Silicone Implant Options

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When you consider that the leading implant manufacturers offer hundreds of saline and silicone breast implant styles to choose from, you might be tempted to forget about breast augmentation and stick with the padded bras. But don’t feel overwhelmed; there are essentially just a few things to learn about, and the experts at Marina Plastic Surgery are here to help.

Want more specifics about breast implants? At our Los Angeles practice, you can receive a FREE consultation with one of our surgeons when you request your appointment online and schedule during select times they have set aside exclusively for Web visitors.

Breast Implants Compared

Saline Implants 4th-generation
Silicone Implants
Form-stable
Gummy Bear Implants
Filling
0.9% ‘normal saline,’ also called sterile isotonic saline
Filling
cohesive silicone gel
Filling
form-stable, high-strength silicone gel
Filling consistency
liquid
Filling consistency
viscous, gooey, pliant; most patients believe silicone feels more like breast tissue
Filling consistency
soft, semi-solid; retains its shape even when cut
Sizing
most models are filled after insertion, allowing flexibility; some are adjustable after surgery
Sizing
implants are filled (sized) and closed prior to insertion
Sizing
implants are filled (sized) and closed prior to insertion
Shapes and covers
both round and anatomical are available with both smooth and textured shells
Shapes and covers
round and anatomical are available; most have textured covers
Shapes and covers
low, moderate, and high profile round; also oval and classic; both smooth and textured shells available
Incisions
several sites are often possible; incisions may be smaller than for silicone implants
Incisions
around the areola or underneath the breast; sometimes larger than for saline implants
Incisions
most women prefer around the areola, but some choose beneath the breast
Rupture
detectable almost immediately as the implant deflates; saline is harmlessly absorbed by the body
Rupture
often undectable by the patient; periodic MRI tests are recommended to check for “silent rupture”
Rupture
high-strength gel does not displace upon rupture, thus typically only detectable through MRI
Rupture rates
Mentor states about 1% in 1 year and up to 10% in 5 years; Dr. Stevens’ study of Mentor implants shows about 0.3% in 1 year and up to 5.1% in 5 years
Rupture rates
Dr. Stevens’ 13-year study of the type 4 Mentor implants showed a 0.4% rate of rupture
Rupture rates
Dr. Stevens’ 60-month study of 708 of these implants found a 0.0% rate of rupture
Other risks
rippling, capsular contracture, loss of nipple sensation, breast pain; normal surgical risks such as infection, swelling
Other risks
capsular contracture, loss of nipple sensation, breast pain; normal surgical risks such as infection, swelling
Other risks
capsular contracture (although studies show a lower risk), loss of nipple sensation, breast pain; normal surgical risks such as infection, swelling
Availability
augmentation patients 18 years old or older; reconstruction patients of any age
Availability
FDA-approved implants available for augmentation patients 22 years old and older; reconstruction patients of any age
Availability
Sientra® & Natrelle® implants are available for augmentation patients 22 years old and older and reconstruction patients of any age; Sientra only from board-certified plastic surgeons; Natrelle® 410 from surgeons who have been certified by the manufacturer; Mentor CPG implants (non-FDA approved) are available only through clinical trials

Why Silicone?

Most physicians agree that this implant type is among the most studied medical devices of all time – yet people still have questions about safety. Most women in the United States have been influenced at least to some extent by the controversy over silicone implants – yet women in Europe and Latin America rarely consider any filling other than silicone.

Silicone breast implants are preferred by many plastic surgeons and patients because they tend to yield superior results. Today’s silicone gel is semi-firm to the touch, yet it also gives and feels pliant. In addition to currently approved (fourth-generation) silicone gel breast implants, Dr. Stevens and Dr. Spring offer the only FDA-approved fifth-generation (gummy bear) implants. The Silimed-brand implants from Sientra and the Natrelle 410s are form-stable, meaning they retain their shape whether you’re standing up or lying down, thereby virtually eliminating rippling or folding in their shells. Additionally, the high strength cohesive gel in these implants remains stable, even when cut in half.


This video shows how remarkably cohesive the new Sientra implants are. Even when the gel is displaced under pressure, it retains its shape and does not leak.

Marina Plastic Surgery Associates also offers Mentor’s cohesive gel implants, known as CPGs, as a part of the clinical study. These are anticipated to receive FDA approval in 2013. This will increase women’s breast augmentation options tremendously.

Saline filling appeals to some women because they’re familiar with the solution and trust its benign properties. And since saline implants are inflated after placement inside the body, incisions can often be smaller than for silicone implants. Dr. Stevens and Dr. Spring have found that many of their patients prefer silicone breast implants, however, due to the aesthetic limitations of saline devices. Some women say they don’t care for the liquid feel and rippling can come with saline implants. Also, saline implants are often not a good choice for small-framed women.

Shapes and Covers

Historically, silicone and saline implants have come in 2 basic shapes, round and anatomical (or teardrop shaped), and with 2 types of covers or shells, smooth or textured. Round implants have been more readily available over the years and, contrary to what you may think, they don’t cause a fake look when proper surgical technique is used. Round saline implants (and older silicone models) move with you, becoming fuller at the bottom when you’re standing up.

Anatomical implants – teardrop in shape – were designed to create a natural-looking breast by facilitating a gradual slope of the chest wall and more volume at the bottom of the breast. Since they have this distinctive shape, it’s important the implants don’t turn inside the breast pocket. Therefore, anatomical implants have textured covers to allow scar tissue inside the breast to adhere and keep them stable. The Natrelle 410 from Allergan is a shaped implant.

The FDA approved, form-stable Sientra implants are available in 3 shapes: round, oval, and classic. This is the only implant manufacturer in the world that makes a round gummy bear breast implant, and they come in low, moderate, or high profile, which means more choices for customizing breast augmentation results.

Dr. Grant StevensDr. Michelle SpringDr. Luis Macias

Size and Projection

It can be difficult to decide on the breast implant size that is right for you. While it’s one of the most important decisions you’ll make for your procedure, choosing the implant size that will give you the result you’re looking for can be a challenge. For one thing, the 3 manufacturers size their implants using cc’s, or cubic centimeters, rather than cup sizes. When you add in the dimension the experts refer to as “projection,” which describes how far the implant “sticks out” from the chest wall, and other measurements such as height and base width, it becomes even harder to choose.