Comparing Breast Implant Options

Saline and silicone implants both have advantages, and both types of implants can and do produce excellent breast augmentation results. Because of current FDA restrictions, for most women having breast augmentation, saline implants are the only option. Silicone implants can be used for reconstructive purposes during augmentation procedures — if you have had previous breast reconstruction or a chest wall deformity, if there's a large difference in your breast sizes, or if you also need a breast lift at the same time.

Saline implants

Before it's placed in a breast, a saline implant essentially feels like a plastic sandwich bag filled with water. It's constructed of an outer shell of several layers of silicone rubber that includes a valve. Saline implants are usually filled to their final size by a disposable tube that runs from a bag of saline to the implant within the breast cavity. When the tube is withdrawn, the valve seals automatically, and a small additional sealing tip attached to the implant is inserted into the top of the valve.

Implants come in various sizes ranging from 150cc (cubic centimeters) to approximately 700cc. The smaller sizes, from 150cc to 400cc are available in 25 to 30cc size increments. Above 400cc, the increments are 50cc.

Here are some facts about saline implants:

• Cost: Saline implants are about half as expensive as silicone gel implants.

• Feel: Saline implants can be somewhat less soft and feel less natural than silicone gel implants. The best results with saline implants, however, are comparable to the best results with silicone gel implants.

• Volume: Saline implants enable surgeons to microadjust the volume in each implant. When the initial breast size isn't the same on each side, the surgeon can microadjust volume to balance the two sides.

• Wrinkling: In many augmented breasts, saline implants can be felt at the bottom or along the lower sides as an edge or as slight wrinkles. This effect is normal.

Silicone gel implants

Silicone gel implants have a shell made of several layers of silicone rubber. In prior generations of silicone implants, the wall or covering of the implants was weaker and more porous. The silicone within the implants was runnier, and small amounts of the silicone would bleed through the implant walls. The silicone now used in gel implants is semi-solid (non-runny and less likely to migrate). Reduced silicone bleed has probably resulted in reduced capsule formation.

Here are some other important facts about silicone gel implants:

• Cost: Silicone gel implants cost about twice as much as saline implants, a problem if the cost of surgery is an issue to you.

• Feel: Silicone gel implants feel softer and more natural than saline implants.

• Wrinkling: If capsule formation does occur, silicone gel implants can develop wrinkling. In general, however, silicone implants don't develop the edge wrinkling that is common with saline implants.

• Volume: No microadjustment in volume of the implants can be made. The implants are completely sealed. From the smallest size available up to 400cc, the implants come in 25 to 30cc size differences. Above 400cc, the different sizes vary by 50cc. This has one small disadvantage in that most breasts normally vary in size, from one side to the other. If size variations can't be corrected in 25 to 50cc increments, some slight asymmetry in breast size will remain.

Other implant options

Although 85 percent of breast augmentations are performed with smooth round saline implants, some other types of implants are also being used. These are

• Textured implants have a rough outer covering. In the past ten or more years, when there was a high rate of capsule formation, surgeons felt that texturing the implant surface reduced the incidence of capsule formation. Textured implants are available in round shapes, but are also available in anatomic, or teardrop, shapes.

Most plastic surgeons have abandoned textured implants because they are perceived by many to cause increased rippling and a higher incidence of capsules and consequently are much easier to feel than the newest smooth, round saline implants.

• High-profile implants allow you to have more volume in a narrower base width. Many surgeons use breast measurements to determine the maximum width of breast implant that can be used on a patient without causing distortion. If a small woman with small breasts and a narrow chest wall wishes to be a C or D cup size, the appropriate standard profile implant that fits her frame may not have enough volume to achieve the size she wants.

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