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

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. 

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.