Breast Implant Options

In addition to choosing size, there are several types of available breast implants (prostheses).  Dr. Laverson uses implants manufactured in compliance with the highest industry standards, and uses only FDA approved prostheses. The two manufacturers in the United States are Allergan and Mentor.   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 consistency and maintains its shape and volume.  The two available fillers are saline (salt water), and silicone gel.  A third filler, semi-solid silicone, is now awaiting FDA approval.

Saline (salt water)  implants are packaged sterile from the factory, and are delivered to Dr. Laverson as an empty solid silicone shell.   During breast augmentation surgery, these saline implants are carefully removed from their package, all air within the sterile implant evacuated, and the implant then inserted in a space behind the breast.  The implant is inflated with sterile biologically compatible iso-osmolar (identical to human plasma) salt water to its recommended fill volume through a specialized valve.  The implant is  positioned and oriented properly, and the patient examined in the sitting position to be certain of a satisfactory result.

Silicone gel implants are also packaged sterile from the factory, but have no valve, and are delivered to Dr. Laverson completely filled to the selected size with soft silicone.  At surgery, these 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.

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.  For women with B cup breasts and larger, Dr. Laverson believes the result with saline and gel implants is extremely similar, and essentially interchangeable.  For women who are very lean, thin, or small breasted, gel may be preferred because of its slightly more natural texture, and less tendency to produce visible and/or palpable (detectable by touch) rippling in certain positions.

Another important difference between gel and saline prostheses:  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 the implant has ruptured.  She will usually want a new implant as soon as possible to replace the deflated one.  Both 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, the thick gelatinous 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 Options – Textured vs. Smooth

Breast implants (prostheses) all have a solid silicone shell.  The surface of this flexible solid shell may be smooth or rough (textured).  Smooth surface implants appear translucent and glossy, while textured surface implants have a rough surface and opaque, ground glass appearance.  Dr. Laverson demonstrates both of these implant types at consultation.  Textured and smooth surface implants both may be filled with silicone or with saline.  Differences in behavior (implant-tissue interaction) between smooth and textured surface implants have been studied only on a limited basis, and 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.