Breast Implants 101

By Elana Pruitt © 2006-2009
PlasticSurgery.com Editor

To truly feel at ease in getting breast augmentation surgery, you should understand not only the risks, uncertainties, and of course, the benefits of the procedure — you should become educated about your implant options as well. This doesn’t just mean basing your decision on which implant will give you the best out-to-here bust size. Now’s the time to dig deep and uncover what you need to know about type, size, shape, surface quality, and other details regarding your big decision. We all have friends who adore their new image, considering their newfound confidence and enhanced appearance, but what is right for them may not be right for you. It’s not enough to just want bigger breasts — you must also take your body’s unique anatomy into consideration. So read up, talk to a doctor, and happy learning!

Breast Implant Anatomy

The three main components of breast implants are:

The shell:
Also known as the envelope or lumen, the shell is the outside layer. All implants have a silicone-elastomer shell, varying in two types of surface qualities: smooth and textured.
The filler:
This is the substance inserted in the shell. Saline, silicone, and cohesive-gel are the available fillers for a patient seeking breast augmentation; although, silicone is only used for patients taking part in an adjunct study.
Fill valve:
Where the filler is inserted; reintroduced into the entry.

Breast Implant Types

Saline
Generally considered the "safest" implant to date, saline is the predominantly-used implant by U.S. plastic surgeons. This implant has been available for more than 30 years, and is composed of a sterile, saltwater-based solution covered in a silicone rubber shell. Although prone to rippling and wrinkling, saline implants are available to breast augmentation patients on an unrestricted basis. Should they ever leak or rupture, danger and risk for infection is considerably low, and comparable to body fluid.

Silicone
Most surgeons would agree that silicone gel-filled implants are more "natural-looking" than saline. Yet, due to very questionable concerns over possible auto immune syndrome, the FDA has conditionally approved the use of silicone in the United States. For a patient undergoing breast augmentation using silicone, she must be a candidate for reconstruction, revision, and/or participating in an adjunct study, which will track their progress for at least five years.

Cohesive-Gel Filled
Made of semi-solid silicone, the newest implant on the block is known as the "Gummy Bear Implant" which also has FDA-regulations. The gummy bear implant was designed to prevent leakage and keep better form with a cohesive, gel-like substance, which possesses the same quality of gummy candy. This implant is only available for U.S. patients who are participating in an adjunct study, wanting breast implant revision, or seeking reconstruction following a mastectomy.

Saline Breast Implants

The type of saline implants depends on a patient’s preference and the doctor’s suggestions. Saline implants vary, depending on how the solution is filled. Patients can choose from:

  • Single lumen implant that is filled through a valve with a fixed volume of saline during the surgery, or intraoperatively. After surgery, no adjustments can be made.
  • Single lumen implant filled through a valve. After surgery, the volume can be adjusted by adding or extracting saline to improve breast size, shape, and symmetry according to the patient’s needs. Adjustments can be made up to six months.
  • Pre-filled single lumen implant filled at a fixed volume before surgery (not FDA-approved and no longer available in the United States).

Silicone Breast Implants

For patients participating in an adjunct study, the types of silicone gel-filled implants vary. Depending on what motivated your decision to undergo breast augmentation combined with your doctor’s recommendation, you can choose from:

  • Single lumen, fixed volume implant that is pre-filled with silicone gel
  • Double-lumen inflatable implant; inner lumen is pre-filled with a fixed silicone-gel, and a valve on the outer lumen is placed so saline can be filled intraoperatively
  • Double-lumen inflatable implant; outer lumen is pre-filled with a fixed silicone-gel, and the inner lumen is filled with saline through a valve intraoperatively, also allowing for postoperative correction or adjustment with saline

Shape and Quality

Along with figuring out which type of implant will best suit your needs, the shape you pick also plays a major role in helping you get the look you’ve always wanted. While round implants are similar to a flattened sphere, offering fullness in the upper poles of your breasts, anatomical implants, popularly known as teardrop implants may give a patient greater projection (because these implants may cause rotational deformity, Dr. Stuart Linder does not use anatomical implants). Besides implant placement, exterior quality matters too. Round implants are available in smooth and textured styles for the outer surface, and anatomical implants are usually textured to maintain their orientation. Textured implants were originally developed to prevent capsular contracture; they tend to be firmer, have an increase risk of rippling, but less risk of displacement. Smooth implants, on the other hand, have a lower risk of rippling, and have a thinner shell that makes them long-lasting. A doctor can help you determine which shape and surface quality will meet your needs and benefit your body type.

Sizing

Picking the size of your implants can be tricky. It’s not enough to just say you want a "C" or a "D," because the same size can look different with each individual and will vary by manufacturer (Inamed Aesthetics and Mentor Corporation). A doctor measures the size of your implants by volume in cc’s — cubic centimeters; he or she will help to translate bra size into the amount of silicone or saline needed.

Placement

Over the muscle (subglandular):
The implant is placed directly underneath the breast tissue and on top of the pectoral, or chest, muscle. Benefits: easy to place, less post-op discomfort, cleavage more easily created. Possible Risks: Ripples may be easier seen and felt, interference with breast cancer detection and mammography, capsular contracture, "fake" augmented look.
Under the muscle (complete submuscular):
The top two-thirds of the implant is placed behind the pectoral muscle and serratus muscle, and the lower one-third sits behind the fascia — the connective tissue that connects the chest muscles and abdominal muscles. Benefits: little risk of visible rippling, low risk of capsular contracture and bottoming out, mammograms easy to read. Possible Risks: Post-op discomfort, widely-spaced implants make it difficult to create cleavage.
Partial Unders (partial submuscular):
The upper two-thirds of the implant are placed behind the pectoral muscle, while the lower one-third is located behind the breast tissue. Benefits: decreased risk of ripples and capsular contracture, more natural-looking slope. Possible Risks: post-op discomfort, ripples, bottoming out, distorted look when flexing chest muscles, may take a long time to settle into a natural-looking position.

Incision Sites

Periareolar (nipple):
This incision is one of the most widely-used for breast augmentation; it is made at the outer edge of the areola, where the dark meets the light. This camouflages the scar, and helps it to blend in. It allows for predictable placement of the inframammary fold, especially with asymmetrical breasts.
Inframammary(crease):
This incision is situated in the inframammary fold, also known as the crease underneath the breast. It may be good for first-time surgeries, as well as breast implant revisions.
Transaxillary (armpit):
The incision is made in the natural "folds" of the skin, concealing the scar. It is important to find a plastic surgeon experienced in this type of incision because the work is done away from the breast area. Augmentation through this site is not recommended for saggy or ptotic breasts.
Transumbilical/ TUBA (belly button or navel):
The newest available for breast augmentation, the transumbilical incision is made at the rim of the belly button. An endoscope, which is a lighted camera, is used for insertion to make a tunnel through subcutaneous leading to loose, breast tissue. (Dr. Stuart Linder does not agree with this operation; he says the incision is too far from the breast area to receive safe, accurate, and predictable results.)

Breast size doesn’t make the woman — but it can definitely make you feel better about your appearance! Whether you qualify for silicone implants or prefer the use of saline, you should understand your options first before making a decision that will permanently change your looks. Keep searching on PlasticSurgery.com to find a doctor who specializes in breast augmentation.

Breast Implants 101

by Elana Pruitt

To truly feel at ease in getting breast augmentation surgery, you should understand not only the risks, uncertainties, and of course, the benefits of the procedure – you should become educated about your implant options as well. This doesn’t just mean basing your decision on which implant will give you the best out-to-here bust size. Now’s the time to dig deep and uncover what you need to know about type, size, shape, surface quality, and other details regarding your big decision. We all have friends who adore their new image, considering their newfound confidence and enhanced appearance, but what is right for them may not be right for you. It’s not enough to just want bigger breasts – you must also take your body’s unique anatomy into consideration. So read up, talk to a doctor, and happy learning!

Implant Anatomy

The three main components of breast implants are:

  • The shell: Also known as the envelope or lumen, the shell is the outside layer. All implants have a silicone-elastomer shell, varying in two types of surface qualities: smooth and textured.
  • The filler: This is the substance inserted in the shell. Saline, silicone, and cohesive-gel are the available fillers for a patient seeking breast augmentation; although, silicone is only used for patients taking part in an adjunct study.
  • Fill valve: Where the filler is inserted; reintroduced into the entry.

Types

Saline
Generally considered the “safest” implant to date, saline is the predominantly-used implant by U.S. plastic surgeons. This implant has been available for more than 30 years, and is composed of a sterile, saltwater-based solution covered in a silicone rubber shell. Although prone to rippling and wrinkling, saline implants are available to breast augmentation patients on an unrestricted basis. Should they ever leak or rupture, danger and risk for infection is considerably low, and comparable to body fluid.

Silicone
Most surgeons would agree that silicone gel-filled implants are more “natural-looking” than saline. Yet, due to very questionable concerns over possible auto immune syndrome, the FDA has conditionally approved the use of silicone in the United States. For a patient undergoing breast augmentation using silicone, she must be a candidate for reconstruction, revision, and/or participating in an adjunct study, which will track their progress for at least five years.

Cohesive-Gel Filled
Made of semi-solid silicone, the newest implant on the block is known as the “Gummy Bear Implant” which also has FDA-regulations. The gummy bear implant was designed to prevent leakage and keep better form with a cohesive, gel-like substance, which possesses the same quality of gummy candy. This implant is only available for U.S. patients who are participating in an adjunct study, wanting revision, or seeking reconstruction following a mastectomy.

Saline Implants

The type of saline implants depends on a patient’s preference and the doctor’s suggestions. Saline implants vary, depending on how the solution is filled. Patients can choose from:

  • Single lumen implant that is filled through a valve with a fixed volume of saline during the surgery, or intraoperatively. After surgery, no adjustments can be made.
  • Single lumen implant filled through a valve. After surgery, the volume can be adjusted by adding or extracting saline to improve breast size, shape, and symmetry according to the patient’s needs. Adjustments can be made up to six months.
  • Pre-filled single lumen implant filled at a fixed volume before surgery (not FDA-approved and no longer available in the United States).

Silicone Implants

For patients participating in an adjunct study, the types of silicone gel-filled implants vary. Depending on what motivated your decision to undergo breast augmentation combined with your doctor’s recommendation, you can choose from:

  • Single lumen, fixed volume implant that is pre-filled with silicone gel
  • Double-lumen inflatable implant; inner lumen is pre-filled with a fixed silicone-gel, and a valve on the outer lumen is placed so saline can be filled intraoperatively
  • Double-lumen inflatable implant; outer lumen is pre-filled with a fixed silicone-gel, and the inner lumen is filled with saline through a valve intraoperatively, also allowing for postoperative correction or adjustment with saline

Shape and Quality

Along with figuring out which type of implant will best suit your needs, the shape you pick also plays a major role in helping you get the look you’ve always wanted. While round implants are similar to a flattened sphere, offering fullness in the upper poles of your breasts, anatomical implants, popularly known as teardrop implants may give a patient greater projection (because these implants may cause rotational deformity, Dr. Linder does not use anatomical implants). Besides implant placement, exterior quality matters too. Round implants are available in smooth and textured styles for the outer surface, and anatomical implants are usually textured to maintain their orientation. Textured implants were originally developed to prevent capsular contracture; they tend to be firmer, have an increase risk of rippling, but less risk of displacement. Smooth implants, on the other hand, have a lower risk of rippling, and have a thinner shell that makes them long-lasting. A doctor can help you determine which shape and surface quality will meet your needs and benefit your body type.

Sizing

Picking the size of your implants can be tricky. It’s not enough to just say you want a “C” or a “D,” because the same size can look different with each individual and will vary by manufacturer (Inamed Aesthetics and Mentor Corporation). A doctor measures the size of your implants by volume in cc’s – cubic centimeters; he or she will help to translate bra size into the amount of silicone or saline needed.

Placement

Over the muscle (subglandular): The implant is placed directly underneath the breast tissue and on top of the pectoral, or chest, muscle. Benefits: easy to place, less post-op discomfort, cleavage more easily created. Possible Risks: Ripples may be easier seen and felt, interference with breast cancer detection and mammography, capsular contracture, “fake” augmented look.

Under the muscle (complete submuscular): The top two-thirds of the implant is placed behind the pectoral muscle and serratus muscle, and the lower one-third sits behind the fascia – the connective tissue that connects the chest muscles and abdominal muscles. Benefits: little risk of visible rippling, low risk of capsular contracture and bottoming out, mammograms easy to read. Possible Risks: Post-op discomfort, widely-spaced implants make it difficult to create cleavage.

Partial Unders (partial submuscular): The upper two-thirds of the implant are placed behind the pectoral muscle, while the lower one-third is located behind the breast tissue. Benefits: decreased risk of ripples and capsular contracture, more natural-looking slope. Possible Risks: post-op discomfort, ripples, bottoming out, distorted look when flexing chest muscles, may take a long time to settle into a natural-looking position.

Incision Sites

  • Periareolar (nipple): This incision is one of the most widely-used for breast augmentation; it is made at the outer edge of the areola, where the dark meets the light. This camouflages the scar, and helps it to blend in. It allows for predictable placement of the inframammary fold, especially with asymmetrical breasts.
  • Inframammary(crease): This incision is situated in the inframammary fold, also known as the crease underneath the breast. It may be good for first-time surgeries, as well as revisions.
  • Transaxillary (armpit): The incision is made in the natural “folds” of the skin, concealing the scar. It is important to find a plastic surgeon experienced in this type of incision because the work is done away from the breast area. Augmentation through this site is not recommended for saggy or ptotic breasts.
  • Transumbilical/ TUBA (belly button or navel): The newest available for breast augmentation, the transumbilical incision is made at the rim of the belly button. An endoscope, which is a lighted camera, is used for insertion to make a tunnel through subcutaneous leading to loose, breast tissue. (Dr. Stuart Linder does not agree with this operation; he says the incision is too far from the breast area to receive safe, accurate, and predictable results.)

Breast size doesn’t make the woman – but it can definitely make you feel better about your appearance! Whether you qualify for silicone implants or prefer the use of saline, you should understand your options first before making a decision that will permanently change your looks. Keep searching on PlasticSurgery.com to find a doctor who specializes in breast augmentation.

This article has been medically reviewed by Beverly Hills plastic surgeon Stuart A. Linder, M.D.