How do I choose the implant that’s right for me?
Choosing the right implant, the position of the implant and where the incision is placed are some of the most important decisions a woman can make when considering breast implant surgery. When we see patients at the Plastic Surgery Clinic we spend most of our time discussing these issues so every woman can make the right choice for themselves.

The two major types of implants available for use in Canada today are Cohesive Gel Silicone implants and saline implants. Saline implants have been available for over 30 years. There is no other implant that has been more thoroughly studied or has a longer track record than saline implants. Essentially these implants are an empty bag that is filled with salt water or saline. The implant is placed into the body, after creation of the pocket, by rolling the implant up like a cigar and then filling it when it is in position. We use the same solution to fill the implant that we give a patient when we start an Intravenous or IV.

The advantage of saline is that it is safe, less expensive and leaves the smallest incision and scar possible. Normal activities do not harm these implants. We have patients  with saline implants who work as female fire-fighters, police officers, fighter pilots and personal trainers. Saline implants can occasionally leak, usually due to a defect which develops around the valve. When this occurs the saline is absorbed by the body and the implant goes flat. Replacing the implant is a fairly simple operation where the incision is opened, the deflated implant removed and a new implant inserted. The implant companies guarantee the implants for life and so will provide your surgeon with a replacement for free. You should check with your surgeon about possible surgical fees for implant replacement. In my practice we replace implants without charging any surgical fee. In fact we tell patients that if they develop a complication which can be fixed, that we will do so at no additional cost.

The risk of implant deflation is 1% per year. That means that one out of a hundred implants will deflate every year. So in 10 years a woman has a 10% chance of developing a leak; in 20 years 20%, 30 years 30%. So in fact the odds are that most women will live their entire lives without requiring a replacement.

There are some disadvantages with saline implants. These implants generally look best when placed behind the muscle. Placing saline implants above the muscle can lead to rippling and capsular contracture. Even when placed behind the muscle some women may be able to feel the implant in the bra crease area. This can give a ripply feel in the bra crease area. This problem is more likely to occur in very thin patients. Most patients however do not experience this problem.

Saline implants can be placed under the muscle through an incision in the bra crease, around the bottom edge of the areola or in the armpit (axilla). In my practice we perform the operation using any of these incisions and allow patients to choose the incision which they feel is best for them.

Cohesive gel silicone implants are the newest form of implant available in Canada. These implants have been used for breast augmentation since 2000 in Canada and for over 15 years in Europe. These implants are filled with a solid or cohesive silicone center. They are commonly called the “gummy bear” implant because if they rupture, they don’t leak. You can stick a needle in these implants, or even cut them in half, and nothing leaks out.

There are some advantages to cohesive implants. They are less likely to give the problem of rippling or palpability of the lower edge in the bra crease area. While they do not reduce the risk to zero, they do make these problems less likely. The other advantage of these implants is that they can be used above the muscle. There are some patients who need to have their implants above the muscle. Such patients are women who have breast droopiness. When a women’s breast droops, an implant cannot be placed behind the muscle without performing a breast lift. A breast lift or mastopexy leaves more scarring on the breast.

When using cohesive gel implants, women with breast droopiness can have a textured cohesive gel implant placed above the muscle. This gives a more natural look but also the “Velcro like” outer cover of  one of the types of cohesive implant helps to give the breast a lift without actually performing a lift. This saves these women the necessity of having the extra scarring associated with a lift. These implants were actually designed for use above the muscle and give women a very soft and natural feel.

Women who are extremely thin also have the advantage of having a decreased chance of rippling and palpability of the implant when they use cohesive gel implants under the muscle. The usual way to insert cohesive gel implants is with a scar around the lower edge of the areola or in the bra crease. At The Plastic Surgery Clinic we have developed a technique of inserting cohesive gel implants under the muscle through an incision at the top of the armpit. The advantage of this technique is that when the scar heals, it does not look like a scar but rather like another normal wrinkle in the armpit.

While there are many advantages to cohesive gel implants, there are also some disadvantages. Because these implants are solid, they leave a larger scar, usually 4-5 centimeters as opposed to 1-2 centimeters with saline.

Cohesive gel implants also have a slightly higher risk of capsular contracture than saline. For most surgeons, the risk of capsular contracture with saline under the muscle is around 1%. With cohesive gel the published risk in the European studies is 5-10%. One of the implant manufacturers reported a 3 year capsular contracture rate of 4% at the recent Health and Welfare Canada hearings in Ottawa.  Oddly enough however there are some patients who have capsular contracture with one implant but do not suffer from this condition when they switch to a different type implant in a new pocket.

The most important myth that needs to be dispelled about breast implants is that one implant is better than another. There are some patients who, because of their anatomy, or the shape of their breasts, need to have a cohesive gel implant. But there are many patients who have the type of chest where both saline and cohesive gel implants will give equally good results. These patients are fortunate  because both cohesive gel and saline implants will give equal results, with breasts that look and feel equally good with either implant. In these patients the choice of implant becomes a personal one based on personal preference, price and size of scar.

Women who are thinking of breast implant surgery should carefully review all of their options before surgery. They should avoid any surgeon who uses only one type or even one make of implant because all implants have advantages and disadvantages. There are even differences in implant characteristics between the two major manufacturers of implants.  The choice of which implant is right for you depends on the appearance of your breast before surgery, your individual anatomy and your specific needs.

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