Breast Implant Choices
San Diego Breast Implant Choices
Round vs. Shaped Breast Implants
Each of the three companies marketing FDA approved breast implants in San Diego offers a vast array of sizes and shapes to meet the needs of most women. Because each woman has a unique combination of breast size and shape, chest size and shape, desired result, and personal preferences, the breast augmentation procedure usually involves both careful selection of the implant that will best fit each woman, and then breast and chest adjustment to best fit the selected implant. Round implants offer fullness of the upper breast for women with “tight” skin envelopes, and change shape easily with positional changes. Round implants are available with both smooth and textured surfaces. Smooth surface round implants can rotate freely within their pocket without change in the visible breast contour. For women who desire large augmentation, it may be difficult to achieve a natural shape with round implants because of upper breast fullness.
Shaped (“tear drop”) implants offer less fullness of the upper breast for women with a tight skin envelope, but more upper fullness for women with a loose skin envelope. Because some shaped breast implants project maximally below the breast meridian (mid-portion of the breast), these prostheses are uniquely suited for women whose nipple-areola are low on the breast and who do not want a formal breast lift to accompany augmentation. Dr. Laverson uses shaped implants for women with elliptical breasts because the footprint of these implants more closely matches the breast being augmented. Using implants that match the woman’s native breast shape avoids surgical maneuvers to reshape the woman’s breast to fit an implant that doesn’t match. These re-shaping maneuvers can detract from the final result by changing the breast shape so it is un-natural, so it “doesn’t feel right” to the woman, and may cause visibility of the breast implant interface with native breast tissue, an undesirable aesthetic feature. Shaped implants always have a textured surface to prevent implant rotation. They are available with both saline and silicone gel fill, and must be selected carefully to match the woman’s pre-surgical breast with her aesthetic goals.
Breast Implants Filled with Silicone Gel vs. Implants Filled with Saline (Salt Water)
Dr. Steve Laverson uses breast implants (prostheses) manufactured by the three companies that market these devices in the United States: Allergan, Mentor, and Sientra. All available prostheses have a solid silicone shell. Although solid, the shell is thin so that the feel or consistency of the implant depends almost entirely on the fill substance inside. Within the shell is a fill substance that gives the implant its texture and maintains its shape and volume. The two available fillers are liquid saline (salt water), and silicone gel. Silicone gel is a polymer (type of chemical) that may be produced in a variety of consistencies. The silicone gel filler of breast implants is high viscosity, and cohesive. If cut in half, gel does not leak out and disseminate in the chest or elsewhere. Cohesive gel implants easily deform when pressure is applied, and they change disposition with the woman’s posture. They are soft to touch. Silicone may also be “highly cohesive”, in which case the implant still feels soft, but more solid than regular cohesive gel devices. Highly cohesive implants have a texture similar to “gummy bear” candies. Highly cohesive breast implants maintain their shape regardless of chest posture, and are thus “form stable.” Highly cohesive implants are Style 410, manufactured by Allergan® and marketed as the Natrelle® brand.
The fact that these implants are placed behind the breast very much affects what they feel like after surgery. The more breast tissue you have before augmentation, the more your final result will feel like your breasts always have. The greater the percentage of implant in your final breast volume, the more your breast will feel like the implant. In many years of performing breast augmentation, Dr. Laverson believes both saline and gel implants feel very natural. The primary cause of un-natural texture is advancing capsular contracture, which causes implant enhanced breasts to become firm, or in advanced cases, hard.
Saline (salt water) breast implants ship sterile from the manufacturer, and arrive in Dr. Laverson’s operating room as empty solid silicone shells. During breast enhancement surgery, saline implants are carefully removed from their package, air is evacuated from the sterile implant, and the device is inserted into a pocket developed by Dr. Laverson behind the breast. The implant is filled with sterile iso-osmolar (identical to human plasma) salt water to its recommended final volume through a specialized valve. The implant is positioned and oriented properly, and all women are then examined in the sitting position to confirm a good relationship between implant location and breast disposition.
Silicone gel implants are also packaged sterile, but have no valve on their surface. Gel implants are delivered to Dr. Steve Laverson for breast enlargement San Diego completely filled to the selected size with cohesive or highly cohesive silicone gel. At surgery, gel implants are removed from their packaging and inserted into a space behind the breast. The result is immediately apparent because the implant comes pre-filled. Proper relationship between implant location and the overlying breast is confirmed in the sitting position.
Some women prefer saline implants, and gel is more suitable for others. They are both high quality implants, and none proven to last longer. Saline implants are less expensive. Highly cohesive implants are more expensive. For women with B cup breasts and larger, Dr. Laverson believes that texture of saline and gel implants is similar, and difficult to distinguish. For women who are very lean, thin, or small breasted, gel may be preferred because of its more natural texture, and less tendency to produce visible and/or palpable (detectable by touch) rippling in certain positions.
An additional difference between gel and saline devices: What happens if the implant shell ruptures? Saline implants deflate as the sterile salt water is absorbed. The woman with saline implants knows almost immediately that her implant has ruptured. She wants a new implant to replace the deflated one. Both saline implant manufacturers (Allergan and Mentor) provide a warranty on their prostheses, so save your implant information in order to get an identical replacement if one side deflates. If a gel implant ruptures, cohesive silicone gel does not leak out, but is contained within the implant shell and the surrounding capsule of scar. Most women with ruptured gel implants do not know immediately of any problem. For this reason, implant manufacturers and the FDA advise women with gel implants to check implant integrity periodically with an MRI (magnetic resonance imaging) study. While recommended, these studies are NOT required. It is strongly recommended however, that if you discover your gel breast implant has ruptured, it should be removed or replaced.
Breast Implant Choices – Textured (rough) Surface vs. Smooth Surface
The solid thin silicone breast implant surface may be smooth or rough (textured) Smooth surface implants appear translucent and glossy. Textured surface devices appear opaque like ground glass and offer more
friction against surrounding surfaces. You will see and feel both types of implants at your consultation with Dr. Steve Laverson if you are considering breast augmentation San Diego. Both saline (salt water) and silicone gel implants are produced with smooth and textured surfaces. Differences in the interaction between smooth and textured surface breast implants (implant-tissue interaction) are understood on a limited basis. Both are acceptable to use in most situations.
Because of the rough surface of textured implants,Dr. Laverson has observed they are more likely to stay exactly where he puts them during breast augmentation. He believes they are less likely to drop after surgery, and less likely to deviate laterally when placed beneath the pectoralis (chest) muscle. Dr. Laverson prefers textured implants when placing the devices beneath the pectoralis muscle. The implant is wedged between muscle in front and the curved ribs behind. Contraction of the muscle during use of the arms applies force to the front of the implant and on its inner aspect, tending to push it out toward the side and down. The capsule your body forms around a textured implant surface grabs the rough surface and like a tire with a deeper tread, resists this downward and outward force. The smooth surface implant slides more easily and with its lower coefficient of friction may be more prone to displacement when placed beneath the pectoralis major muscle.
Smooth surface implants however, probably have an advantage when the implant position is subglandular (in front of the pectoralis major muscle). To produce a soft implant that assumes a natural shape, the implant shell is not filled to capacity during the manufacturing process. This allows the implant to shift its shape like the natural breast with changes in body position. Normal behavior of the implant is to wrinkle slightly at the top because of this underfill. In thin, lean women, women with large implants, and women with implants in subglandular position, these implant wrinkles may be transmitted to the skin, which produces a very artificial appearance, and discloses the presence of implants. This tendency is magnified when a textured surface prosthesis is subglandular, because the textured surface grips the capsule, which is attached to overlying soft tissue and skin. Thus, when a superficially placed textured implant ripples, these ripples may be more visible on the skin surface than if the superficially placed implant is smooth, and less likely to be adherent to the capsule.
Depending on your body type, your lifestyle, your preferences, and the size implant you select, Dr. Laverson may recommend smooth surface or textured surface implants. There is no cost difference.