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          Types of Breast Implants: Understand Your Options

          Once you decide to have breast augmentation surgery, you will need to decide on several factors relating to your breast implants, including:

          Implant Fill: Saline or Silicone?

          There are two types of breast implants approved by the Food and Drug Administration (FDA): silicone-filled and saline-filled. They come in various sizes and shapes, and with two types of shells: textured shells and smooth shells. A type of silicone-filled implant with a thicker filling, called a form-stable highly cohesive implant, or "gummy bear" breast implant, is currently under investigation and may one day provide another option for women undergoing breast augmentation with implants.

          Both saline-filled breast implants and silicone-filled implants have an outer shell composed of silicone elastomer. This shell is basically a flexible envelope that contains the implant filling. In the case of some anatomically shaped implants, the shell also gives the implants shape. Some models of implants have a "double lumen." This is an elastomer envelope inside of another elastomer envelope (sort of like double-bagging your groceries) which may reduce the risk of implant rupture.

          Saline-filled Breast Implants. Saline-filled breast implants are filled with sterile saline (salt water). They come in both smooth and textured shells and can be round or anatomically (tear-drop) shaped. Saline breast implants are also available in low and high profiles, and in many sizes. A saline-filled breast implant is usually empty before implantation. The doctor moves it into place during your surgery, and then fills it. The saline is administered via a process that ensures the implants remain sterile.

          The minimum age for getting saline breast implants is 18, unless the implants are needed for reconstructive purposes. Cosmetic breast augmentation is not recommended for anyone younger than 18 because they may not be mature enough to make an informed decision. Additionally, their bodies and breasts may not have reached their full adult size.

          Silicone-filled Breast Implants. Silicone-filled breast implants are filled with a silicone gel. Over the years, the consistency of this silicone filling has changed. The first silicone breast implants were filled with a very thin, oily silicone. Currently, the silicone used in implants is a gel that is less likely to leak out of the shell if it ruptures. This gel is referred to as "cohesive." Some breast implants — called gummy bear breast implants — are even more cohesive, or "form-stable," and have the consistency of a gummy bear, thus the nickname.

          The minimum recommended age for silicone-filled implants is 22. This is a different minimum age than for saline implants; the risks of silicone-filled implants are greater than with saline implants, so a greater level of maturity is required.

          Both silicone-filled and saline-filled implants have their own sets of advantages and disadvantages.

          In general, silicone-gel-filled implants are smoother, softer and feel more like natural breast tissue than their saline-filled counterparts. Silicone implants feel like a semisolid gel, while saline implants are often likened to water balloons. Silicone-gel implants are also less likely to wrinkle and ripple than saline breast implants. Wrinkling is actually considered one of the major disadvantages of saline implants. The thinner the woman and the less breast tissue she has, the more likely the saline implant's crinkles and wrinkles will be felt and even seen.

          If a saline implant ruptures it typically deflates within four hours. Silicone ruptures, on the other hand, can be silent. As a result, magnetic resonance imaging (MRI) exams of your breasts are needed three years postoperatively, then every two years.

          Implant Surface: Smooth or Textured?

          Breast implants come in shells that are either smooth or textured. Smooth implants have a thinner shell than textured ones. They may be less likely to ripple than textured implants, the surface of which can pull on the implant, causing wrinkling and rippling.

          Textured implants feel like sandpaper. They were developed to lower the risk of capsular contracture, but this has yet to be borne out conclusively by research.

          Textured breast implants are thicker to compensate for their intentionally rough surface. Patients with thin skin or small breasts may be more likely to feel textured implants.

          There are pros and cons to both smooth and textured breast implants. Be sure to discuss these with your board-certified surgeon when deciding which is best for your breast augmentation surgery.

          Implant Shape: Round or Contoured?

          Contoured implants, also called anatomical or teardrop-shaped implants, are shaped like a natural breast and create a sloped shape when placed over the chest muscles. Round breast implants have that, well, "round" Victoria's Secret or Playboy model shape. Contoured implants may flip over if the surgeon does not create the pocket correctly, resulting in a misshapen breast. Not true with round implants. If a round breast implant flips, it still looks the same. Your decision on implant shape should be based on how you want your new breasts to look.

          Implant Profile: Low, Moderate and High

          Breast implants are available in low, moderate and high "profiles." The profile of an implant determines how far it protrudes from your chest wall. If you are a woman with a small chest wall, a moderate or high profile implant will look like a larger implant.

          Implant Manufacturers

          Currently, three companies market FDA-approved breast implants in the United States: Allergan, Mentor Corporation and Sientra. They each offer saline-filled and silicone-filled implants.

          You should decide on the fill, size, surface, shape, profile and manufacturer of your implants before your breast augmentation surgery. Discuss your options, goals and concerns with your surgeon. He or she can help you make these important decisions.

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            Joseph A. Mele, MD, FACS

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