I want breast implants. I have children, what if any is truly THE safest material for the long term of possibilities.
Doctor Answers 10
The best type of implant for you
What is the safest material for breast augmentation?
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California
I want breast implants. I have children, what if any is truly THE safest material for the long term of possibilities.
Thank you for your question. Both saline and silicone implants today are FDA approved and safe with most women choosing silicone gel because of its natural feel. Some women however have more peace of mind knowing that if their implants rupture, they'd prefer to have salt water instead of silicone. Implants can be placed above the muscle if that is your preference although most are usually placed underneath in order to achieve a more natural look and reduce the risk of capsular contracture. Finally, there are options now to transfer fat from one part of your body to your breasts for augmentation in case you did not want any foreign objects in your body. Be sure to consult with an experienced board certified plastic surgeon. Good luck!
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Safe Options for Breast Augmentation
In this answer, I will first discuss the options of going over or under the muscle, followed by discussion about different implant fillers, and fat-based breast augmentation.
The decision to go behind the muscle or over the muscle has to do with the amount of soft tissue coverage – “padding” under the skin. Choosing a pocket that is tight with sufficient soft tissue coverage not only prevents implant visibility, palpability, and risks of excessive stretching on the breast, but also excessive implant movement into the outer or inner sides of the breasts. A hand-in-glove fit for the implant allows for a natural and long-lasting result. Your surgeon will do a pinch test in the upper pole of the breast to see how much “padding” you have. If you have less than 2 cm, then you do not have much padding and it would be best to go under the muscle. Generally speaking, if your ribs are visible under the muscle, then you do not have much “padding.” If however, you have more than 2 cm of tissue, then you have the option to go over the muscle or under the muscle.
OVER THE MUSCLE
If you are hoping to fully preserve the functionality of the pectoralis major muscle due to athletics or body building, or if you have a shapeless, constricted, tuberous, sagging breasts without cleavage, then over the muscle may be a better option.
- Over the muscle implant placement causes less trauma to the chest muscles, and the implants will not be subjected to any pressure or injury due to muscle movement. The implant can directly apply pressure on breast tissue to shape the breasts.
- However, over the muscle implant placement may have higher risks of breast tissue wasting, interference with mammography, and capsular contracture compared to under the muscle placement.
UNDER THE MUSCLE
Under the muscle (partially submuscular) is a preferred option for many surgeons because the muscle helps to maintain a slope for the upper pole while allowing for a curvature in the lower pole, while over the muscle will mostly make your breasts appear round and augmented.
- In thin patients, additional coverage by the muscle reduces the risk of implant visibility in the upper and inner sides of the breasts. It also reduces risk of synmastia, and provides less interference with mammography and breast imaging. It also brings lower rates of capsular contracture.
- However, under the muscle implant placement may allow the chest muscles to put pressure on the implant distorting the breast shape and position in the long-term. You may experience more pain following surgery due to the dissection of some muscle attachments and you may lose strength while flexing your chest muscle and is not suitable for athletes and body builders.
Now I will discuss about saline vs. silicone implants.
1) Saline Implants
- Since they come in a non-inflated form, the implant can be inserted without having a large incision on the skin and this results in minimal scarring adding to a natural look.
- The non-inflated form also allows the implant to be placed through all incisions including the transaxillary incision which is referred to as the “scarless technique” because there is no scar on the aesthetic unit of the breast itself.
- The non-inflated form allows their volume to be adjusted during operation to make aesthetic looking breasts.
- Saline implants have a 1%/year chance of spontaneously deflating (10% chance after 10 years), and although no one can predict when this will happen, it will be obvious as the breast with implant deflation will reduce in size significantly. Even if the implant ruptures, there is no harm. Saline is “Salt water” which is administered into veins when a person is extremely dehydrated, and thus, it is harmless when absorbed by the body
- Saline may not make the breasts feel natural because it is not compressible – there will be a strong resistance when you squeeze your breasts making them feel firm rather than soft and squishy. However, the difference in feel compared to silicone disappears with the amount of breast tissue you have. Special care should be taken on choosing the right size and shape so that they are proportionate with your overall body contour.
- Saline implants have higher chance of rippling (wrinkling) which may be visible if you have less soft-tissue coverage (i.e., soft tissue refers to your skin, fat layer beneath your skin, and the breast tissue). The thinner you are the more you see it. Rippling often develops on the outer perimeter of the augmented breasts: on the side, bottom or in between the breasts. It can be caused by under-filling of the implant. Solutions would be to choose a moderate sized implant, choose behind the muscle implant placement, choose smooth surfaced implant, and gain weight. That being said, visible rippling can occur with saline implants even behind the muscle on the lateral (outer) aspects of the breast near the breast fold when you lift your arms, or lean forward.
- Silicone as a filler will make the implant feel softer resembling the feel of the natural breast tissue due to its gel-like cohesiveness. This characteristic also makes the implants less detectable even by touch or feel.
- Silicone implants are ideal for thin woman with small breasts
- Silicone implants experience minimal rippling which is barely visible and may occur mostly when patients lie down on their breasts
- Silicone’s cohesive gel allows more a greater variety of implants – i.e, shaped implants are only silicone-based and provide a natural look which is helpful in treating certain conditions related to the chest wall or breast development.
- Silicone implants have a 1%/year chance of rupturing similar to saline implants (10% chance after 10 years), however, the rupture is silent which means that the breast size will remain stable. The downside is that you will require an MRI test to diagnose the gel leakage/rupture. Current FDA recommendation is to have an MRI 3 years after implantation, and subsequently every 2 years.
- Silicone implants cannot be safely introduced behind the breast through the transaxillary incision unless they are small or moderately sized (>500 cc).
- Silicone implants appear in a pre-filled form which means implant insertion requires a longer incision on the skin to prevent its damage, and its volume cannot be manipulated.
The New Silicone Implants:
- There is often a concern over safety and monitoring of silicone implants, but these implants have a similar complication rate compared to saline implants. Several clinical trials have shown the safety and longevity of silicone implants that allowed them to be approved by the FDA since 2006. Please note that today's 5th generation silicone cohesive gel implants have been proven to be very durable and safe. In fact, they have lower rates of capsular contracture and gel diffusion. These 2 things were the major concern from previous silicone implants. The new silicone implants also have thicker shells, wider variety of surface textures, and implant shapes.
Both saline and silicone implants are very safe and durable, and there is almost no difference in terms of safety. However, if your question considers only the filler of the implant, then saline solution is inherently safer when exposed to the body compared to silicone which can cause an inflammatory response.
If your major concern is safety, and you also prefer a natural look, then the new IDEAL Implants may the right choice for you. IDEAL implants have been created to provide the natural look and feel but with saline as a filler rather than silicone. The unique structure of the IDEAL Implants allows for a similar look and feel as silicone with the safety of saline. Ask a board-ceritied plastic surgeon about IDEAL implant.
The SAFEST material to be placed in the body has to be your own. A natural option for breast augmentation is using fat transfer.
Fat transfer to the breast involves carefully harvesting fat using liposuction from areas in which you have excess, unwanted, and stubborn fat deposits such as the outer thighs and abdomen, flanks, hips, etc., and injecting it safely back into the breasts which may be lacking in aesthetics or volume.
Once injected, the fats cells must form a new blood supply to be nourished and remain alive. What can hinder is the technique used to inject and process the fat. If fat is injected in large quantities in one sitting, then blood supply cannot be formed effectively, resulting in death of some fat cells and their removal by the body – this results in a decreased breast size over time. Furthermore, your harvested fat can have certain impurities and oils which increases fat reabsorption. Purifying it is essential. 2 effective techniques are centrifugation and filtration (using PureGraft system).
I use the Puregraft system and it has been shown to more effectively remove the oily, watery, and dead components from the fat harvest. It is also prevents contamination of the fat from air exposure, and can be used for breast augmentation, while centrifugation is most good for purifying small amounts of fat as used for the face.
If an expert, and board-certified surgeon purifies fat using the PureGraft system, and places fat in multiple directions and layers within your breast, then only will blood supply form around the transferred fat, and then only will your results be sustained over the long-term.
Below I describe the pros and cons of the fat-based breast augmentation. Pros
- Fat is usually inexpensive, abundant, readily available and accessible, and can be harvested numerous times
- Fat is your own tissue, and your body will not reject the transplanted tissue
- There is no foreign tissue reaction as seen with implants – i.e., Capsular Contracture
- Your body figure is improved by removal of fat while your breasts are enhanced
- The procedure results in soft and natural breasts with long-lasting results
- It is minimally invasive and your recovery will be quick
- It can be used to enhance the cleavage area, improve symmetry, and change the shape of narrow based breasts
- It is a scarless procedure
- Fat transfer to the breast will also improve the skin quality overlying the breasts through a rejuvenation effect (i.e., repair sun damage)
- There is a limit to the augmentation size possible with fat
- Unlike implants where you can choose the size you want, you can only go up by a maximum of 1 cup (e.g., ½ - 1 cup increase in breast volume) – If you want to go for a C cup, only an implant can be used
- You may require more than one procedure to get the desired effect for 2 reasons: 1) you can only put a limited amount of fat in the breasts at a time, 2) fat reabsorption can occur resulting in reduced volume
- In case a retreatment is needed, it can only be done 3-6 months later to avoid death of fat tissue
- Procedure is not possible if you do not have enough fat available for transfer from donor sites
- It cannot change the shape of the breast, correct the nipple position, or correct sagging of breasts (ptosis)
- It does not provide the upper pole fullness that can be achieved with an implant.
I hope this information is helpful.
Please consult a board-certified plastic surgeon about your options for breast augmentation.
Breast augmentation - safest implant material
- You have a very reasonable goal.
- You want implants that go over the muscle - this leaves the pectoral muscle in its normal position.
- You want an implant that is not too large - the right size will depend on your body shape and proportions.
- (Something between a 250 - 350 cc implant is a range to start with.)
- As for the material - both the new firm gel and the saline are safe.
- The gel is firm enough that it does not seem to spread or leak.
- Saline implants are water filled - but they can deflate and are more likely to be visible if you are very flat.
- So a small, gel over-the-muscle implant seems a good approach for you.
Safest Material for breast implants
Breast Implants are All Safe
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.