Breast Implant Information

Types of Breast Implants

Breast implants were originally brought onto the plastic surgery scene several decades ago. Now, after years of research and evolution in implant characteristics, women have hundreds of possible choices for breast enhancement. The volume, projection, shape, fill material, and shell surface structure variations allow for hundreds of different permutations, which offer women the possibility of finding a truly unique look to fit their desired results. Currently, breast implants are available in three main types: saline-filled implants, IDEAL IMPLANT Structured Breast Implants, and silicone gel-filled implants. All implants consist of an outer, solid silicone shell — but the internal component is what primarily differentiates the many types of breast implants.

Saline Implants

Saline implants are round, consist of a single outer shell, and are filled with varying amounts of saline solution. The body can absorb saline in the event of a rupture.

IDEAL IMPLANTs

IDEAL IMPLANT Structured Breast Implants are round, contain two chambers and a layered system of external shells, and are filled with a variable amount of saline solution.

Silicone Gel Implants

Silicone gel implants have a single outer shell and come pre-filled with different types of silicone gel in a specific volume. The silicone gel ranges in density to produce a different feel and shape retention. The most cohesive gel implants, also called “gummy bear” implants, are available in both round and teardrop shapes.

All About Saline Implants

Saline-filled implants are round implants composed of a pliable, smooth silicone outer shell and filled at the time of the breast augmentation surgery with a variable amount of sterile saline solution. They are available in a wide variety of sizes and projections, which allow for customization to each patient’s specific anatomy and desired results.

How are Saline Implants Placed?

Saline implants may be placed either directly under breast tissue (subglandular) or underneath the pectoralis major muscle (subpectoral). They may be inserted using any of the following access incisions:

Inframammary (under the breast)
Periareolar (around the nipple)
Transaxillary (via the armpit)

Additionally, these implants may be inserted through the same incision used to perform a tummy tuck if an abdominoplasty is performed concurrently.

All incisions will result in a scar in the area, but the scar is very short — usually an inch or less — because the implants are inserted when they are deflated. They are subsequently filled with saline once they are in the proper location.

Pros and Cons of Choosing Saline Implants

Advantages

Very short incision
Adjustable volume at time of surgery
Filled with saline, which the body can absorb if rupture occurs

Potential Disadvantages

These implants feel more firm than natural breast tissue
May be more likely to produce visible or palpable rippling

a close up of a woman wearing a white lace bra

Saline Implant Procedure and Risks

Most breast augmentation with saline implants is performed under general anesthesia for patient safety and comfort. Dr. Hutchinson performs breast augmentation with saline implants either in the safety, privacy, and comfort of her fully AAAASF certified operating room at her Upper East Side practice or at one of her affiliated NYC hospitals. The procedure usually lasts 1-1.5 hours, and patients are able to go home afterward. Recovery requires the restriction of strenuous physical activity for two weeks after surgery.

All surgery carries the risk of complications and untoward results. Potential complications of breast augmentation with saline implants include bleeding, infection, unsightly scars, capsular contracture, asymmetry, implant deflation, palpability, or visibility. In some cases, revision breast augmentation surgery may be necessary.

All About Structured Implants: The IDEAL IMPLANT

The IDEAL IMPLANT is an alternative to saline-filled breast implants. Developed by a plastic surgeon to provide a more natural feel to saline implants, the IDEAL IMPLANT comes without some of the risks associated with silicone gel implants (such as silent rupture and silicone gel leaking).

In addition, unlike traditional saline-filled implants, which consist of a single silicone shell, the IDEAL IMPLANT has several layers of built in baffles to create a softer, more natural feel. In clinical studies, the IDEAL IMPLANT also has a lower risk of capsular contracture and a lower rupture rate than silicone gel-filled implants.

Pros and Cons of Choosing IDEAL IMPLANTS

Advantages

Natural feel; closely resembles normal breast tissue
Adjustable volume at time of surgery
Filled with saline, which the body can absorb if rupture occurs
Short scar in an imperceptible location

Potential Disadvantages

Feel slightly firmer than silicone gel filled implants
Require placement under the pectoralis muscle

How are IDEAL IMPLANTS Placed?

IDEAL IMPLANTS should be placed underneath the pectoralis major muscle (subpectoral). They are inserted using either an inframammary incision (under the breast) or a periareolar incision (around the nipple). Regardless of which incision is used, a short scar will be located in that area. This scar is usually well hidden and most often measures less than an inch.

the ideal implant

IDEAL IMPLANT: high fill volume (left); maximum fill volume (right)

IDEAL IMPLANTS are inserted empty of any saline and are filled with an adjustable amount of saline once they are inserted in the proper location under the breast or pectoralis muscle inside your body. Since the fill volume is adjustable at the time of the breast augmentation surgery, asymmetry in appearance of the breasts — whether in size and shape — may be addressed by using different amounts of saline.

In addition, the implants may be filled to either “high” or “maximum” volume, which also changes the shape of the implant and how the breasts ultimately look. With a “high” volume fill, the implant is more conically shaped, with more central projection, whereas with the higher “maximum” volume fill, the implant assumes a rounder shape with more lateral fullness on the sides:

IDEAL IMPLANTS Procedure and Risks

General anesthesia is typically used for breast augmentation surgery with Structured implants. Dr. Hutchinson will perform this outpatient procedure either at her fully AAAASF certified operating room at her Upper East Side practice or in a hospital setting. Surgery usually lasts 1-1.5 hours, and patients go home afterward. Strenuous activities should be avoided for approximately two weeks following surgery.

It’s important for patients to understand that any type of surgery poses a risk of complications. For breast augmentation with structured implants, these risks can include bleeding, infection, unsightly scars, capsular contracture, asymmetry, and implant deflation, palpability, or visibility. For some patients who are not entirely satisfied with their results, breast revision surgery may be indicated.

All About Silicone Implants

Silicone gel-filled breast implants are available in a wide variety of options including size, shape, and type of gel used for the inner fill. Silicone gel implants are also available in a denser, more cohesive gel as either round shaped or teardrop shaped, which mimic an anatomical breast shape. These implants are filled with highly cohesive silicone gel, sometimes referred to as “gummy bear” implants. Originally used for breast reconstruction, they were subsequently cleared by the FDA for aesthetic surgery and are now also an option for cosmetic breast augmentation patients over age 22. Many alternatives exist with variations in height, width, projection, and type of teardrop shape of the implants, allowing for exceptional customization for patients’ unique characteristics and goals. The outer shell is composed of either smooth or textured silicone, and the inner gel ranges from softer or less cohesive to highly cohesive (“gummy bear”) gel. Depending on the type of gel and other characteristics of the implants, different types of cosmetic results may be obtained for any given size of implant.

Silicone gel implants with different projections: low (left) and high (right)

3 different types of breast implants

How are Silicone Implants Placed?

Silicone gel-filled implants may be placed either directly under breast tissue (subglandular or submammary) or underneath the pectoralis major muscle (subpectoral). They are inserted using either an inframammary incision (under the breast) or a periareolar incision (around the nipple). All incisions will result in a scar in the area, and although the incision is made as short as possible, larger implants require longer scars for implant insertion.

Pros and Cons of Choosing Silicone Implants

Advantages

Closely match the feel of natural breast tissue
Available in multiple styles with a wide spectrum of size, diameter, and projection
Highly cohesive gel does not spread in case of implant rupture

Potential Disadvantages

Require slightly longer incision for insertion than saline implants
Highly cohesive gel feels firmer
May undergo “silent” rupture that may not be visible or palpable on examination and requires imaging (mammogram, ultrasound, or MRI) for definitive diagnosis

Silicone Implant Procedure and Risks

Most breast augmentation with silicone implants is performed under general anesthesia for patient safety and comfort. Dr. Hutchinson offers this cosmetic surgery either in the safety, privacy, and comfort of her fully AAAASF certified operating room at her Upper East Side practice or at one of her affiliated NYC hospitals.

Breast augmentation surgery usually takes about 1-1.5 hours and is performed as outpatient surgery, i.e., patients go home on the same day of their surgery. Recovery requires restriction of strenuous physical activity for two weeks after surgery. All surgery carries the risk of complications and untoward results.

Potential complications of breast augmentation surgery with silicone gel-filled implants include bleeding, infection, unsightly scars, capsular contracture, asymmetry, implant rupture, palpability, or visibility. In some cases, breast revision surgery may be necessary to improve the ultimate result.

A Note on Textured Breast Implants

Dr. Hutchinson is proud to offer patients many options of breast implants — including silicone gel-filled breast implants, with a softer texture and more natural feel — as well as saline-filled implants, which contain natural saline solution.

All currently available breast implants used for plastic surgery in the U.S. have been subjected to extensive research and clinical studies and have all been cleared by the FDA as safe and effective medical devices that may be safely used for both breast reconstruction and aesthetic breast augmentation.

One specific type of breast implant made by Allergan, namely implants with textured shell surfaces, were recalled worldwide as of July 24, 2019. These textured shell breast implants are no longer available for implantation due to the associated risk of developing a very rare complication known as Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL).

At this time, the FDA recommends that textured shell implants be removed only in patients who have symptoms or issues with their implants, such as swelling, a mass, or fluid around the implant. However, many patients who have textured implants prefer to have their implants replaced with smooth implants regardless in order to avoid the potential development of BIA-ALCL.

All currently available breast implants used for plastic surgery in the U.S. have been subjected to extensive research and clinical studies and have all been cleared by the FDA as safe and effective medical devices that may be used for both breast reconstruction and aesthetic breast augmentation.

woman holding breast implants against her breasts

What are the Risks of Breast Implants?

Complications following breast augmentation surgery are uncommon, and many resolve on their own with time or with limited intervention. They may include:

Capsular contracture
Swelling and pain
Infection around the implant
Breakage or leakage of the implant (implant rupture)
A change in nipple sensation
Wound healing issues

If a saline implant ruptures, the implant will simply deflate in a few hours, and your body will absorb the saltwater. If a silicone implant leaks, you should be evaluated for possible implant removal or revision.

Not all implant ruptures cause symptoms in patients. Sometimes they are “silent” ruptures that are incidentally found during physical examination or routine imaging studies.

Regular monitoring of breast implants after breast augmentation is recommended to ensure continued breast health and implant integrity. A very rare disease, Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), has recently been identified and occurs in a very small subset of patients and seems limited to those with current or prior textured implants. This lymphoma is specific to breast implants.

It usually presents as a late fluid accumulation (seroma) around the implant or mass in the breast. Treatment requires surgical removal of the tumor along with the implant, capsule, and fluid. Dr. Hutchinson provides consultations and evaluations of patients who have textured implants and are concerned about swelling, a mass, or fluid in the breasts. She will formulate the most appropriate plan for managing your implants.

Breast Implant Placement

Breast implants may be placed either under the breast itself or below the pectoralis major muscle. Implant placement beneath the muscle of the chest offers some advantages over placement beneath the breast tissue only. These include reduced risk of capsular contracture (postoperative tightening around the implant) and the least degree of interference with mammogram examinations. Disadvantages include potentially greater patient discomfort in the first few days following surgery and a slightly longer recovery phase. During your consultation with Dr. Hutchinson, she will discuss which option may be right for you.

After the implants have been inserted into their respective pockets and positioned beneath each nipple, the incisions are sutured closed, then taped and bandaged. The bandages may be removed after two days, at which point a surgical bra or strap may be worn depending on the placement and type of implants.

Types of Breast Implants

Saline Implants

IDEAL IMPLANTs

Silicone Gel Implants

All About Saline Implants

How are Saline Implants Placed?

Pros and Cons of Choosing Saline Implants

Advantages

Potential Disadvantages

Saline Implant Procedure and Risks

All About Structured Implants: The IDEAL IMPLANT

Pros and Cons of Choosing IDEAL IMPLANTS

Advantages

Potential Disadvantages

How are IDEAL IMPLANTS Placed?

IDEAL IMPLANTS Procedure and Risks

All About Silicone Implants

How are Silicone Implants Placed?

Pros and Cons of Choosing Silicone Implants

Advantages

Potential Disadvantages

Silicone Implant Procedure and Risks

A Note on Textured Breast Implants

What are the Risks of Breast Implants?

Breast Implant Placement

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