Ideal implants?Are they better, do they last longer, do only certain doctors do these? Why are these better than the old saline?

Question

I don't see much before and after photos or anybody posting about Ideal implants. Since they cost more, do you feel they are worth the money? I want saline and I am very active so one of my concerns was that the older saline implant may have that swooshing feeling and might bother me during my work outs. Does the Ideal implant really have less movement? I would love to here more from people who actually have the Ideal implant. Are more people starting to choose these as I read they are new?

Robert N. Severinac, MD · Answer

The Ideal saline breast implant was developed to address some of the issues that saline implant have as compared to silicone implants.  These issues include the feel, the motion sensation, and the surface wrinkling of the implants.  My opinion is that these issues are most concerning in the very small breast sizes (A cup or less) where the Ideal implants can improve results.  I am the first Plastic Surgeon in the Fort Wayne region and second in Indiana to offer the Ideal Implant.I have been doing saline breast augmentation for over 20 years and my patients have been very happy with the results.  So first, let's take a look at saline vs. silicone and why over 99 percent of my patients choose saline implants.  You will better understand the Ideal implants in the context of implant history and choices.Saline implants are filled with saline solution.  Saline is essentially salt solution (NaCl) that is isotonic, or has the same concentration as the body fluids.  (You are sitting there at about 80% saline solution).  Most saline implants have a one way valve on the surface that is opened by a special filler tube.  The implant can placed through a small 1 ¼ inch incision because the implant can be deflated, inserted into the dissected implant pocket, then inflated to the desired size.
Silicone is an inert substance that is found everywhere in our daily lives.  Depending how it is processed, it can be made into a liquid, a gel, or a solid.  The silicone implants of the 1960?s to the 1990s were of a runny consistency.  The new silicone implants are more gel like.  The implant companies have avoided the name "silicone" and call their implants words like "Gels" or "Gummies".  This is a result of the very negative press silicone implants got in the mid 1990's when patient's complained of illnesses like rheumatoid arthritis, lupus, scleroderma, fibromyalgia and other systemic autoimmune ailments.  The main implant company at the time, Dow Corning Wright, was sued in a class action and the FDA restricted their use for cosmetic augmentation pending further studies.  Since then, tens of thousands of patient's have been studied and none have shown any systemic illness associated with silicone implants.
Silicone implants come pre-filled and require a 3 or more inch incision to insert the implants safely without damage.  Silicone implants have less of a tendency to ripple on their surface than saline, which allow an over the muscle approach.  On the other hand, the highest risk of capsular contracture (too much scar formation around the implant) is with a silicone implant on top of the muscle.
It is felt that silicone implants have an advantage over saline with a softer feel and less of a tendency to have surface wrinkling.  For the most part, appearance of saline and silicone is the same.  It is very rare to have a patient complain of saline implants being too firm or the subtle wrinkling seen in the outer breasts in the very thin, small breast patient.  I used to offer silicone implants in these patients but now offer the Ideal implants in patients who benefit from them the most.
Saline implants are recommend in my practice in more than 95 percent of patient?s for the following reasons:
Breast size: Saline implants are filled during surgery and can be adjusted to be just right for a given patient.  This is particularly helpful for asymmetrical breasts so that different fill volumes can be placed.  Also, it is not uncommon for patients to wish they were bigger following surgery (especially those who where adamant that they didn't want to be too big).   This can be done in our office under local anesthesia and oral sedation ($2250 for our own breast augmentation patients, $2500 for patients from other practices).  The filler tube valve is located and the change in volume is made using the same small incision.  With silicone implants, once the box is opened, the implants are yours without any ability to change their size during or after surgery.  To change your size, new silicone implants would have to be used (about $1500 just for the implants, plus all the other surgical fees.)
Incision size: Saline implants can be deflated and placed through a smaller incision than silicone.  Silicone implant incisions need to be at least twice as long as the saline implant incision. There is increased risk of implant damage in silicone implants that are ?forced? through incisions the surgeon is trying to keep too small.
Implant failure: When a silicone implant ruptures, there is no easy way to tell as the silicone substance remains in the pocket within the breast.  Typically, a patient with silicone finds out there has been a rupture with symptoms of capsular contracture; a hard and often painful breast implant area.  Removing a ruptured silicone implant often involves having to remove the associated scar encapsulation, requiring a general anesthetic.  Until recently, the FDA mandated that all patients with silicone implants have MRI scans every 2 years to detect the "Silent Rupture".  To me, it is ridiculous for a cosmetic elective procedure would lead to an expensive MRI scan every other year typically used to detect severe medical illness.   When a saline implant ruptures, the patient knows because the saline is absorbed and the breast deflates.  A saline implant can be replaced in the office under local anesthesia and oral sedation in our practice.
Longevity: There is the notion out there that implants have to be replaced every 10 years.  This is false and based on studies that have shown that about 50% of patients have a procedure related to their breast augmentation in the first 10 years.  My rate is more like 5% and the most common reason being "I wish I were bigger".  I believe most of my saline implant patients will have these for life and certainly won't have any procedure just because 10 years have passed.  The new silicone implants have not been around long enough to be sure of their longevity but most recent rupture rates are of a concern.The Ideal implant is a saline implant and have all the advantages I listed above.  They have two chambers and two fill valves on the back and the front of the implant.  The back chamber is like a saline implant and is filled to a certain amount. The front chamber has baffle membranes to prevent "slooshing" of the saline, much like a water bed design.  This chamber has a range of saline that can be placed so they are also adjustable like the typical saline implants.  The design also prevents wrinkling of the perimeter of the implant that might be seen in the very small breast patient (flat to A cup) on the outer and/or the lower breast surface in the naked state.  These wrinkles may also be palpable.  The Ideal implant gives a more natural feel than the saline implants approaching that of silicone implants.In the B-cup or greater size breast augmentation, I will continue to recommend Mentor's Moderate Plus Profile Saline implants.  These patients have adequate soft tissue coverage of the implants where the issue of wrinkling and feel of the implant should be minimal.  For the flat to A-cup breast, I will offer the Ideal implant as an option for breast augmentation.The cost for Ideal implants are in the range of silicone implants.  The Indiana Plastic Surgery Center offers typical saline implants at $4995 and Ideal saline implants at $5995.All my best!

Jed H. Horowitz, MD, FACS · Answer

Good day! The Ideal Implant™ was recently FDA approved and is now being offered at our facility, Pacific Center for Plastic Surgery Newport Beach. Some women are not comfortable having silicone implants in their body and that was one of the reasons why the Ideal Implant was created. This implant gives a more natural feeling than traditional saline implants on the market. The unique structure of the Ideal Implant allows for a similar look and feel as silicone with the safety of saline. Find a board-certified plastic surgeon that has already performed procedure with this implant and discuss realistic goals and expectations. #RealSelf100

Farhad Rafizadeh, MD · Answer

The Ideal Implant is a better saline implant because of it's internal structure and a better shape and feel. The extra few hundred dollars in cost is really not significant. Every time I talk to a patient about the benefits of these implants as compared to traditional saline or silicone implants the patients choose these implants without hesitation despite the slight difference in cost.

Larry S. Nichter, MD, MS, FACS · Answer

Natural feel is not the only thing women care about. The FDA approved intact silicone gel implants as safe. However, if a gel implant ruptures the implant and any gel should be removed including the surrounding capsule (capsulectomy). IDEAL® IMPLANT offers women natural feel without the risk of silent rupture. Women value the advantages of IDEAL® IMPLANT over silicone gel:Rupture AdvantagesNo silent rupturesSaline absorbed, free Silicone Gel remainsNo MRI needed to detect rupturesLook in the mirror to know implants are intactEasy to remove and replaced if rupturedFiller AdvantagesOnly saline inside for peace of mindSafety of salineNo silicone gel in the bodyClinical AdvantagesYouthful shape/contourLower capsule contracture rateHigher rupture strengthLow rupture rate

Jeffrey Umansky, MD · Answer

Thanks for your question. The "ideal" implant definitely feels closer to silicone than the regular saline. They are a newer implant, but are very promising. I suggest you visit a board certified Plastic Surgeon to discuss your options and the implant that is right for you. Good luck!

Steven L. Ringler, MD, FACS · Answer

The IDEAL structured saline breast implants have been FDA approved since September of this year. On the outside, the Ideal Implant resembles a standard saline implant, but with lower edges so that it contours better to the chest wall. On the inside, there are a series of additional implant shells that are nested together to reduce bouncing, wrinkling and collapse in the upper part of the implant. The Ideal Implant is hybrid implant that combines the best of the saline and silicone gel implants. This unique design allows women to have the best of both worlds with their implant – a natural look and feel, but the ability to just look in a mirror and know the implant is intact.There is no concern about silent rupture that might happen with silicone gel implants. The Ideal implant does have less movement due to its unique design.  Not every plastic surgeon offers the IDEAL implant at this time, but if you go to their website, you should be able to find a physician near you offers this option.  We offer the Ideal structured saline implant, silicone gel, and saline implants to our patients.  You can achieve very nice results with any of these implants depending on your own preferences and body type. We do have many patients who have been very happy with the new Ideal implants.You should be seeing more before and after pictures as more patients seek out these implants.  I hope this helps.

Eric Desman, MD · Answer

Great question! All implants have advantages and disadvantages. Some of the advantages of the Ideal implant: They have lower rupture rates, by far, at 6 years compared to regular saline and silicone implants. When they do rupture, unlike a silicone implant, you can tell because your breast will get smaller. An advantage over "old fashioned" saline implants is that they feel better to the touch due to the way they are constructed. Disadvantages of Ideal implants: they don't feel exactly as good as silicone implants to the touch, though they still are pretty good. Also, they are more expensive than many other implants. I hope this helps.

David F. Pratt, MD · Answer

Over the past year and a half, I have used Ideal Implants in the majority of my breast augmentations and have been quite pleased with the aesthetic results and lack of complications.  My patients have overwhelmingly chosen the Ideal Implant over silicone, and have been very happy that they did. 
I believe that Ideal Implants certainly are better than silicone in that they do not need to be monitored for the dreaded “silent rupture” which can occur with silicone implants.  As far as feeling natural, I would have to say that the Ideal Implant is much more natural feeling than a “Gummy Bear” highly cohesive silicone implant, which tend to feel like a solid rubber mold.
  
Another advantage is the fact that size asymmetries can be corrected with Ideal Implants which is not possible with silicone gel implants.  
  
As far as longevity is concerned, we will have to wait and see if Ideal Implants stand the test of time.  However, it is encouraging to note that up to this point in time, Ideal Implants have been found to have a lower rupture rate than their competitors. 
  
Only surgeons that are certified by the American Board of Plastic Surgery can obtain the Ideal Implant for breast augmentation.
  
Ideal Implants are different from traditional saline implants in that they are designed as “structured implants”, which means that they have less of a tendency to collapse and ripple.  Also, Ideal Implants contain multiple baffles which dampen the fluid wave which is one of the downsides of a traditional saline implant.
  
I hope that I have answered all of your questions. Good luck!

Jonathan Hall, MD · Answer

The ideal implant may be “ideal” for you, if you are concerned about silent rupture of silicone gel implants, but did not like the less natural feel of traditional saline implants.  They are more natural in feel than saline but still not quite as soft as silicone. They definitely have less movement of the saline in the implant and are very close in feel to a silicone gel.

The Ideal implant was approved by the FDA in November of 2014, but has only had limited availability until recently.  Initially only the 120 plastic surgeons who were investors in the company had access. They are now starting to release it to more board certified plastic surgeons.  It has a profile similar to a high profile implant.  I would say that it is much more natural in feel than a saline implant, but still not quite as soft and natural as a silicone gel implant.  So my patients that want the most natural feel are still choosing silicone.  The most common implant used in the country is a round smooth silicone gel implant.  And the FDA has shown silicone to be safe and effective.  The FDA recommends in their labeling instructions that you get an MRI 3 years after surgery and every 2 years thereafter to check for a rupture. One analysis in 2014 in the Archives of Plastic Surgery found that 
  
silent ruptures occurred in 9-12 percent of cases eight years after implantation. In a silent rupture, the outer shell of the implant can rupture, but the cohesive gel stays inside the scar 
  
tissue capsule that has formed around the implant. SO there may be no visible or palable change in the 
  
breast- the rupture is silent. Is it harmful- 
  
no
  
- in the short run not much is seen. Over years the silicone 
  
can cause some irritation of the local capsule and thickening. But if we 
  
know the implant is ruptured we generally like to replace it.  
  
So leaked.  The saline is absorbed and the shell goes flat.  The American Society for Aesthetic plastic surgery, in 2014, reported that 20% of breast augmentations used saline implants.  But they do not feel as natural-some patients describe them as being like a water balloon, and they are prone to palpable and visible rippling and wrinkles. A recent survey of 300 patients by Allergan showed that 52% of patients were fearful of silent ruptures, with 45% being concerned that despite the science and FDA saying silicone gel is safe and effective it is still a foreign substance, and 34% of patients having a fear of silicone all together.  
  
So the Ideal structure saline implant will be a good option for some patients that like the idea of a more natural feel than saline with the advantages of being easier to detect a rupture.  The Ideal implant has two chambers and if one leaks it will lose volume that is harmlessly absorbed by the body.  If I had to predict I would guess that the majority of patients will still use silicone gel implants prioritizing the natural feel, but an increasing number of ideal structured implants will be used in patients that are concerned about silent rupture but didn’t like the feel of the traditional saline implant.

It is a small company, and warranty concerns are valid- but I would be surprised if they are not purchased by one of the larger main implant companies in the future. The 6 year data shows a lower failure rate that the other silicone and saline implants currently on the market, including the highly cohesive “gummy bear” implants.

Josh Waltzman, MD, MBA · Answer

I believe that if someone wants saline implants, then the IDEAL implant is definitely the way to go.  They feel more like silicone implants than traditional saline implants, and in general they have less visible rippling.  As you point out, some traditional saline implants have the feeling of a water moving back and forth.  This is essentially eliminated with the IDEAL implant because it has multiple lumens inside the implant which prevent the saline from sloshing back and forth.  The initial data from the company suggests that the IDEAL implant has a lower rate of capsular contracture compared to other implant brands.  Another pro is that this implant is only sold to Board Certified Plastic Surgeons.  I definitely think it is worth the added expense because you are paying for a significantly different type of implant with much newer technology than traditional saline.

Ideal implants?Are they better, do they last longer, do only certain doctors do these? Why are these better than the old saline?

Answers (13)

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