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Breast Implant Surgery: Sizing, Placement and Types of Implants

What are the different types of breast implants?

Breast surgery, whether for augmentation, reduction, lift, revision, or reconstruction, changes the way a woman views her body in and out of clothes. Most women want perkier, more youthful, fuller breasts after surgery, but everyone has a different idea of what they think they want in terms of volume, shape and balance with their overall body. At OC Breast Surgery, we will step you through all considerations and how we help you get from where you are to where you would like to be. 

There are two important characteristics of breasts that we can alter: shape and volume. The Shape of the breast is determined by the external skin envelope and the volume is whatever is inside the skin envelope (fat, breasts tissue and maybe implant). If the shape of the breast needs changing, then we will discuss various types of mastopexies (breast lifts). If the breast shape only needs some additional fill, then we are talking about adding an implant. 

The different types of breast implants may be foremost in your mind. They all have a silicone rubber shell that has a smooth surface (textured surfaced implants are no longer used). Some are filled with saline (salt water) but most have a cohesive silicone gel filling. There are three companies that manufacture and sell implants in the US: Allergan, Mentor and Sientra. All three companies make excellent implants but have varying shapes, rippling, palpability, diameters, etc. 

The saline-filled implants can feel more like water balloons and have more palpable rippling along the edges. When the shell fails, the implant deflates, and the saline is redistributed into the body (60% of the body is saline). This can be comforting to know but a flat breast will be the result. Silicone gel filled implants have very cohesive gel these days and if the shell fails, the gel will generally stay put inside the implant. Medical grade silicone is used in a variety of cosmetic and medical implants and the body is generally minimally reactive to it just as it is with the silicone rubber shell of the implant or the variety of silicones we are exposed to in our diets. It’s also good to know that there are different implants available with different levels of structured gel which effects the softness and rippling. 

As the silicone shelled implants are round and smooth, the only other real difference one can have is in diameter and projection. For similarly volumed implants, the narrower diameter (width) is associated with more of a stepped-off appearance along the edge and therefore less of a fill toward the cleavage and upper breast pole. That is why a wider diameter implant (“moderate profile”) is preferred in the lower breast volumes as it will fill out the cleavage and upper breast pole better than the narrower diameter, “higher profile” contour. If the cleavage and upper breast pole is filled out with a larger implant, then one can aesthetically consider a narrower, “higher profile” implant…depending on the patient’s desires.  

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What about fat injections for breast augmentation?

A lot of people have heard that fat can be substituted for an implant. Let’s talk a minute about whether fat injections/grafts are an option to augment a breast. Many people do it, but we believe that the downsides outweigh the possible benefits. Fat transfers are fantastic options in other parts of the body but when fat doesn’t survive, microcalcifications can result. Microcalcifications in the breast are known to frequently be associated with breast cancers and therefore any possible microcalcifications resulting from a fat transfer can cause unnecessary grief and angst for the patient and radiologist trying to properly interpret the mammogram. We therefore do not recommend this approach to augmenting the breast. An implant is a much more predictable outcome with far less risk.