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Different Breast Implant Types Available

Breast implants have changed over the years since they were first invented. There are two types of breast implants that are approved by the U.S. Food and Drug Administration (FDA) for marketing in the United States: silicone-filled and saline-filled. These come in various sizes and shapes, and with a textured shell or a smooth shell. A type of silicone-filled implant with a thicker filling, called a high-strength cohesive implant or a gummy bear breast implant is under investigation. Several other types of implants are available in other parts of the world, or were used for a while in the United States, but are no longer available.

Breast implants were once said to last a lifetime. They do not. You must expect to replace your implants at least once in your lifetime and perhaps more often than that, depending on your age. Most breast implants last between 10 and 15 years.

Only two companies market approved breast implants in the United States, Allergan and Mentor Corporation. Allergan owns Inamed, which bought the McGhan line of breast implants a few years ago. You still see the McGhan name occasionally in discussions of breast implants, but implants are no longer made under that name. A third company, Silimed, is conducting clinical trials of high-strength cohesive silicone breast implants in the United States, as are both Allergan and Mentor.

We are going to confine this discussion to the two basic types of breast implants approved in the United States, silicone-filled and saline-filled. Both saline and silicone-filled implants come in several variations, including textured versus smooth shells, round versus anatomical shapes, and different profiles. We will discuss the pros and cons of all these options.

Silicone vs Saline Breast Implants

Both silicone-filled implants and saline-filled breast implants have an outer shell of a substance called silicone elastomer. Silicone elastomer looks like a clear or translucent rubbery plastic. This shell is basically a flexible envelope that contains the implant filling and, in the case of some anatomically shaped implants, gives them shape. Some models of implants have a “double lumen.” This is an elastomer envelope inside of another elastomer envelope, sort of like double-bagging your groceries. The double lumen is thought to reduce the risk of rupture.

Saline Breast Implants

A saline-filled implant is filled with sterile saline, which is sterile water with the same concentration of salt as many body fluids. Saline breast implants come in both smooth and textured shells and models that are round or anatomically (tear-drop) shaped, as well as in low and high profiles and in several sizes. They are constructed of an elastomer shell with a single valve on the front surface of the implant. A saline-filled breast implant is usually empty before it is implanted into you. The doctor moves it into place (either over or under the muscle) and then fills it from a sterile bag of saline. The saline is injected using a syringe and tubing similar to the way saline is dripped into your arm when you have an intravenous line, and it will remain sterile all the way into the implant and stay that way.

Saline breast implants were on the market during the years before silicone-filled implants were reapproved in 2006. The main benefit of a saline implant is that saline is safe in the body. If the breast implant ruptures, the saline leaks out and is absorbed harmlessly. Unlike a silicone-filled implant, the implant deflates immediately or within a few hours and it is evident that a rupture has occurred.

A ruptured saline breast implant should be removed and replaced as soon as possible. Until the ruptured implant is replaced, you will have one deflated breast. You can use a “falsie” or a “cutlet,” one of those silicone or rubber bits to place in your bra, to balance yourself until you get the problem fixed.

Another benefit of saline breast implants is that the amount of filling can be varied. Implants are made in several sizes and have a recommended fill level, the amount of saline that they should contain, as determined by the manufacturer. However, it is perfectly all right to overfill the implant by a small amount to get the right amount of breast augmentation. An implant that is labeled 350 cc (cubic centimeters, which is the same measurement as milliliters) can be filled to 365 or 370. This overfilling breast implants may be done to balance out natural breasts that are sized slightly differently.

There is a limit to how much overfilling can be done. Curiously, if your breast implants are underfilled, they may show visible ripples and gurgle, and if they are overfilled, they may show visible ripples and gurgle.

Some models of saline breast implants can also be adjusted in size several days to several months after they have been implanted. The Spectrum line of implants from Mentor Corporation is expandable. Each implant has a dime-sized filler port that is left in near the incision. Your surgeon will inject more sterile saline using this port until you are at the size you want. These implants can be a good choice if you are very small-breasted, but want to be augmented to a much larger size. The gradual filling will give your tissues time to adjust and not be as traumatized. It can help minimize the risk of developing stretch marks on the skin of your breasts.

Expandable breast implants come in several sizes, just like standard implants. However, they cannot be filled up beyond a certain point nor can their size be changed more than 6 months after surgery.  You have to have a general idea of what size you would like to be before your breast augmentation surgery so that a size and profile of implant can be chosen, then build on this size. These implants come in textured and smooth shells and can be placed either above or below the muscles.

With expandable breast implants, your plastic surgeon puts them in place and then fills them, but does not fill them completely full.  You will go back to the surgeon periodically for more saline over the next few weeks, usually in 50-cc increments. Most patients say that the additions cause them minor discomfort since the body has to adjust to the implant again. Once you’ve reached the size you want, the filler port is removed.

Spectrum implants cost somewhat more than regular saline breast implants. Until the filler port is removed (through the original incisions in a simple in-office procedure) you will be able to feel the port and the area may become chafed if your bra or clothes rubs up against them. There is a very small risk that the filler port may be extruded through the incision, but this happens in less than 1% of cases.

The minimum age for getting saline breast implants is 18, unless the implants are needed for reconstructive purposes. Cosmetic breast augmentation is not recommended for anyone under age 18 because they may not be mature enough to make a reasoned decision and because their bodies and breasts may not have reached their full adult size.

Silicone Breast Implants

Silicone-filled breast implants are filled with a silicone gel, and have been around in one form or another for about 40 years. Over the years, the type of silicone filling has changed, as has the materials and type of shell used.

In the 1990s, reports began surfacing about silicone breast implants breaking down and the silicone oil or gel leaking into the pocket around the implant and even migrating to other parts of the body. The body usually reacts to any foreign object by trying to wall it off from the rest of the body. It does this with the silicone that leaks out of an implant shell and often forms what is called a granuloma around the silicone or a pocket of fibrous material.

At that time, there were many anecdotal reports in the media about women with silicone filled breast implants and cancer, autoimmune disorders such as lupus erythematosus, scleroderma, and rheumatoid arthritis; connective tissue disorders; and neurological problems. The leading maker of breast implants at that time, Dow Corning, was hit with large lawsuits and paid out millions in settlements. In the 1990s, the FDA ordered makers of silicone-filled implants to cease marketing them. Their use was limited to women who needed breast reconstruction after mastectomy and to a few other situations.

Several years of epidemiology studies were conducted. The Institute of Medicine, an independent research group, determined that there was no link between silicone breast implants—even ruptured ones—and any known health complication. The FDA approved two brands of silicone-filled implants for use in the United States in 2006, with the requirement that the manufacturers continue to conduct extensive follow-up studies.

Over the years, the consistency of the silicone filling has changed. The first silicone implants were filled with a very thin silicone that was the consistency of oil. Currently, the silicone used in implants today is a gel—along the lines of very thick uncooked egg white—and it is less likely to leak out of the shell if the shell cracks or ruptures. This type of a gel is referred to as cohesive. Even more types of cohesive gel breast implants are under investigation. These almost solid implants are nicknamed gummy bear breast implants because they are the consistency of the little gel candies.

Unlike a saline implant, where a rupture is apparent quite soon, rupture of a silicone-filled implant can go undetected for years. Because of this, the FDA recommends that women with silicone-filled implants undergo magnetic resonance imaging (MRI) every few years to detect any ruptures. Your health insurance company may refuse to cover the costs of these MRIs or for removal of your implants if you have any problems. There have also been some reports that health insurers have raised premiums for women with silicone breast implants.

The minimum recommended age for silicone-filled implants is 22. This is a different minimum age than for saline implants because the risks of silicone-filled implants may be greater than with saline implants and thus require a greater level of maturity.

Other fillers besides silicone gel and saline have been used in the past or are being used outside of the United States. Breast implants filled with soy oil were used in Europe for a few years, but were shown to have problems including reactions to oil that leaked out of the shells. Several implant makers worldwide are investigating breast implants filled with materials similar to those used for injections to fill wrinkles and pockmarks.

One type of breast implant that has been used for women who want enormous breasts is the polypropylene (PPP) string implant. These are not approved in the United States and will probably never be approved here. The string implants absorb fluid in the body and continue to expand and grow to huge proportions—and do not stop growing! Breasts with string implants reach absolutely absurd proportions. String implants have primarily been used by exotic entertainers.

Round or Contoured?

Contoured implants (also called anatomical, teardrop, or biodeimensional) are implants that are shaped like a natural breast. They create a natural sloped shape when placed over the muscles. For some women, round implants may be too spherical and look less natural than they want and contoured implants can be a better choice.

In general, contoured breast implants are more expensive than round ones. One disadvantage for contoured implants is the possibility of them flipping over or inverting themselves if the surgeon did not form the pocket correctly. This would result in a misshapen breast. If a round implant flips or rotates, it still looks the same. A textured contoured implant may be less likely to flip in place.

Smooth or Textured?

Breast implants come in shells that are either smooth or have a slightly rough texture. There is much disagreement in the cosmetic surgery community as to whether smooth is better than textured and for what reason.

Textured implants are thought to reduce the incidence of capsular contracture. The idea is that the texture allows the body to bond with the texture of the shell. However, even the implant manufacturers say there is no evidence of a difference between incidence of capsular contracture between smooth and textured implants.

Smooth implant shells are slightly thinner than textured shells, but are thought by some to be stronger because there are no intentional defects like those created in the surface of the outer shell for textured implants. Textured breast implants are thicker to compensate for their intentionally rough surface.

One problem with textured implants is that you are more likely to be able to feel them, especially if you have thin skin or have small natural breasts.

Another disadvantage with textured breast implants is that if a patient develops capsular contracture, the texture is less likely to make the implant difficult to remove from the scar tissue. However, there is a lot of controversy and many different opinions on this subject, just as with other aspect of breast augmentation. Your surgeon may have his or her own opinion

High Profile Breast Implants Versus Low or Moderate

Both Allergan and Mentor make breast implants in different profiles, usually low, moderate, and high. The profile of an implant is how far from the chest wall the implant will project. If you are a woman with a smaller chest wall, using a moderate or high profile implant will result in what appears to be a larger implant. Similarly, if you want larger breasts, but still want them to look very natural, the choices in profiles allow you and your cosmetic plastic surgeon to choose the one that is exactly right for you.

When you factor in saline or silicone-filled, smooth or textured, round or contoured, and the different profiles and sizes, each of the implant makers has dozens of different implants. The implants you receive, combined with the amount of breast tissue you have naturally will give you results that no other woman on the planet will have. Breast augmentation is truly individualized to you.