Women seek breast enhancement (augmentation mammoplasty) for a variety of reasons. For many women, it is not just to increase the size of their breasts, but may be to feel more comfortable in a swimsuit or confident out of clothes. It may be to return to their pre-pregnancy shape and volume. Some aim to correct an asymmetry or abnormal breast development that has plagued them since adolescence. Whether a woman wants people to know they’ve had a “boob job” or prefers a more reserved look, Dr. Albright will assist you in achieving your specific goals.
The two main types of implant filling are saline (or salt water) and silicone gel. Traditional salt water filled breast implants tend to feel less natural and may feel somewhat firm. Depending on the amount of fluid inside the shell, there may be more or less implant rippling or folds. Silicone implants are considered to have a more "natural" breast-like feel. People also talk about gummy bear implants. These implants are filled with a silicone gel that is more like a semi-solid (gummy bear consistency) than a liquid. Some folks consider these to be anatomic or shaped (tear drop versus circular) implants, when it really more broadly describes the consistency of the filling. The most recent development in breast implants involves the concept of a structured implant. By placing additional layers inside a saline-filled implant, fluid waves are disrupted and the implant feels closer to a gel than to a traditional saline implant.
Silicone shell with saline (salt water) filling.
Saline implants are inserted empty (just the silicone shell; like an empty balloon). After being placed in the breast, they are filled with sterile salt water. Saline implants are available to women 18 and older.
Silicone implants are pre-filled with silicone gel. Their shape and volume are predetermined. Silicone gel is more viscous than water and is designed to more closely mimic breast tissue. For cosmetic breast augmentation, the FDA has limited the use of silicone gel implants to patients older than 22 years of age. They may be used on patients under 22 only for breast reconstruction purposes.
During your consultation, Dr. Albright will discuss the differences between salt-water (saline) filled versus silicone gel filled breast implants. For most patients the choice will boil down to the overall comfort level with risks/benefits of the implant fill material. Here is a brief comparison of saline versus silicone breast implants:
For saline implants, if the implant were to rupture, your body would slowly absorb the salt-water and you would notice a “deflation” or loss of volume in the afflicted breast. Conversely, with newer cohesive silicone implants, implant ruptures are often “silent”, meaning you may not be able to see or feel a difference in the implant after a rupture. The FDA recommends scheduled MRI surveillance of silicone implants to help detect these silent ruptures. If your silicone implant ruptures, the FDA recommends having it removed with or without replacement. The recommended MRI’s are not covered by insurance and will have to be paid out of pocket.
Saline implants are typically less expensive to purchase than silicone implants (typically several hundred dollars) but may have a less extensive warranty, unless it is purchased separately. An exception to the cheaper initial cost for saline-filled implants is the new “Ideal Implant”, which is a “structured”saline-filled implant that is purported to feel more like a gel and has a similar overall cost to silicone implants.
Silicone implants, including gummy bear breast implants, are widely accepted as feeling more “natural” or“breast-like” particularly when squeezed or prodded. However, this is likely an over simplification. The overall implant feel is also affected by implant pocket selection, implant fill characteristics (over-filled vs under-filled saline and more or less cohesive silicone gel), and overall soft tissue coverage. Dr. Albright typically reserves traditional saline-filled implant use to below the muscle (total submuscular) to minimize any unnatural feel or rippling. Furthermore, he discourages using saline implants in a dual-plane pocket as these implants may migrate more quickly due to a water hammer effect from the saline fluid wave within the shell.
The implant fill density (typically grams per cc of volume) is very similar between 0.9% Normal Saline, and cohesive silicone gel. Both approximate 1g per cc. Since saline implants come deflated and are filled with salt water during the procedure, they have a range of fill volumes that can be placed and are more adjustable during the surgery, whereas silicone implants come pre-filled and have a fixed volume/shape. But even with these variables, differences between implant weight (at least within the range of most implant sizes) are negligible.
Every breast implant has the risk for rippling/scalloping/waviness/folding in its shell. This is why ensuring adequate soft tissue coverage to “hide” the implant is so important. There are certainly differences in overall risk of seeing or feeling these ripples or folds. Underfilled-saline implants are at greater risk than over-filled saline implants. Less cohesive silicone gel filled implants are at greater risk than more cohesive silicone gel implants.
Check out this link for some before and after photos with different implants.