What’s the Best Breast Implant Type?

There is no ‘best’ breast implant, which is why so many options exist. What looked amazing on one of your best friends, or an Instagram model with similar measurements to you doesn’t necessarily mean that the same implant will be the best choice for you. This is why an in-person consultation with a board-certified plastic surgeon is absolutely essential. The implant chosen for you will depend on many things including your body measurements, your goals for your final outcome as well as other personal factors about your lifestyle.

All breast implants available in Canada today are made of a silicone rubber outer shell that is filled with ‘something’. That ‘something’ can include cohesive silicone gel (aka traditional silicone implants), highly cohesive silicone gel (aka gummy bear silicone implants), and saline implants. These options also come with smooth and textured shells, however as of the writing of this blog I am personally not using textured implants for two reasons: Allergan bio-cell textured implants are linked with a rare lymphoma (Breast-implant associated ALCL) and other brands’ texturization is not textured enough to cause them to behave any different than smooth implants and therefore doesn’t justify the larger incision that needs to be made.

Because of the subtle differences in their look, feel, and overall performance, each implant type can be the ‘best’ choice depending on who it is being chosen for.

Regular Cohesive Silicone Gel Implants

Regular silicone breast implants (a.k.a. Smooth round silicone gel implants) are filled with cohesive silicone gel. The silicone gel feels a little bit more like natural breast tissue compared to its highly cohesive and saline counterparts.

The Pros:

  • Regular silicone breast implants are the softest and most natural feeling implant available today.
  • Implant ‘rippling’ is less likely to happen in regular silicone implants compared to saline implants.
  • Are the most commonly used implants chosen today because of their natural look and feel.

The Cons:

  • At larger sizes, they require a slightly longer incision in the skin compared to saline breast implants because the implant is pre-filled.
  • There is known ‘bleed’ of silicone oil through the shell, which while studies have shown it to be inert, is not a natural substance and therefore will be a concern for some women.

Pro or Con, depending on your perspective

  • If a silicone breast implant leaks, the cohesive gel will typically remain within the implant shell or capsule and will reasonably maintain its shape – a phenomenon known as silent rupture.
    • For some women this is a positive thing – the implant stays intact and there is no need to have an emergency surgery.
    • For other women it is a negative – the only way to know the status of your implant is to get an MRI to assess the shell’s integrity.

If you choose silicone implants, I recommend considering replacing them after 10-15 years. While they don’t have an expiration date, they are not considered lifetime devices and will fail given enough time under the stress and strain of being in a living, moving body. The failure (rupture) rate is about 1% per year so the probabilities are still greatly in favour of them remaining intact, but I still think its good measure to try and replace them before they fail and we have to deal with free silicone gel in the breast, something that requires a more complicated procedure to remove than a simple swap out. Rest assured though, silicone breast implants are considered as safe as can be for any medical device – they have not been linked to causing breast cancer or any other diseases and are the most extensively studied medical device in history.

Highly Cohesive Silicone Gel Breast Implants

Highly cohesive silicone gel breast implants, also known as gummy bear or form stable implants, are filled with a highly cohesive gel that makes them a little bit thicker and firmer than implants filled with traditional silicone. Gummy bear implants were growing in popularity due to their excellent performance and highly satisfying outcomes until the issues with BIA-ALCL arose and now we rarely use them for cosmetic breast augmentation in Canada.

The Pros:

  • May have superior long term performance with lower rates of rupture, rippling, and capsular contracture compared to regular silicone breast implants and saline breast implants.
  • May maintain better long term shape with enhanced projection and lower rates of malposition and bottoming out.
  • The teardrop shaped gummy bear implant can theoretically achieve a more “natural” looking result with less bulging and roundness of the upper portion of the breast and increased projection and fullness of the lower portion of the breast compared to round implants, yet with the trade-off of a slightly firmer feel.

The Cons:

  • Gummy bear implants feel slightly firmer to the touch compared to regular silicone breast implants.
  • Placement requires a slightly longer incision in the skin, which can make it more difficult or even impossible to place these implants through the areola, underarm, or belly button.
  • Gummy bear implants are available in only a teardrop (anatomic) shape in Canada at the moment.
  • Anatomic shaped implants must be textured, and there are issues with this texturization as I mentioned above
  • Shaped implants can rotate and end up upside-down, giving extreme upper pole projection and a lack of fullness at the bottom of the breast.
  • Shaped gummy bear implants, in particular, are slightly more expensive than other breast implant options.
  • In women with sufficient tissue coverage, numerous studies have shown that no one can tell whether a woman has a shaped or round implant, meaning many of the potential downsides of a shaped device are simply not worth the risk given no real potential upside.

Saline Breast Implants

Saline breast implants are filled with sterile saltwater. This implant type is recommended for women who do not wish to have silicone implants as well as some women who desire the ‘Baywatch’ look with a high degree of upper pole fullness and projection. In the right patient, saline implants can also look very natural, in particular now that the IDEAL implant is available. Traditional saline implants are significantly less popular today than silicone implants, however the IDEAL implant is rapidly gaining market share.

The Pros:

  • The volume of fill can be adjusted in the OR, allowing for me to correct for minor asymmetries.
  • A slightly smaller incision can be used during placement.
  • Saline implants generally cost slightly less than silicone implants.
  • The fill is completely “natural”. Studies have shown that both saline and silicone implants are completely safe. However, some women still feel more comfortable knowing that saline implants are filled with a natural solution that can be easily and safely absorbed by the body should a leak or rupture occur.

The Cons:

  • Saline implants feel slightly firmer and less like natural breast tissue compared to silicone implants. IDEAL implants for the most part feel very similar to silicone.
  • Implant rupture and rippling are slightly more likely to happen.
  • Saline implants weigh slightly more than silicone implants, which slightly increases the risk of ‘bottoming out’ due to gravity.

Pro or con, depending on your perspective

  • Implant rupture is easier to detect because the breast will deflate.
    • This is a pro to women who might be inclined to worry about whether a silicone implant is intact or not. No MRIs are ever needed to assess the integrity of saline implants
    • Can be a con because when the implant deflates, the pocket starts collapsing and the implants need to be replaced within a few weeks to avoid having to do additional maneuvers to re-open the pocket to accommodate new implants.

Fat Transfer Breast Augmentation

Breast enhancement with fat transfer is a newer procedure that removes unwanted fat from your thighs, abdomen, or hips; purifies the fat and then injects it into the breasts to add volume. It’s technically not a type of “breast implant” but I am including it here because it’s something that should be considered as an alternative (or adjunct) to breast implants. This procedure is growing in popularity because it is an all natural option that offers the double benefit of sculpting other areas, but it is still much less commonly performed than implant breast augmentation because it is less consistent and less reliable.

The Pros:

  • It is your own tissue, so it is the most natural of all options.
  • Once the fat has “taken” it is permanent

The Cons:

  • Fat transfer is typically limited to approximately one half to one cup size increase in breast size per round, so several rounds of grafting may be needed to achieve the volume increase an implant could provided
  • The transferred fat may be absorbed again by the body. Once it is transferred, it needs to get a new blood supply from the breast tissue. Only 60-70% of the transferred fat will do this, meaning some will be lost.
  • It is more expensive because of the extra time involved in harvesting and processing donor fat
  • The fat that does not take can become lumpy. It usually resolves after about a year, but can be problematic to women while it is healing
  • The fat that does not take can form calcification’s, which can worry the radiologist when you eventually have mammograms for breast cancer screening. It is important to let the technician know you’ve had this procedure done.

Hybrid Breast Augmentation

In some cases fat transfer may be used in conjunction with breast implants to provide additional softness and cover for the implants. This is starting to get a bit too complicated to explain in a blog post. If you are a good candidate for a hybrid procedure we’ll discuss that at your consultation.

Given all of the available options for implants, you can see this is not a decision that should be made without a thorough discussion with a plastic surgeon who has expertise in breast augmentation. If you’d like to schedule a complimentary consultation to come and discuss your breast augmentation options then contact the office today!

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