If you are interested in breast augmentation surgery or simply curious to learn more about breast implants this article will guide you through the history and specifics of the popular breast lift surgery. Breast implants are the most studied medical device in the world and have been proven to be safe overall.
The procedure was introduced in the 1960s before medical devices were strictly regulated. As women with implants realised that the devices do not last forever, endless lawsuits were filed leading to their removal from the market in 1992. Short after, saline implants were invented as an alternative. Many studies were performed over the next 15 years and eventually, silicone implants were reapproved by the FDA in 2007. Since then, the procedure has been consistently available.
Silicone implants have made dramatic advances since their invention in the 1960s. The implant shells have improved and the silicone fill inside of the implants is now more solid, leading to the gummy bear description. Some are slightly more solid or firm than others. The more firm the implant, the less the implant will wrinkle and the more it will hold its shape. Several of the implant companies offer various firmness levels for their implants which can be used depending on the goals and each individual person’s anatomy.
There are four breast implant companies on the market in the United States currently – Allergan, Mentor, Sientra, and Ideal Implant. Allergan and Mentor produce both silicone-filled and saline-filled implants. Sientra produces only silicone-filled implants. Ideal Implant produces only saline-filled implants with a unique structured shell. In addition to silicone or saline fill, implants also come in different shapes and textures. The most common implant shape is round. The alternative is an anatomic implant, also known as shaped. This type of implant has a more natural appearance and is especially useful for breast reconstruction after cancer.
Implants also come with different surface textures. The most common surface texture is smooth. The alternative surface texture is rough and is called texture. Textured implants offer more stability of implants over time which is especially important with anatomic implants since the rotation of an anatomic implant can lead to alteration of the breast shape. Textured implants have been shown to be associated with a very small risk of lymphoma of the breast, known as ALCL (Anaplastic Large Cell Lymphoma), while smooth implants have no risk of lymphoma. One of the companies, Allergan, discovered that their textured surface had a higher incidence of breast lymphoma so their textured implants were removed from the market in 2019. The textured implants from Mentor and Sientra remain available.
Saline implants were launched when silicone implants were pulled from the market in 1992. Saline Implants remain available today and represent a reasonable alternative to silicone implants. Both have a solid silicone shell, but saline implants are filled with saline (saltwater) rather than silicone gel. Saline implants often do not feel quite as natural as silicone, but they do have the advantage of becoming empty when they break, making them easy to detect. The saltwater simply gets absorbed by the body and the implant shrinks in size leading to an obvious change in breast size.
Most patients come into the office requesting a certain breast cup size such as C or D. However, breast implants do not come in bra cup sizes. Breast implants are measured in cc’s (cubic centimetres) or ml’s (millilitres), both of which are equivalent. Part of the challenge is that the volume of a 34C cup is different from the volume of a 36C cup so cc’s offers better standardization across different cup sizes. That is why cc’s has always been the conventional measurement for implant volume.
In addition, for round implants specifically, the implants have two dimensions, diameter and projection. Diameter is the width of the implant (think about it from the cleavage going across the chest towards the arm). Projection is how far the implant sticks out forward on the chest. Round breast implants are made with varying profiles such as low, moderate, moderate plus and high. The higher the profile, the more forward projection the implant will have on the chest and the bigger the implant will look. So not only is the cc measurement important, but the profile is important as well.
It is worth noting that implants don’t last forever. Any implant will fold, wrinkle, and bend inside of your body and, after decades of that folding, an area of weakness will develop and the implant will break. If the implant is filled with silicone, it will be difficult to tell if the implant is broken since the silicone gel will still hold its shape. Radiographic imaging such as an MRI or ultrasound can help determine if the implant is broken.
There is no medical urgency to get the implant replaced but a silicone implant that remains broken for many years can lead to scar tissue formation and discomfort so it is best to replace the implant if it is broken. The FDA recommends regular monitoring of silicone implants with MRIs.However, most patients do not follow the recommended monitoring schedule.
In summary, smooth round implants are the way to go for most breast augmentation patients. Moderate profile implants offer more of a natural look while high profile implants offer more fullness and volume. Silicone-filled implants are the most commonly used and all silicone implants on the market today offer some level of gummy bear consistency. Saline-filled implants including the structured Ideal Implant are reasonable alternatives for those who don’t want to worry or deal with implant monitoring.
Article by Dr Michael K. Newman, MD