is permanent and non-adjustable. Secondly, saline implants are more of a “shaping” implant than silicone gel-filled implants because they can have a greater “rounding” effect on the breast mound than the softer silicone implants. Saline breast implants are often also more useful than silicone breast implants in combination with minor breast lifting techniques since they tend to produce a slightly perkier shaped breast than silicone breast implants. Saline implants are often “over-filled” within the guidelines of the manufacturer’s recommendation which leads to a slight increase in firmness of the breast but also a decreased risk of implant rippling.  Some patients consider an advantage of saline implants the fact that if they rupture, the saline (salt water solution) is harmlessly absorbed by the body. In addition, if a saline breast implant ruptures it will deflate rapidly and an obvious size difference in the breast will be quickly and easily noted. This is not true with silicone-gel filled implants which can have a “silent” rupture due to the fact that the silicone gel is not absorbed by the body and no obvious change in breast volume may be noted immediately. In terms of capsular contracture, saline-filled implants seem to fare better than silicone gel-filled implants whether they are inserted above or underneath the chest muscle.

Overall, saline breasts implants seem to be of particular use in patients that already have some breast tissue, have asymmetry, may need some lift or shaping of the breast, desire the smallest possible incision, have a fear of silicone, absolutely want to know if the implant is leaking immediately and/or possibly have had a problem with capsular contracture in the past. Saline breast implants come in different sizes, shapes and profiles and the outer surface of the shell can be either smooth or textured.  Although saline-filled breast implants can be placed into any of the various implant pocket positions (see below), they are most frequently placed in the submuscular position.  Saline implants can also be placed though any of the available incision locations including inframammary (breast crease), periareolar (nipple), transaxillary (armpit) or transumbilical (belly button).

Silicone Gel-filled Breast Implants
Even though the FDA has officially approved the use of silicone gel-filled breast implants in breast augmentation for women over the age of 22, preconceived notions and misconceptions about silicone breast implants have not been easy to dispel even though they have proven to be only myths scientifically.

Current day silicone gel-filled breast implants have their advantages and disadvantages. In comparison to the older silicone breast implants of the 1960’s and 1970’s, the modern day silicone breast implants have a thicker, stronger outer shell and a cohesive silicone gel filling that is less liquid than solid. Some patients feel that silicone implants may create a more “natural” appearing breast that feels softer than a breast containing a saline breast implant. Although this may be partly true, saline breast implants can also appear natural and feel soft. I like to think of silicone breast implants as “filler” implant since they give a patient a bigger version of whatever breasts they already had before surgery. Silicone implants do not have the same ability as saline implants to shape and lift breasts because they are soft and malleable by nature. Also, silicone gel-filled implants are pre-filled and pre-sized from the manufacturer so they require a longer incision for insertion into the breast and are not adjustable once they have been placed inside the breast pocket. Therefore, in order to adjust for any breast asymmetry, two different size silicone implants must be used.  In contrast, saline implants can be adjusted by simply “over-filling” the implant in one breast as compared to the other.

Silicone gel-filled breast implants seem to be more useful in patients that simply need added volume without much need for shaping, lifting or adjusting the breast for asymmetry. Silicone implants do a wonderful job of giving a woman a larger version of whatever shape breasts she has prior to surgery and they are extremely effective in creating very natural and soft appearing breasts in women that already have perky, small, evenly shaped breasts. One other important thing to mention about silicone implants is the phenomenon of a “silent leak.” If a silicone implant ruptures/leaks it is termed a “silent leak” because the leaking silicone is not absorbed by the body and the breasts therefore typically do not change drastically in size, shape or volume even if the silicone is leaking. Although the silicone has not been proven to be harmful to the body, some women do not like to worry about “not knowing” if their implants are leaking. Lastly, silicone implants cost approximately $1000.00 more per pair directly from the manufacture.

GUMMY BEAR IMPLANTS
Gummy Bear implants are made from a solid/highly-cohesive silicone gel.  These breast implants are often mentioned by our patients during breast augmentation consultations. These implants are not yet on the market in the United States because they are still awaiting approval by the Food and Drug Administration (FDA).  These highly-cohesive gel implants are manufactured as a solid mass of silicone which is similar in consistency to the well-known small, rubbery, gelatin-based Gummy Bear® candies, hence the nickname.

There are several disadvantages to gummy bear implants. First, because of their solid nature, they feel much firmer than any silicone gel implants, hence, are not as natural. The tear-drop shape of the cohesive gel implant prevents a more natural-looking rounder result. In fact, the result is usually the opposite of what women are seeking. Implants can also rotate inside of the breast pocket.  If a gummy bear implant rotates, its teardrop shape can cause asymmetries and distortions of the breasts that can require revision surgery to correct. They also require much larger incisions due to their solid nature and cannot be squeezed through small incisions like saline or silicone-filled gel implants. Typically, an incision between 2-2 ¼ inches (4.5 to 5.5 cm) is required to insert the “solid” gel implant. This generally rules out periareolar and transumbilical incisions and makes a transaxillary (armpit) incision very difficult. This leaves an inframammary incision (the fold under the breast) as the only option. Lastly, although they are not available in the U.S., gummy bear implants cost several hundred dollars more per pair than traditional silicone gel implants (which are already considerably more expensive than saline implants).

FAT GRAFTING
In the future, another option for women who are interested in a modest amount of breast augmentation (less than half a cup size) is breast augmentation via fat grafting which can also be used to make cosmetic improvements during or after breast augmentation.

In summary, there are many factors that need to be weighed when deciding which type of breast implant might be right for you, including your anatomy, your desires, your budget and any concerns you may personally have regarding the two types of available filler material. By the conclusion of your consultation, Dr Motykie will go through the advantages and disadvantages of both types of breast implants in your particular case in order to help you determine which type of breast implant may be the “right” one for you.

BREAST IMPLANT SHELL
There are two main categories of implant shells: smooth and textured (rough). Textured implants have a thicker, more palpable shell, leading to a higher risk of rippling and palpability of the implant. Also, textured breast implants have a higher risk of implant malposition and asymmetry since they stick to the surrounding breast tissue and therefore must be placed exactly in the desired position during surgery. This stickiness also makes breast massage protocols more difficult which can increase your risk of post-operative internal scar formation (capsular contracture). Therefore, the smooth implant shell is the preferred implant shell in the vast majority of patients.

To find out more about breast augmentation please contact us at 310-246-2355


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Dr. Gary Motykie