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Breast Implants Information and FAQ
This section covers frequently asked questions (FAQ) about the breast prosthesis (breast implants). This section should cover the most common questions. If you have a suggestion for any additional questions, please let us know.
- Can saline (saltwater) filled breast implants harden?
- What are the differences between smooth and textured mammary implants?
- What are the differences between round and contoured (anatomical) mammary implants?
- How long do breast implants last?
- I have heard that breast implant manufacturers have implant "warranties", is this true?
- Is it true the replacement of breast implants is fairly minor?
- I have heard that the silicone shell of a saline breast implant can cause silicone toxicity or silicosis, is this true?
- I have heard of fungus growing in the saline of a saline-filled breast implant. Is this true and can it cause an infection?
- What are my breast implant choices?
- Are silicone gel-filled breast implants safe?
- How many ccs make a cup size?
- What is overfilling and how much can a breast implant be overfilled?
- Which is better, Allergan or Mentor?
- What are expandable breast implants?
- Can I get cohesive silicone breast implants?
- Will the breast implant burst when I get my next mammogram?
1. Can saline (saltwater) filled breast implants harden?
The hardening that can occur with a breast implant is due to the formation of excess scar tissue and contraction of that tissue around the implant. This is called capsular/capsule contracture (CC). If this occurs and is very severe, then another operation may be required to remove the scar tissue. Capsular contracture may also be treated in some cases with a prescription of a drug called prednisone and repeated manual compression of the breast by the patient.
2. What are the differences between smooth and textured mammary implants?
Implants with smooth surfaces are more commonly used than ones with textured surfaces. The goal of a textured surface was to prevent capsular contracture. Smooth breast implants are made with the goal of a flawless surface and there is less rippling reported with smooth implants, but it is been reported that the rate of capsular contracture is higher in patients with smooth implants. Some reports say that the rate of contracture is about the same with both breast implants.
However, textured breast implants may take longer to drop into a more natural position after implant surgery, resulting in implants that appear higher on the chest and unnatural.
3. What are the differences between round and contoured (anatomical) mammary implants?
Breast implants come in a variety of shapes, but the two major types are round and contoured (also called anatomical), which is a shape more like a natural breast on a woman who is standing. The idea that a contoured implant will be more natural looking is good in theory, but in actuality when contoured implants are used, the results are about the same in most patients. This is especially true when contoured breast implants are placed behind the muscle, because the muscle and chest wall exert force on the implant on all sides, and give it a more rounded appearance. Also, contoured implants have been known to invert themselves or turn themselves upside down if placed improperly. If this happens, a second surgery to correct the problem may be needed.
Contoured implants are more frequently used for women who are having breast reconstruction after mastectomy. Contoured implants are slightly higher in price than round ones. Round implants are the most common choice for breast augmentation, because they produce a rounder, more voluptuous breast that is very desirable to most people.
4. How long do breast implants last?
A breast implant will not last forever. You should expect to have to replace your breast implants at some point during your lifetime. The Institute of Medicine estimates that the average breast implant will last 16 years. The Food and Drug Administration and implant makers recommend that breast implants be replaced at some point. However there are women who have had implants in for over 25 years with no problems. There is no definite answer.
5. I have heard that breast implant manufacturers have implant warranties, is this true?
Yes. Breast implant manufacturers such as Allergan (formerly known as Inamed and McGhan) and Mentor offer conditional guarantees for their implants. Each breast implant is numbered by lot and has a serial number for identification. You will usually receive the serial number stickers with your postoperative information packet. Most patients are given half of the set of their ID stickers. The other half is given to the implant manufacturer, along with your records and social security number for warranty and identification purposes.
You can read about Mentor’s warranty at their website.
You can read about the warranties from Allergan (Inamed/McGhan) at their website
Check with your plastic surgeon to get information about any warranties in writing. The FDA makes it mandatory that you receive a copy of the implant package insert as well as a copy of the risks and complications (informed consent) of breast augmentation surgery.
6. Is it true the replacement of breast implants is fairly minor?
For removal and replacement of smooth, saline breast implants, replacement of implants is relatively minor. The major part of the original operation is the creation of the pocket. When replacement is needed, the pocket is still there, so all the surgeon needs to do is take the old implant out and put in a new one.
However, for a silicone implant that has ruptured, the removal of silicone can take quite a while if it has leaked out of the envelope of the implant and into the pocket. Many surgeons report that it can be difficult to fully remove free silicone from within the pocket.
7. Can the silicone shell of a saline breast implant cause silicone toxicity or silicosis?
This subject is controversial. All breast implants, whether filled with saline or silicone gel, have an out shell made of solid silicone. There are no certifiable cases of silicone toxicity caused directly and solely from the silicone shell or gel of a breast implant.
Silicon is a very common element. Silicone is any of a family of chemical polymer compounds that contain chains of silicon and oxygen. Silica is silicon dioxide, which is the main ingredient of sand, quartz, and glass. Silicosis is a lung disease cause by inhaling crystalline silica powder. Only crystalline silica can cause silicosis, which primarily occurs in industrial workers who deal with silica, such as stone workers or people working in foundries.
So not only is silicosis not caused by silicone, you have to inhale silica to get the disease. This means that the amorphous silica in the silicone of the implant must selectively detach itself out of its solid form and must somehow transform into a crystalline form and then travel through the chest wall and lungs and specifically plant itself into lungs. Which translates into impossible.
At best, this is an extremely rare occurring incident. There are no documented reports of an implant removed having fungal infection. At one time, saline breast implants were filled from an open bowl or bottle of saline. Now, they must be filled from a sterile bag of saline. Although it is possible for water to pass through the silicone envelope of the saline implant, salt and bacteria or fungi are too big to pass through. In other words, if the saline breast implant is sterile when it is inserted, it should not become contaminated within the body.
9. What are my breast implant type choices?
The U.S. Food and Drug Administration (FDA) has approved two types of breast implants: silicone-filled and saline-filled. Both types of implants are basically shaped envelopes made of silicone elastomer (a type of plastics) that is filled, one with silicone gel and the other with saline, which is salt water.
Two companies make both FDA-approved silicone and saline breast implants, Allergan and Mentor Corp. Allergan bought Inamed, which was the maker of McGhan implants, and you still often see the names McGhan and Inamed used.
Other types of breast implants, notably the firmer cohesive (“gummy bear”) implants are under investigation, and you cannot get them unless you agree to be part of a preapproval study. Both Mentor and Allergan make approved implants that they call cohesive, which means that they are filled with a very soft solid form of silicone that can hold its shape and would not leak out easily in the event of a rupture. However, there are also studies underway of a type of implants that have even more solidity, the consistency of a gummy bear candy, which is how they got the name.
A few years ago, breast implants filled with soy oil were being studied. Women in Europe and the United States had them implanted, but there were reports of significant adverse reactions and the product was shelved.
10. Are silicone gel-filled breast implants safe?
Products made of solid silicone have been used within the body for decades without incident. Solid silicone is used to augment or reconstruct the cheeks, chin, brow bone, calves, pectoral areas for men, and is used in artificial joints, testicles, and heart valves. The U.S. Food and Drug Administration has approved the use of silicone elastomer-shelled saline-filled breast implants and silicone elastomer-shelled silicone gel-filled implants for breast augmentation and reconstruction. Some of the approved gel-filled implants are being marketed as cohesive, in that they have a thicker gel that holds its shape, sort of like a soft solid. There are a few even firmer silicone breast implants under investigation.
The FDA does not approve of injections of liquid silicone, a method of breast augmentation that was used decades ago and that was found to have serious drawbacks. The liquid migrated and the body formed pockets of inflamed tissue called granulomas around the liquid. Unfortunately, silicone injection is still being practiced on the black market.
A good place to check out information about silicone gel is the Independent Review Group's Website. The side run by the British government and is unbiased.
Silicone is often referred to as inert. Usually this means that a substance is chemically inert and does not react to other chemicals. Silicone is chemically inert, but it may not be biochemically inert. Biochemically inert would mean that these substances would not change composition when implanted in the body. The silicone elastomer shell of a breast implant deteriorates with time. It can also rupture allowing silicone gel to slowly seep out. This is one reason that implant makers are trying to develop an implant with a more solid gel that would not be extruded if the shell is ruptured.
11. How many ccs make a cup size?
A cc is a cubic centimeter and there are 236.6 of them in a cup. However, this information is good only if you want to convert a cooking recipe. If you want to determine what size implant would give you what size bra cup, it is a little less exact. For one thing, bra cup sizes are not standardized in the least and even putting the same size implant into two different women won’t produce exactly the same sized breast because they probably don’t have the same amount of breast tissue and different chest walls to start with. (By the way, a cc is equal to a milliliter, which is a thousandth of a liter, which the most common unit of volume measurement in medicine. I don’t know why implant makers still use cc rather than ml.)
But let’s give a general rule that may not really be useful. One study found that an average of 189 cc of saline was needed to go up one bra cup size. Increasing an A cup to a C cup required a total of 391 cc, or 196 cc per cup. Moving from a B cup to a D cup required a total of 448 cc, or 224 cc per cup. The largest change, an A cup increasing to a D, cup required 437cc, or 145cc per cup.
To a great extent, picking a size for an implant is an art, not a science. You really have to bring in pictures of what you want to show the surgeon and then try on a lot of implants by inserting them into your bra and see which size suits you.
12. What is overfilling and how much can a breast implant be overfilled?
Overfilling is a controversial subject for two reasons: whether it should be done in the first place and what do we mean when we say “overfill.” Overfill can only be done with saline breast implants, so if you are getting silicone-filled implants, you don’t have to read this at all.
Overfill is the practice of adding more saline to the breast implant than the manufacturer says is the maximum amount it should hold. Many women assume that if a 350-cc implant is overfilled by 40 cc if it has been filled to 390 cc, but since the maximum size for that implant is actually 380 cc, it is only overfilled by 10 cc. Overfilling makes the implant feel firmer, but it does not affect the size of the implant. Overfilling past the maximum amount recommended by the implant maker will void the warranty.
Be advised that although manufacturers have an advised optimum fill for breast implants, there are many women walking around right with an overfill that surpasses that amount. Many surgeons overfill a certain amount to prohibit rippling, or wrinkling of the implant. Curiously, both underfilling an implant and overfilling it can cause rippling.
For a good explanation of overfill, please read this article on overfilling by Richard V. Dowden.
13. Which is better, Allergan or Mentor?
Which is better, Coke or Pepsi? A Nike shoe or one from New Balance? McDonalds or Burger King? There is no better, there is only what is best for your own needs. Actually, it is more likely that your surgeon uses one brand over the other because many do not offer both.
Many of you will also find surgeons who believe one is better than the other and will give you their reasons for it. Some like that Mentor Shells are thinner than the ones made by Allergan (the company was once known as McGhan and Inamed). Having handled implants by both brands both out of the body while optimally filled and within someone's body, I don't feel there is much of a difference.
14. What are expandable breast implants?
Expandable implants are saline breast implants that can be adjusted in size by adding more saline through a special valve. Originally, this type of implant was
designed by Dr. Hilton Becker and the Mentor Corp. for use primarily in breast reconstructive patients, to gradually expand breast tissues after a mastectomy so that an implant could be inserted. The expandable implants started being used in cosmetic breast augmentation in the 1980s.
Like standard breast implants, expandable implants comes in different sizes and the size can be adjusted during implantation by injecting sterile saline solution. You have to have a general idea of what size you would like to be, then build on this size. They come in textured and smooth models and can be placed either subglandularly or subpectorally.
Most saline breast implants are made so that the surgeon can adjust the size at surgery, and that is the only time a change can be made for those implants. However, Mentor makes a line of saline implants (Spectrum) that can be adjusted in size up to 6 months after they are implanted. Each implant has a tube and a small round port that is left near the incision site. The surgeon can inject more sterile saline into this port. When the last adjustment in size is made, the port is removed. The gradual filling gives your tissues time to adjust and reduces the risk of stretch marks if you are small to begin with and going up in size by more than a cup. Just remember with breast augmentation, stretch marks are always possible.
More saline is added in 50-cc increments. You will probably have another fill about 1 week postoperatively, then 2 weeks after that, and then perhaps a few weeks later.
The downside is that this type of implant is more expansive. You can expect to pay about $400 more for a Spectrum. Until the filler port is removed, you will be able to feel it and the area may become chafed if your bra or support garment rubs up against it.
15. Can I get cohesive silicone breast implants in the United States?
Cohesive silicone is a type of silicone gel that is more like a soft solid than a liquid. Cohesive implants are sometimes called “gummy bear” implants because the gel is more like the consistency of a gummy bear candy. Both Allergan and Mentor have what they call cohesive implants that are approved by the U.S. Food and Drug Administration.
The idea behind cohesive implants is that having a thicker filling, so to speak, will help keep the silicone gel in place in the event of rupture. However, there is no guarantee that microscopic amounts of gel might not migrate out of the shell in the event of rupture.
Other, even firmer models of cohesive gel breast implants are being studied. These contain an even thicker type of silicone filler.
16. Will the breast implant burst when I get my next mammogram?
It is possible that it can, but it is not likely. You must tell the mammography technician that you have breast implants. She will have to take extra films of your breast since you have implants and she will know that special care is needed. Please see our Mammogram and More section for more information about breast exams, mammogram, and breast cancer awareness.
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