: Before & After Photos

In my last blog, I discussed the textures of breast implants to help explain how I customize my choice of implant for you. In this blog, I’ll be discussing implant shape.

For many years implants were only available in one shape – round.  Not round like a ball, but round like the top of a muffin.  If you put the implant on a table and look at it from the top down, it is round in shape.  If you look at it from the side, the implant is flat on the bottom and curved over the top.  Implants are placed in the breast with the flat surface against your ribs and the curved side towards your breast.

Manufacturers have tried for years to switch plastic surgeons to teardrop shaped implants, claiming that the ideal breast is naturally teardrop shaped.  While I can’t argue with that, the question is, does a teardrop shaped implant create a more attractive breast then a round implant?

Think of a plastic bag filled with water: if you hold it at the top of the bag, you’ll notice that the bag takes on a teardrop shape – more water at the bottom of the bag, and less towards the top. That’s what happens with a round implant – due to gravity, it naturally takes a teardrop shape when a woman stands up, but when she is lying on her back, it becomes more round (muffin top) like a natural breast. Round implants act like teardrop implants when a woman is upright – and that’s what you want.

Large studies have been performed where plastic surgeons are shown before and after photos of women with either teardrop shaped implants or round implants, and the surgeons are asked which implants the women have.  The studies have consistently shown that the surgeons can’t determine the implant type – the teardrop and round implants look the same after surgery!

What are the negatives of teardrop shaped implants? Teardrop implants cost approximately twice as much as round implants.  If the teardrop implant rotates after surgery, the breast shape will be negatively impacted. Finally, teardrop-shaped implants have a textured surface which creates certain problems (see my earlier blog on textured vs smooth breast implants).  For these reasons, I rarely recommend teardrop implants.

In a past blog on breast implants, I discussed the different implant manufacturers. In this blog, I’ll discuss the different options for filling implants.

Implants consist of two components – the implant shell and the implant fill material.  Simply, the shell is a container for the fill. The shell is constructed of a silicone type material, is elastic, and will be discussed in detail in another blog. The fill material is either saline (sterile salt water) or silicone gel. Implants can be roughly categorized as saline or gel, based on the fill material.

Saline Implants

Saline implants are provided to the surgeon as an empty shell. A fill tube is attached to the shell and the implant is inserted empty. Once in place, the surgeon injects saline through a fill tube. Once the implant is filled, the tube is removed. There is a valve in the shell that accepts the fill tube, and this valve seals automatically when the fill tube is removed.

Saline implants have a fill range so that minor adjustments in size can be made once the implant is in place – the range is generally about 10%, say 300cc to 330cc.  Also, since saline implants are placed deflated, then inflated, they can be placed through very small incisions. Saline implants have a firmer feel than gel implants and a greater tendency to ripple which can be felt through the skin in thin, smaller breasted women.  Saline implants generally last 10-15 years and then need to be replaced due to leakage.  When they leak, the saline is absorbed by your body and represents no health risk.  Replacement is simple but is performed in an operating room.

Saline implants are less expensive then gel implants and the risk of capsular contracture is lower.  There is no age restriction on the use of saline implants.

Gel Implants

Gel implants are provided to the surgeon as a filled implant and therefore require a longer incision to insert. The gel can be thinner or thicker (more or less cohesive) depending on the specific model of implant chosen.

Gel implants since 2006 are all cohesive, meaning the gel is designed to stick together as a single mass and not ooze away, even if the shell fails.  The thickest gels can be molded into a specific form (teardrop) and will maintain that shape – they are called Form Stable (sometimes called “Gummy Bear” implants.)  As cohesive gel implants are relatively new the lifespan is not yet known.  I anticipate that they will last, on average, 20-25 years or longer.

Gel implants are softer than saline implants and have less tendency to ripple. Gel implants are more expensive than saline, but as they last much longer, are less expensive in the long run. Capsular contracture risk is higher than saline. Gel implants can only be used in women 22 or older, based on FDA restrictions.

Gel implants are much more popular than saline, but saline implants definitely have a place.  The safety profile, other than the risk of capsular contracture, is the same for gel and saline.  No studies have compared the impact of saline vs gel on breastfeeding but the general consensus is that neither impact breastfeeding babies.

In future blogs, I’ll discuss other implant characteristics.

In my last blog about breast implants, I provided a brief overview of implant options. In this blog, I’ll discuss the Manufacturers.

As of 2017, there were three major manufacturers of breast implants. Breast implants are controlled by the FDA, just like drugs, and all manufacturers must follow very strict guidelines and practices to be allowed to manufacture and sell breast implants. It is not legal to use implants from non-FDA approved companies, and there must be a “chain of possession” between the manufacturer and the doctor.  Surgeons are not permitted to use implants provided by overseas companies, or to use implants provided to the surgeon by the patient.

All three manufacturers, Allergan, Mentor, and Sientra are large, publicly traded companies. That’s important to you as a consumer, because they have the resources to test and produce high quality products. I work with all three manufacturers, and since I’ve been doing breast augmentation for quite awhile, I have excellent relationships with senior people at all three. This is helpful when there are implant shortages, or when new products with limited availability, are offered. I’ve also done research with these manufacturers.

Breast implants are mature products. They’ve been around for over 50 years, and while there are small differences in the offerings from the different manufacturers, the differences are minor. One manufacturer has no major advantage over the other. Their prices are also very competitive. All manufacturers offer warranties on their implants – the warranties change frequently – but because of the competitive nature of the business, the differences are marginal. You can review the warranties on the individual manufacturer’s website. While warranties change, the warranty in place when you have your surgery is the warranty that the manufacturer is bound by.

Major improvements in implant technology have occurred over the years and these same improvements, with subtle differences, have been adopted by all three manufacturers. At any given time, one manufacturer’s latest upgrade may give it a temporary advantage, but its’ generally short lived.

Take Away Message

No single manufacturer stands out above the others. That said, the subtle differences between the implants may affect you due to your particular needs. The best breast implant surgeons will choose the implant that is correct for you and go to the manufacturer that makes that implant!

In the next blog I’ll discuss the important subtle differences!