Lara Devgan, MD, MPH, is a Yale-educated, Hopkins-instructed, and Columbia-trained plastic and reconstructive surgeon in private practice in New York City. For more information, please visit www.LaraDevganMD.com.

BLOG: Which breast implants are best for you?

With breast augmentation currently ranking as the number one most commonly performed cosmetic surgical procedure in America, questions about breast implants are incredibly common among my patients, and among women all over. Indeed, over 300,000 breast augmentation procedures are performed each year in the United States alone. If you or someone you know is thinking about breast augmentation, it is essential to answer several questions about which type of breast implants are right for you.

Which brands of implants are FDA approved?

There are three large suppliers of breast implants that have passed all aspects of FDA approval in the United States: Allergan, Mentor, and Sientra. Although there are indeed other brands of breast implants available in Europe, South America, Asia, and the rest of the world, the United States has the largest and strictest regulatory process for FDA approval. As such, I recommend sticking to one of these three brands.

Silicone or Saline?

Saline implants are FDA approved for anyone over the age of 18. They are filled with inert salt-water and if they accidentally rupture, your body will easily resorb this fluid.

The advantages of saline implants are that they can be placed through slightly smaller incisions, they can be used in younger women, and they contain salt-water that your body can resorb. In addition, in the event of an implant rupture, for example, if you have a car accident, you will immediately notice the size of the affected breast decreasing.

The disadvantages of saline implants are that they look and feel slightly less natural than silicone implants. Particularly in thin women, saline implants can sometimes be associated with visible or palpable rippling. For this reason, they are much less common in my practice.

Silicone implants are FDA approved in women over the age of 22. The newest generation of implants is filled with form-stable silicone, which is a synthetic material that feels something like a cross between Jell-O, a gummy bear, and an actual breast.

The advantages of silicone implants are that they look and feel extremely natural, even in thin women, particularly when they are placed below the pectoralis major muscle. They move more like regular breasts, and for this reason, they are more common in my practice.

The disadvantages of silicone implants are that they require slightly larger incisions for placement, as compared to saline implants. It is also harder to detect implant rupture with silicone implants since they tend to remain in a similar conformation. For this reason, women with silicone implants are advised to undergo MRI surveillance of their implants 3 years after they are placed, and every 2 years from there on.

If silicone, what kind?

If you opt to have silicone implants, there are a few further choices you must make. Do you want round implants or "tear-drop" (anatomic) implants? And do you want low, medium, or high profile implants? And what about gummy bear implants?

Round or Tear-Drop?

Most women undergoing cosmetic breast augmentation opt for round breast implants. The main advantage of round implants is that they have no particular radial orientation, so even if they shift or rotate over time, the result will not be noticeable. As a result, round implants are the more popular type. Round implants are semi-spherical in shape, which is regarded either as an advantage or a disadvantage, depending on the desired look, as they tend to create more upper pole breast fullness.

The alternative to round implants is anatomic-shaped, or "tear-drop" shaped, implants. The advantage of tear-drop breast implants is that they resemble the actual physiologic shape of a real human breast, with a gently downsloping upper pole and a fuller lower pole (in other words, like the shape of a tear drop). Women who want a very subtle, natural look are sometimes drawn toward this type of implant. The main disadvantage here is that in situations where rotation of the implant occurs over time, a second surgery may be required to correct the implant position.

High or low profile?

Breast implants come in low-profile, regular-profile, or high-profile types. Profile refers to how high the implant sits above your body, with low-profile implants staying the closest, and high-profile implants sticking out the most. Those who want more prominent cleavage or a fuller look should opt for higher profile implants, while those who prefer a more subtle look should opt for lower profile implants.

Regular silicone or gummy bear breast implants?

Although "gummy bear" or highly cohesive breast implants have received a lot of attention-- some of which undoubtedly comes from their catchy nickname-- standard silicone implants remain more popular overall and in my practice.

Gummy bear implants are made with a highly cohesive form of silicone that is form-stable, meaning that even if the implant ruptures, it will not spill or leak. Women with gummy bear implants report that they feel slightly harder and less comfortable than they would like. Still, those who are worried about silicone implant rupture sometimes prefer them.

Textured or smooth?

There is no universal opinion among plastic surgeons regarding whether textured or smooth implants are superior. There is some data to suggest that the rate of capsular contracture is lower with textured implants. However, more cases of the rare cancer known as ALCL have been associated with textured implants as well. I advise discussing the choice of smooth versus textured implants with your plastic surgeon.

What size?

The size of the breast implants you choose is one of the decisions that women think about the most. A general rule of thumb is that 250cc corresponds to approximately one cup size in an average woman. However, this depends on the size of your frame and the elasticity of your skin envelope. In addition, if implants are placed under the muscle-- which I consider to be the current standard of care in most situations-- this can make their apparent size approximately 50cc less than their actual size.

Before committing to a particular size, discuss your ideal look with your surgeon, look at her before and after pictures, "try on" a variety of implants inside your bra, and listen to your surgeon's advice about what size implants your body will safely accommodate.

It is important to remember that not every breast can accommodate every implant. The best size range for your individual anatomy depends on the base width of your breast, your skin pinch thickness at the top and bottom of your breast, your tissue elasticity, and other factors that may be unique to you.

When considering breast augmentation, I advise all women to see a board-certified plastic surgeon with verifiable credentials and a large number of before and after photos. Ask questions, read about the procedure in advance, have realistic expectations, and choose long-term quality over seductive advertising or cheap prices.

For questions about this article, I can be reached via www.LaraDevganMD.com.

 

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