There has been a significant increase in availability of the types of breast implants in recent years. These can be saline of silicone filled, shaped or round, textured or smooth, and may have different profiles or projections. Each has its advantages (and disadvantages). Saline filled implants have been available for many years, even through the moratorium on silicone filled implants. These are filled with salt water and are unlikely to cause any local or systemic health concerns if there is a leak. A deflation is relatively easy to detect clinically and does not require any specialized testing such as an MRI (magnetic resonance imaging study). They may be placed through a smaller incision meaning a smaller scar. And they are less costly.
Silicone filled implants have a more natural feel and may be prone to less rippling than saline filled implants, particularly in the thinner female with less of her own breast tissue. The FDA returned silicone filled implants to the general market in 2006 for women 22 years of age and older seeking cosmetic breast enhancement after a 14 year hiatus. This followed the results from multiple studies which confirmed that there was no scientific basis linking these implants to the systemic diseases some were attributing to them. However FDA guidelines include recommendations for an MRI 3 years following the procedure and every 2 years thereafter to monitor implant integrity. More cohesive silicone filled implants (sometimes referred to as “gummy bear” or form stable) are also available. Implant shapes and profiles are recommended based on the individual’s anatomy. Implant shell texturing is often selected with use of silicone implants to reduce the risk of capsular contracture (scar thickening around the implant with firming of the breast).
Selecting implant size is not an exact science (despite much work attempting to make it so). Letting your plastic surgeon know what bra cup size you are visualizing may be a helpful starting point, but bra sizes are notoriously inaccurate. One company’s B cup may be another’s C cup. Implants are measured in cc of volume (where 30 cc or cubic centimeters equals 1 ounce). Reviewing photographs with your surgeon may also be helpful. The ideal goal of the procedure should be to enhance one’s proportions without making it absolutely clear that a plastic surgeon was involved. Obviously, everyone’s goals are different. Factors that are taken into consideration in addition to the individuals desires include the breast anatomy, tissue elasticity, and body habitus. In our practice, we make decisions on breast implant size with the patient prior to surgery so as to maximize satisfaction afterwards.