Which implant is least likely to migrate laterally in pectus carinatum, saline or noncohesive?

Silicone gel implants migrate less because on average the capsule is thicker than with saline due to silicone gel bled which occurs to some extent even with cohesive gel implants.  With pectus carina when lying down gravity tends to push implants laterally.  Textured implants move much less.

Hi Nurturing3696,

The two main types of implants are silicone and saline. The shell of the implants can be either textured (which reduces capsular contracture) or smooth. A textured implant sometimes requires a larger incision. The shape of the implant can be either round or tear drop shaped (gummy bear). Both have their advantages and disadvantages.

The different types of implant offer different pros and cons. For instance, the pros of silicone implants are that they look and feel more natural and ripple less.

On the other hand, the pros of saline implants are that they do not require as large of an incision as silicone, less expensive, they have less incidence of capsular contracture (scarring around the implant), one can tell immediately if there is a rupture, the size can be slightly adjusted, and they can be used for women less than 22 years of age.

You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD, MHA, MS

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

With limited dissection out laterally, it would not make any difference whether saline or silicone implants are used in terms of risk of implant lateralization. This is also impacted by implant size. It may make some difference with textured implants as they tend to 'stick' more in place. But with the recent potential issues with textured implants, it would not be a bas decision to stay with smooth surfaced implants for now.

There is no definite answer. Someone with a keel shaped chest or pectus carinatum is more likely to have lateral displacement over time. The smooth implants may stay in place, especially if smaller. The textured have more"drag" and thus may be less likely to to displace over time and hold the shape better. It is not one does and the other does not, but many physicians feel the textured are less likely to migrate. You must balance that over the increased risk of ALCL with textured implants. That risk also has to be calculated against the risk of repeat surgeries.Choosing an implant based on price sometimes works out fine, but other times it leads to regret and the patient instead wishing they had saved for their best implant. Obviously a repeat surgery would be much more expensive than the difference in cost between implants.The smooth saline could turn out fine, but many surgeons feel they do have more displacement over time than textured. Saline may have a different feel and higher wrinkling than gel implants.I have found that choosing the implant that you like is the best decision. Cost is secondary, and if necessary save a little more for the implants you really want. Otherwise you might be unhappy later, and additional surgery is more expensive in the long run.

The surface of the outer shell of breast implants can be smooth or textured
and either can produce good cosmetic results.. There are pros and cons of each
and the best implant for any particular patient depends on many factors
including individual anatomy and desired outcome. Smooth implants usually have
thinner shells and move more freely in their pocket than their textured
counterparts. Many plastic surgeons believe that the thinner shell allows
smooth implants to feel more natural. Implants with smooth surfaces are less
likely to ripple. Textured implants were designed to lower the risk of capsular
contracture, but whether it achieves that is open to debate. The textured
implants tend to migrate laterally less but may have a greater chance of leakage or deflation. One type of
implant, known as the anatomical or teardrop-shaped implant
("gummy-bear" or form-stable), is only available with a textured
surface, because this surface helps keep these contour shaped implants in
position and diminishes the risk of rotation and distortion. Some of the
differences of the implant surface characteristics depend on whether the fill
material is saline or silicone gel. Textured implants also have a potential
greater risk of developing an extremely rare tumor,  Anaplastic Large Cell Lymphoma (ALCL) around
the implant.
Currently, most plastic surgeons in the U.S. prefer smooth implants. You should
discuss your concerns with your plastic surgeon, who should be certified by the
American Board of Plastic Surgery and ideally a member of the American Society
for Aesthetic Plastic Surgery (ASAP). Robert Singer, MD FACS La Jolla, California

It would be nice to see photos of the severity of this condition.  Any smooth implant will behave the same whether saline or silicone gel.  The profile will not make a significant difference. Textured implants may work better but with the new concerns of ALCL I personally am reluctant to recommend them.

Thank you for this excellent question. I'm not sure there is one right answer. I try to avoid the textured devices at all costs. I don't feel strongly that either a saline-filled or silicone-filled (of any type) is likely to make a difference in this aspect. I would likely use a more moderate profile to help "spread" the implant over a wider surface area on your chest which would, hopefully, provide you long lasting results. Best wishes

Dear Nuturing,
Hello and thank you for your excellent question. Breast implant sizing is a combination of current versus desired breast size, chest wall and breast measurements, and skin and subcutaneous tissue quality. In general, a textured silicone implant will move less than a smooth saline implant, but there are exceptions. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. Preoperative visualization with Crisalix can simulate what your body will look like after surgery and can help you make your decision. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. Good luck!

Best,

Jon Ver Halen, MD FACS