Choosing the right breast implant involves navigating a complex landscape of materials, shapes, and surgical approaches. Breast implants are medical devices used to increase breast size or reconstruct breast tissue, and they are not one-size-fits-all products. The best choice is highly individualized, depending on your unique anatomy, lifestyle, and desired final appearance. Understanding these options is the first step in making an informed decision that aligns with your personal aesthetic goals and long-term health considerations.
Comparing Implant Fill Materials
The material inside the implant shell is a primary factor influencing both the feel of the breast and the long-term management requirements. The three main options are saline, traditional silicone gel, and highly cohesive silicone gel, often called “gummy bear” implants.
Saline implants consist of a silicone shell filled with a sterile saltwater solution after insertion. This allows for a smaller incision size compared to pre-filled implants. A significant benefit of saline is the immediate detection of a rupture, as the breast will noticeably deflate when the salt water is absorbed harmlessly by the body. However, saline may feel firmer and has a higher potential for visible rippling, especially in patients with minimal natural breast tissue. Saline implants are generally less expensive than silicone.
Silicone implants are pre-filled with a cohesive gel designed to mimic the feel of natural breast tissue, providing a softer consistency. Because they are inserted pre-filled, they require a slightly longer incision than saline implants. Modern silicone implants, including highly cohesive varieties, are less prone to rippling and maintain their shape well.
A rupture in a silicone implant is often referred to as a “silent rupture” because the thick gel tends to remain within the implant capsule, preventing immediate deflation. This necessitates periodic monitoring with imaging, which is a key difference in long-term maintenance. Silicone implants typically cost more than saline implants.
Understanding Implant Shape and Profile
The physical structure of the implant—its shape and profile—plays a significant role in determining the final aesthetic outcome. Implants are primarily available in two shapes: round and anatomical (teardrop).
Round implants are symmetrical and provide uniform fullness across the entire breast, resulting in more projection and fullness in the upper part of the breast and greater cleavage. Anatomical, or teardrop, implants are shaped more like a natural breast, being thinner at the top and gradually fuller toward the bottom. This design creates a subtle, natural downward slope and is often preferred for a discreet enhancement. Because of their specific shape, rotation of an anatomical implant can alter the breast’s appearance, which is not a concern with symmetrical round implants.
Implant profile refers to how far the implant projects forward from the chest wall relative to its base width. Profiles range from low to extra-full. A low-profile implant has a wider base and less forward projection, suitable for individuals with a wider chest wall who desire a subtle enhancement. Conversely, a high-profile implant has a narrower base and greater forward projection. High-profile implants are often recommended for individuals with a narrow chest who want a more noticeable and defined silhouette.
Surgical Placement Options
The choice of where the implant is placed surgically, either above or below the chest muscle, significantly impacts recovery, appearance, and screening for breast health.
Subglandular Placement
Subglandular placement positions the implant behind the breast tissue but in front of the pectoralis major muscle. This placement generally allows for a quicker recovery time with less initial pain because the muscle is not manipulated. Subglandular placement often provides a more pronounced fullness in the upper breast, creating a rounder look and defined cleavage. However, this positioning can lead to a higher risk of visible rippling or the implant’s edges being felt, especially in patients with thin skin or minimal natural breast tissue. It is also associated with a higher incidence of capsular contracture and can interfere more with routine mammography screening.
Submuscular Placement
Submuscular placement involves positioning the implant partially or entirely beneath the pectoralis major muscle. Placing the implant under the muscle provides an extra layer of tissue coverage, which helps camouflage the implant edges and reduces the visibility of rippling. This placement is often preferred for women with less existing breast tissue and may result in a more natural-looking slope to the breast. While submuscular placement is associated with a lower risk of capsular contracture and allows for easier mammography, the recovery is typically longer and more painful due to muscle manipulation. Patients may also experience a temporary distortion of the breast shape when the pectoral muscle is flexed, known as animation deformity.
Long-Term Maintenance and Longevity
Breast implants are not intended to last a lifetime and require ongoing monitoring and potential replacement. The expected lifespan for both saline and silicone implants is typically between 10 to 20 years. However, many may last longer without complications, though up to one in five augmentation patients may require removal within 10 years due to complications.
One of the most common long-term complications is capsular contracture. This occurs when the scar tissue capsule that naturally forms around the implant tightens and squeezes it. This complication can lead to the breast feeling firm, becoming distorted in shape, and causing discomfort or pain. The risk of capsular contracture can vary depending on the implant placement and other factors.
For individuals with silicone gel-filled implants, the FDA recommends a specific screening protocol for silent ruptures. The first magnetic resonance imaging (MRI) scan is advised three years after the initial implantation. Following this, an MRI is recommended every two years for the lifetime of the implants. Saline implants do not require this routine imaging because a rupture is immediately apparent upon deflation.