Breast Implants come in different, sizes, fills, projections, shapes, positioning and textures. Choosing the right one for the patient is not random but is, instead, dependent on many factors. The plastic surgeon’s experience is critical in helping the patient make the proper choice.
Size is probably the patient’s greatest concern. What is important is that the patient’s perceived bra cup size may not coincide with objective cup sizes. Also, certain retail undergarment brands tend to distort sizes by exaggerating them.
A great way of demonstrating cup sizes is by showing lots of before and after photos of breasts and properly labeling them with the appropriate cup size. It is surprisingly common how the patient’s perceived “C” cup size is so very different from an actual C cup size.
Implant fill is probably the second most important patient’s concern. There is a lot of confusion about silicone versus saline implants. Both fill types are safe and may provide very satisfactory results. In patients who have thin skin and minimal breast tissue, it is probably preferable to use silicone implants because the consistency of silicone feels more natural than that of saline. Patients who are still fearful of possible silicone side effects may be more comfortable with saline implants. Patients with subtle breast size differences may possibly be better corrected with saline implants because they can correct minor size differences (10- 20 ccs) since silicone implants come pre-packaged in 25- 30 cc increments.
Implants come in different projections from moderate to moderate plus to high profile. Most patients will benefit from moderate plus profiles. However, patients with a narrow chest frame would be best augmented using high profile implants because the volume is confined to a smaller diameter size which would be better accommodated in a small chest frame.
Implants come in 2 different types of shapes, round and tear- drop. Round shapes are by far the most common shapes being used. Tear-drop shapes were introduced many years ago with the anticipation that they would lead to a more natural result. Experience and follow-up have shown this not to be quite true. Round implants can lead to just as natural results without the possible distortion caused by rotation of tear-drop implants.
Breast implants can be placed above or below the pectoralis muscle. There is a suggestion in the literature that below the muscle placement may lead to a smaller incidence of capsule formation (hardening) and it is a more popular technique. Certainly, in patients with minimal breast tissue, most surgeons would position the implant underneath muscle so as to lead to a more natural result.
Implants come in different outer textured covers, with the most common type being smooth. Textures and polyurethane covers have been used with the belief that it would lead to a lower incidence of capsule formation. While this may possibly be true, negative consequences using these types have made them very unpopular and most manufacturers have removed them from the market. Breast Implant Associated Anaplastic Large Cell Lymphoma, a type of a cancer, while very uncommon has been directly associated strictly with textured implants. There has been up to the present time no direct association of this with smooth implants.