Breast Implant Types

There are two manufacturers responsible for the majority of implant sales in the United States - Mentor and Inamed (formerly McGhan). Surgeons have preferences over which company's implants they use - trust your surgeon on company choice.

Regarding the implants themselves, all FDA-approved implants are filled with sterile saline - water that contains biological concentrations of salt. If the implant ruptures, the harmless saline will be resorbed by your body.

Patients undergoing reconstructive surgery may be candidates for receiving the current version of the original (or regular) silicone gel implants - the very implants that were the subject of the short-lived 1992 FDA imposed moratorium. These silicone gel implants may also be available to women undergoing revisions of previous breast augmentations, or women undergoing breast augmentation surgery with breast lift surgery. They remain unavailable to all patients not described by the categories mentioned.

There is a new implant type filled with a cohesive silicone gel that is currently undergoing clinical trials in the United States. If the implant envelope ruptures, the gel has a decreased incidence of leaking into the surrounding tissues when compared with the original (or regular) silicone implants. The consistency of the gel is often likened to gummy bears. Interested in cohesive gel implants? Mentor, Inamed and Silimed manufacture these new implants. Ask your surgeon if he or she participates in one of these studies.

Regardless of whether you choose a saline or silicone implant, you will also have choices regarding the "feel" and the shape. There are pros and cons with all options.

Smooth Breast Implants VS Textured Breast Implants

The difference between these implant types is intuitive - the surface of one is textured and the other is smooth. Smooth implants move freely in the pocket in which they are inserted. Their shells are thinner when compared to textured implants, and they tend to last longer than textured implants. Textured implants have a higher risk of leaking. Textured implants were originally designed to prevent a complication called capsular contracture - whether they achieve that continues to be debated. Overlying tissue will grow towards the implant and "grab" a hold of the textured surface - which is the intent of the manufacturer so the implant does not move freely in the pocket. However, sometimes the tissue and the implant will move in opposite directions and the tension can cause visible rippling on the skin surface. Rippling does not occur as often with smooth implants.

Round Breast Implants VS Contoured Breast Implants

Implants are basically available in two kinds of shapes: round and contoured. The first is self-explanatory. Contoured implants - sometimes called anatomical implants - were originally designed for reconstructive purposes, and more recently have been used for breast augmentation. They are "bottom-heavy," meaning that because of their conical shape more of the volume is distributed to the bottom when held upright. Contoured implants can turn or flip in the pocket, so they are usually implanted in a textured form to maintain their position.

Placement of Breast Implant

The placement of an implant is commonly referred to as 'overs' and 'unders' which basically refers to the implant being placed over or under the pectoralis muscle.

You will find a lot of information about this subject on the web and in breast augmentation literature, and many surgeons have different and often opposite opinions on the subject. This can create a lot of confusion, especially if you get two different opinions from 2 different surgeons you consult with!

When reading on the internet about implant placement it seems that the majority of women have implants placed partially under the muscle. This is probably as the majority of women had little breast tissue to begin with so this placement is recommended, but also that many surgeons prefer to use this method. Some surgeons prefer to place implants below the muscle as they feel the risk of capsular contracture is higher with placement above the muscle. However other surgeons say they see no more capsular contracture in their overs vs. unders and perform both placements regularly.

The type of implant chosen can occassionally determine the placement. In most cases it is favourable to place a saline implant and a silicone gel implant under the muscle to decrease the chance of rippling, unless the patient has a good amount of tissue to cover the implant. The newer cohesive gel implant has a lower risk of developing visible ripples therefore either placement could be recommended to you by a surgeon.

Subglandular Breast Implant Placement

With subglandular placement the implant is placed OVER the pectoralis muscle, under your breast tissue. This placement is considered to be less painful post-surgery as only the skin and fat are cut, with a quicker recovery.

If you have little breast tissue pre-surgery this placement is not recommended as there is more chance you will feel and see rippling of the implant with saline implants. This could be avoided with the new cohesive silicone gel implants.

If you have mild Ptosis (sag) of your breasts pre-surgery this placement may be recommended. If you place the implant below the muscle without a lift with sagging breasts there is a risk of the implant sitting up high with the skin hanging down. However other surgeons think that placing the implant above the muscle could lead to move sagging in the future. It is said that this placement can interfere with the ability to perform a mammography as it prevents complete imaging of the breast tissue. It is also widely reported that there is a higher risk of capsular contracture with subglandular placement, but some surgeons disagree with this.

Submuscular Breast Implant Placement

With submuscular placement the implant is usually placed partially UNDER the pectoralis muscle. (2/3's of the implant is behind the muscle, the lower 1/3 is not). This placement is considered to be more painful post-surgery as the skin, fat and muscle are cut and the muscle is stretched, with a slightly longer recovery.

If you have little breast tissue pre-surgery this placement is definitely recommended as there is less chance you will feel and see rippling of the implant with saline implants. (However the bottom 1/3 is not covered by the muscle).

Post-surgery it does take a little longer for the implant to drop and settle than with over the muscle placement, so often the first few months the implant placement can look quite high.

If you have Ptosis (sag) of your breasts pre-surgery this placement may have to be performed with a lift to avoid the implant sitting high and the skin lower.

This placement makes performing a mammography easier, as the implant is separated from the breast tissue by the muscle. Many surgeons consider this placement to lessen the risk of capsular contracture, others disagree.