Implant Characteristics

Inside Fill

Silicone:

The medical use of silicone arose after World War II and quickly became the gold standard for biomedical devices because of the body's lack of reactivity to its presence. In the 1950's silicone gel was injected directly into the breast tissue with large needles. The results were disastrous. Scar tissue capsules formed throughout the breast in an attempt to isolate the silicone. The breasts frequently became hard and there was no way to excise the silicone without excising the breast tissue with it.

In 1962 the first silicone implants were developed and tried with vastly improved results. Breasts were soft and natural. If capsular contractures developed the implant could easily be removed leaving the breast tissue relatively untouched. The scar tissue could also be removed fairly easily with little breast tissue attached.

In 1992 when questions arose about the safety of silicone breast implants their use was severely restricted by the FDA and remains so in spite of the fact that over 1700 studies done around the world have demonstrated no increased risk of associated autoimmune diseases. It is unlikely we will see silicone back on the market for wide use for several more years until the American studies undertaken in the early nineties are officially completed and the results fully analyzed.

Saline:
Saline filled implants became available within a few years of their silicone cousins. Early on there were problems with a high deflation rate and they fell out of favor with many surgeons. But in 1992 when silicone implants were, for the most part, removed from the market, saline implants which had been greatly improved, became the standard for breast augmentation. They, too, are soft and can give very natural looking results.

Surface: Smooth or Textured

Smooth Implants:
In the early days of breast augmentation all implants were smooth and placed in a subglandular position. The scar capsule that develops around them is highly organized. The capsular contracture rate is very high, perhaps as high as 70%. More than twenty years ago it was discovered that if smooth implants were placed beneath the pectoralis major muscles the contracture rate dropped to around 9%. The muscle only covers about half the implant and no one knows exactly why it changes the contracture rate so dramatically, but it has become the standard in breast augmentation.

Textured Implants:
The first textured implants that were used were covered with a layer of polyurethane foam. They remained very soft in most patients. Some surgeons still feel they were some of the softest breasts ever achieved with implants. As the capsule grew around them scar tissue developed within the foam in a disorganized fashion. It was felt that this disorganization prevented the contraction of the scar around the implant, keeping the breast feeling soft. When the concern about the safety of silicone arose the company that made these implants stopped manufacturing them because it was learned that the human body would breakdown the foam coating. No one had proved whether or not that presented a problem.

Other manufacturers decided to mimic the physical characteristics of the foam by texturing the silastic shell of their implants so they felt rough. The capsular contracture rate fell to somewhere between 5 and 10%, but another problem came up, that of visible rippling especially along the upper and inner aspects of the breasts. This may be due to the adherence of the capsule to the implant, which in my mind, is rather like velcro.

Shape: Round or Teardrop

Round Implants:
Round implants have been the traditional shape since the beginning of breast augmentation. As the diameter of the implant is increased the implant gets larger by the same amount in all directions. The distance the implant projects outward can also be selected. There are low or mid-profile implants that are the most commonly used in cosmetic breast augmentation and high-profile implants that are more commonly used in breast reconstruction.

In my experience I have found that the more the skin is stretched the rounder the breast will look no matter what the shape of the implant. In women with some tissue laxity who do not desire a large increase in breast size a round implant can have a very natural looking result. In a woman with no tissue laxity even a small implant will result in a rounded upper portion of the breast. Many woman are looking for just this shape.

Teardrop Implants:
Oval or teardrop implants have been tried off and on over the years with varying degrees of success. Today's versions are sometimes referred to as "anatomical" because their shape closely resembles that of a "natural" breast with a straight slanted upper portion and rounded lower portion. The more the skin is stretched the rounder the upper portion will look. I have been pleased with the appearance of the implant in very small breasted woman with tight skin who want a natural shape. In the few instances when a woman has enough breast tissue to place the implant over the muscle this implant has also given nice results.

Two recent studies took women with both shapes of implants, sat them up, took x-rays and traced the shape of the implants. There was essentially no difference in shape between the round and the teardrop implants. This is certainly compelling evidence that spending the extra money on teardrop implants will not get you a better shape. Again the relationship of the amount of tissue laxity to implant size makes the difference whichever implant you chose.

Click here to continue reading about breast enlargement

Introduction | Breast Cancer and Mammograms | Capsular Contractures
Implant Characteristics | Anatomical Considerations | Surgical Considerations
| Complications | Breast Enlargement Photos

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