Breast Augmentation - Breast Implants
San Francisco Breast - Breast Augmentation Pages
Breast Implants now come in many sizes, shapes and styles. With more options comes the opportunity for more individualized results. Matching different body types with the most proportional breast implants gives better results. Whether you are looking for results that are smoldering, smoking or hot, there is a Breast Implant for that.
The main options to consider when selecting your breast implants are the type of filler, the shape of the implants and the volume of the implants. Below many of the frequently asked questions about breast implants and breast augmentation are answered. Since this site is designed for general informational purposes only, specific recommendations can only be made after a consultation with your selected plastic surgeon.
Breast Augmentation Before and After Photos (Augmentation Mammoplasty with Breast Implants)
How do you pick your Breast Implants?
The best answer is, "With the guidance of a Board Certified Plastic Surgeon, who has years of practice." The details of each Breast Implant Option must be evaluated on the basis of both the benefits and limitations. The current options for Breast Implant fillers are saline filled breast implants and silicone filled breast implants. There are also options in the amount of projection a Breast Implant has too. Implant Profiles range from low profile to high profile, with moderate profile and moderate-plus profile in the middle. Breast Implants can be round or shaped, smooth or textured, depending on your goals. By selecting the best Breast Implant Options, the optimal Breast Augmentation results are achieved. A Breast Implant that matches your body, provides you the best volume, width, projection and most importantly gives a more natural and proportional result.
There is a downside to options too. Without a clear understanding of all the pros and cons, the large number of Breast Implant choices can lead to confusion. A Board Certified Plastic Surgeon with years of Breast Augmentation Expertise, like Dr. Joseph Mele, can guide you through these choices to the Breast Implants that are optimal for your body, and help you get the look you want. The best Breast Implants are those that provide you with the best possible cosmetic result, with safety and predictability. Below are more details about the current options available for breast implants.
Breast Augmentation Video Presentation
Click or touch to view a video presentation.
Breast Implant Options
So what are your options for Breast Implants? You will find the answers to many of the most frequently asked questions about breast implants on this page. The following Breast Implant information can serve as good baseline knowledge. Despite the detail provided, it cannot replace an in person consultation with a Board Certified Plastic Surgeon.
Breast Implant Frequently Asked Questions
The five main aspects of Breast Implants that spark questions are listed below. If you are just starting your research, reading the entire page is recommended. If you are looking for specific information, clicking on the question will skip down the page to sections addressing topic such as: size, filling (silicone vs. saline), profile, shape and surface choices.
- How do I choose my Breast Implant Size?
- Which is better, Silicone Breast Implants or Saline Breast Implants?
- Which Breast Implant Profile best fits my body?
- Which is best, Round or Teardrop Shaped Breast Implants?
- Which is better, Smooth Breast Implants or Textured Breast Implants?
Breast Implant Size
Breast implant size is perhaps the most difficult aspect of breast augmentation because there are so many breast implants to choose from. Implant size, specifically breast implant volume, determines the final cup size. The choice will be affected by the amount of breast tissue present before surgery, the desired end point, the amount of skin on the breast, the elasticity of the breast skin and to a lesser extent, the size of the pectoralis major muscle when the implants are placed behind the muscle.
Most of my breast augmentation patients would like to increase their breast volume by one or two cups sizes. There are many methods to help determine the best size match for your body. One easy way is to get a bra that is the cup size you desire. The number will be the same as the bra you are currently wearing. Add volume to the bra's cup with a Zip-Lock® bag filled with rice. The volume of rice can be varied to get the desired results. This is an easy way to try out a range of volumes. Bringing the optimally filled bags to the office can help me choose the best breast implant for you.
There are a large number of breast augmentation before and after pictures available online. If you see some that look how you would like to look, print them and bring them to your consultation appointment. This too, can serve as a guide to optimize your results. It is important that you are comfortable with the size, because this a big step towards the ultimate goal, that you are comfortable with your breast augmentation. A little homework can really help get you where you want to be.
Saline Breast Implants vs. Silicone Gel Breast Implants vs. "Gummy Bears"
There are two types of fillers currently available for my San Francisco Bay Area Breast Augmentation Patients: Saline and Silicone. Both are safe and effective fillers for breast implants. Both saline breast implants and silicone gel breast implants have a silicone shell. Since the shell is solid, it is stable and well tolerated by the body. Silicone is used in many medical devices including facial implants for cheeks and chins, artificial joints, catheters, even IV's. What makes saline and silicone breast implants unique is their center. There are pro's and con's with both saline and silicone gel, and it is important that you know the differences so you can choose the filler that makes the most sense for your specific needs.
Dr. Joseph Mele has been a primary investigator for saline and silicone breast implants, with both Mentor and Allergan, since establishing his Walnut Creek Plastic Surgery private practice. He is familiar with the pros and cons of each filler. For some patients, there will be a clear advantage to using one implant filler over the other, but for many women, both fillers will work equally as well, with some minor trade-offs. Reviewing the options is an important part of your confidential consultation.
Saline Breast Implants
Saline Breast Implants have a soft shell of solid silicone. A diaphragm valve is built into the shell of the Breast Implant. This valve keeps the saline inside the breast implant, and allows the fill volume to be adjusted during surgery. Saline implants are normally inserted empty, with the fill valve attached. With the implant already in the pocket, saline is added. The volume of saline is adjusted, prior to removing the fill tube, to help fine tune the final results.
- Advantages of Saline Breast Implants:
- Easy detection of leaks. The implant will noticeably deflate, so no MRI is needed.
- Saline is quickly absorbed by the body. We are mostly saline, so the body handles is like it handles normal swelling.
- Increased projection. The saline implant is stiffer, so it will push the breast out further, an advantage when desired.
- Slightly lower risk of capsular contracture.
- Peace of mind for those who are unsure about the silicone gel filler
- Requires a smaller incision than other implants. Three centimeters is an average length.
- Simpler to replace if they deflate
- Lower cost
- Disadvantages of Saline Breast Implants:
- Higher risk of rippling
- Easier to feel (more palpable)
- Firmer silicone shell when compared to silicone gel filled breast implants
- Slightly higher leakage rate
Silicone Breast Implants
Silicone Breast Implants also have a soft shell of solid silicone; however, they do not have a built-in valve. Instead, silicone breast implants come sealed and pre-filled.
- Advantages of Silicone Breast Implants:
- A softer result than saline breast implants, especially with thin breast tissue coverage.
- Better movement with changes in position
- Decreased rippling
- Softer silicone shell when compared to saline filled breast implants
- Slightly lower leakage rate for cohesive gel breast implants
- More profiles (shapes) are available
- Highly cohesive (form stable, gummy bear or 410's) have a soft solid center and cannot leak.
- Disadvantages of Silicone Breast Implants:
- For cohesive gel breast implants, it can be difficult to detect leaks, so FDA recommends an MRI at three years and then at two year intervals
- Silicone is not absorbed by the body, and if the implant leaks, surgery is required for removal as the body will try to surround it with scar.
- Requires a longer incision than saline implants. Five centimeters for cohesive gel, seven centimeters for highly cohesive (form stable, gummy bear or 410's)
- Silicone breast implants cost more than saline breast implants.
- Slightly higher risk of capsular contracture
- Despite being the most investigated medical device to date, some people just don't like them.
Gummy Bear Breast Implants (High Strength Silicone Gel)
Gummy Bear Breast Implants are Silicone Gel Breast Implants that go by many names: High Strength, Highly Cohesive and Form Stable. The advantages and disadvantages are similar to those listed above for silicone gel breast implants, with a few differences directly attributable to the improved cohesiveness (stickiness) of the gel filling the implant.
The filling in Allergan's Natrelle style 410, Johnson & Johnson's Mentor Contour Profile Gel (CPG) and Sientra's (Silimed's) entire line of silicone breast implants is a high strength silicone gel. This is a silicone gel that no longer flows like a liquid. The most obvious advantage of this is that even if the breast implant is ruptured, the gel cannot leak out like its predecessors. It is a soft solid that can be easily compressed, but the gel "remembers" its shape. In other words, when the compression is released, these form stable breast implants return to their original shape. This feature allows gummy bear implants to formed into specific asymmetrical shapes.
The anatomic, teardrop shaped, breast implants can provide advantages to women who have very little breast tissue. This is true for cosmetic breast enhancement for women born with small breasts, and is equally true for reconstructive breast surgery, for women who have had a mastectomy for breast cancer treatment. Shaped implants were not reliable before the advent of this highly cohesive gel. All shaped breast implants are made with a textured surface to help prevent them from rotating in the breast.
- Advantages of Gummy Bear Breast Implants:
- Minimal risk of leakage and silicone gel migration due to "solid" center
- Ability to make implants in specific shapes
- A softer result than saline breast implants, especially with thin breast tissue coverage
- Decreased rippling
- Softer silicone shell when compared to saline filled breast implants
- More profiles (shapes) are available
- No need for routine MRI scans to check for silent leaks
- Disadvantages of Gummy Bear Breast Implants:
- Requires a longer incision than saline implants: five centimeters for cohesive gel, and up to seven centimeters for highly cohesive (form stable, gummy bear or 410's)
- Shaped cohesive gel breast implants cost more than other silicone gel breast implants.
Gummy Bear Breast Implant Video
The gummy bear breast implant video below demonstrates that even when the breast implant shell is cut completely in half, the cohesiveness of the high strength silicone gel allows it to remain intact. The center is solid, and does not flow like saline or liquid silicone gel filled breast implants.
Breast Implant Shapes
Round Breast Implants
The most commonly used breast implants today are smooth and round, but implants also come in teardrop shapes. Since most breasts are more full at the bottom naturally, a round implant will still give a teardrop shaped result. Placing the implant behind the muscle enhances the natural breast contours. The muscle tapers the contour of the upper pole, giving a more natural appearing profile. This is true for all implants filled with liquid (saline or silicone gel) because the muscle compresses the upper pole, blunting the transition at the upper edge of the breast implant. The liquid is drawn downwards by gravity, so the lower pole is preferentially full and round.
Teardrop Shaped Breast Implants
The first breast implant sold in the US was teardrop shaped. Saline and silicone gel filled, teardrop shaped breast implants are available; however, since they are liquid filled, the shape is not stable, unlike the newer form stable implants. Form stable implants, sometimes called gummy bear implants after the Gummi Bear® candies, retain their shape. Most frequently, teardrop shaped implants are employed. Unlike liquid filled breast implants, form stable implants are filled with a soft solid, which enforces the breast implant's shape on the breast. The filler is silicone that has been polymerized into a solid that is like Jello®. To prevent rotation, all shaped implants are textured.
Breast Implant Profiles
The profile of an implant refers to its projection. The higher the profile, the more spherical the implant. High profile implants are helpful in achieving larger cups sizes for narrower chests. For a fixed volume, a high profile breast implant will have a narrower base. Conversely, a low profile breast implant will have a larger diameter. This can be used to adjust a desired volume to your breast's diameter or BWD (breast or base width diameter).
Matching the diameter of the breast and implant is important for achieving a natural appearance. If the breast implant is too wide, the breast will be wide and push outwards towards the arms. On the other hand, if the breast implants are too narrow, they will preferentially fill the outer part of the breasts and increase the space between the breasts.
Smooth Breast Implants vs. Textured Breast Implants
Smooth and textured refer to the surface of the breast implants' outer shell. Texturing allows the capsule, the scar that normally forms around the implant, to attach to the surface of the implant. The result is similar to Velcro®. For shaped implants, this attachment is very important in preventing rotation.
A smooth, teardrop shaped implant would tend to rotate its thinner top towards the center, and its fuller bottom to the side. Texturing normally prevents rotation, and preserves the desired effect of a teardrop shaped breast. When the texturing fails to prevent rotation, as high as ten percent of the time in published studies, the side of the breast is preferentially enlarged. Since this usually only occurs on one side, the result is asymmetry requiring a second surgery to correct the breast implant malposition.
Since texturing allows the implant to adhere to the capsule, the implant tends to feel more firm and immobile, and any wrinkling in the implant is more fully transmitted to the surface. So rippling is seen more frequently with textured implants. Deflation rates are also slightly higher with textured implants.
Smooth breast implants tend to give a softer and more mobile result. Since there is no attachment to the capsule, the implants can rotate. Only round implants are made smooth, because there is no visible change in the breast's shape, when a round implant rotates.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare tumor that is associated with textured breast implants. The more highly textured the breast implants the higher the association. The most aggressive texturing was Allergan's® BioCell® surface. Breast implants with BioCell® texturing were responsible for almost 85% of the known cases of BIA-ALCL; which lead to Allergan® voluntarily withdrawing their BioCell® textured breast implants from the world markets on July 24, 2019.
Breast Implant Manufacturers
Breast Implants come in hundreds of shapes, sizes and contours, making customization of results more practical. If you are looking for the fine details of today's Breast Implants, be certain to visit our Currently Available Breast Implants Page. There you find listings of the types, sizes, dimensions, contours, profiles and fillers available from the three current US Breast Implant makers. Full catalogs from Natrelle® (Allergan), Mentor® (J&J) and Sientra® (Silimed) are available to view.
Natrelle® (Allergan) Breast Implants
- Natrelle® (Allergan) – Allergan offers a full line of both Saline filled Breast Implants and Cohesive Silicone Gel filled Breast Implants. Both saline and silicone gel filled implants are available as round and teardrop shaped and come in a variety of profiles and dimensions. Allergan is the manufacturer, and their Breast Implants are marketed under the brand name Natrelle®. Their texturing process was called BioCell®, but it was recalled in 2019 due to an association with BIA-ALCL.
Mentor® (J&J) Breast Implants
- Mentor® (J&J) – Mentor® also offers a complete line of Breast Implants including both Saline filled Breast Implants and Silicone filled. Mentor's® Silicone Breast Implants are marketed under the brand name MemoryGel®, and their textured Breast Implants are marketed as Siltex®.
Sientra® (Silimed) Breast Implants
Sientra® (Silimed) – Sientra® is the newest company to offer FDA approved Breast Implants. They do not have a Saline filled Breast Implant line and only offer Silicone Filled Breast Implants.
They are the first US company use a high strength silicone gel filler in their Breast Implants. This type of implant has been available outside the US for several years, and is sometimes referred to as the Gummy Bear Breast Implant. The high strength gel provides stability of form and allows Sientra® to manufacture the first FDA approved teardrop shaped silicone gel Breast Implants in the US. Natrelle® and Mentor® are expecting approval for similar implants very soon.
The same high strength gel used in the textured teardrop shaped Breast Implants is also used in their Round Breast Implants. Recently released 5-year data shows that the leakage rate for these Silicone Breast Implants is about half that seen in the PMA data of previous manufacturers.
For more information about currently available breast implants visit our Currently Available Breast Implants Page. For more information about your options in Breast Augmentation, be certain to visit our Breast Augmentation Page.