Which brand of Breast Implants are the least toxic?

Hi! Thanks for your question. These studies refer to a type of breast implant called a textured breast implant, which has a rough surface designed to adhere to the surrounding tissues. There is a small association of a cancer called ALCL with textured implants, although considered how many implants are placed each year, the risk remains relatively small. Although the FDA has decided not to completely ban textured implants at this time, many surgeons are moving toward using only smooth implants, which have not been linked to cancer or other breast implant illness. To ensure safety and long-lasting results, I would recommend choosing smooth implants, and would also recommend working with a board-certified plastic surgeon experienced in performing breast augmentations with a low rate of complications. In addition, if you choose silicone implants, you may to have regular MRI screenings to prevent leaks from going undetected. I hope you find this helpful!

The textured breast implants are linked to breast implant associated-anaplastic large cell lymphoma (BIA-ALC), a cancer of the immune system.  The FDA reports that BIA-ALCL may develop in 1 in between 3,817 to 30,000 women with textured breast implants (Clemens et al,  2017; Loch-Wilkinson et al, 2017; De Boer et al, 2018).  As of this date, the risk appears to be very small.  In most cases, BIA-ALCL is found in the scar tissue and fluid near the implant but can be widespread. The most common test for ALCL is to take a biopsy of an enlarged lymph node and check it for lymphoma cells. After three years, 93 percent of BIA-ALCL patients are disease-free when the condition is detected and treated early, according to American Society of Aesthetic Plastic Surgery data.
If silicone implants are ruptured, the implants should be removed as well as remaining silicone material that has extruded.  Silicone is relatively inert, and I would not anticipate a change in antibodies after removal.Your PS will be able to explain his/her preference of breast implant manufacturers based upon experience, knowledge, scientific research, and patient feedback.
Kenneth Hughes, MD, ABPS Board Certified Plastic Surgeon
Los Angeles, CA

Dear Lindsey23465,Thank you for your question. The FDA recently released a statement regarding the link between silicone implants and anaplastic large cell lymphoma. This risk from the information we have is almost entirely with textured, silicone implants. The theory is that friction between the textured implant surface and the breast capsule may be causing this issue. From what we know smooth surface silicone implants and saline implants do not carry or have a much smaller to no risk. Breast implant illness is a separate discussion. Although many women report resolution of symptoms such as fatigue, mental fogginess, and joint pain after breast implant removal, there are currently no scientific studies proving such a relation. Hope this helps,Nirmal R. Nathan, M.D.

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgeons
Real Self Hall of Fame

The relationship between breast implants and a rare type of lymphoma continues to be a subject of much investigation.  What we know thus far is that this is linked mainly to textured silicone gel implants so fir the most part plastic surgeons are using primarily smooth surface implants.

Hello, thank you for your inquiry. It has been seen BIA-ALCL on patients who have or have had TEXTURED implants only not SMOOTH gel implants. There is no issue with smooth implants. I suggest seeking board certified plastic surgeons and discuss details. Best of luck!

Hello,Causation has not yet been established, only association.  However, shell particulate and bacteria are the main focus of probable cause. BIA-ALCL has only been seen in women who have or had textured devices. The risk remains very low. Using smooth implants eliminates the risk entirely. 

Ultimately, there is no safest implant. There are 3 major silicone gel implant manufacturers (Mentor/Allergan/Sientra) whose products are FDA approved for use in the US. They all have similar product lines with minor variations throughout (although the Allergan Natrelle line does have a greater variety of offerings). Every surgeon will have his/her own preference but with regards to safety and product performance the differences are minimal.Despite recent media attention, there has yet to be a causative link between silicone gel implants and cancer. The few documented cases of BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) have all been in cases of textured devices. However, there have been a few hundred documented cases as compared to the greater than 40 million implants in circulation. The association is enough to cause many (including myself) to shy away from textured devices. However, this is not causative. If it were, they would no longer be in useBreast Implant Illness (BII) and silicone related medical complications/autoimmune disease is another controversial topic. It is a phenomenon which is supported by a wealth of anecdotal data (patient testimony on the internet) but no empiric data (hard scientific research). Patients reports a litany of symptoms which they attribute to their implants but the connection is difficult if not impossible to prove via objective evidence (lab tests etc).
Physician scientists may recognize anecdotal data but unless it is supported by Class I empiric data, it is difficult to place a great deal of faith in it. Clinicians should make decisions based upon evidence based medicine as this is the best tool we have to evaluate new and emerging treatments and technologies. Any claim can be made about anything, but unless verified it is difficult to put too great a degree of stock in it. 
That being said, it is easier to identify what one knows rather than what one doesn't. What we do know is that by all available measures today...implants are safe and specifically silicone implants are safe.
Silicone breast implants are among the safest medical devices in use today. These devices are also among the most rigorously studied and tested medical devices currently being used in the U.S. today. It is biologically inert and in that respect no different than the titanium used for bony fixation. There has been no demonstrated "causative" link between silicone and the commonly cited myth of autoimmune disease.
For those who remain unconvinced by the data, there is very little anyone can say to dissuade them and they may be better served to avoid augmentation.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).
Donovan Rosas MD
Board Certified by the American Board of Plastic Surgery
Member: American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons
RealSelf Top 100
RealSelf Hall of Fame 

Dear Lindsey23465,
there have been numerous studies on the safety and efficacy of silicone breast implants. The FDA has approved them to be safe and breast augmentation is the most common cosmetic surgical procedure performed in the United States every year. Implants are much different than they used to be with rigorous testing and cohesive gel. I can't tell you how happy my breast augmentation patients have been with their implants.
I would recommend a consult with a plastic surgeon to go over all of your concerns. Saline implants are also a perfectly good option if you are still concerned and are less expensive.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hello, and thank you for your question. (Keep in mind that an in-person consultation is necessary for the best advice.) Studies indicate that having textured implants increases your risk of BIA-ALCL (although the overall risk is incredibly small). No studies have demonstrated that a particular brand/model of modern breast implants has a more favorable or less favorable chemical profile. If you decide to pursue surgery it’s very important that you find a surgeon whom you are comfortable with and trust and who evaluates you in-person, addresses your concerns, and tailors an individualized treatment plan for you and your aesthetic goals. Best of luck!
Matthew A. DelMauro, M.D.

but one implant style from one company seems to have the greatest correlation with the development of anaplastic large cell lymphoma.  Your surgeon should clearly know what company to avoid when it comes to using a textured implant.  I won't use that company's product anymore, even if the FDA did not remove it from the market at this point.  There is nothing toxic about silicone or the fill (gel or saline).