Your primary choice is between saline and silicone implants. Within the category of silicone implants, there is a choice between round and shaped (cohesive gel) silicone implants. A consultation can help to decide which implant choice is the most appropriate option for you. Please see the descriptions of implants choices below:
Saline implants are placed deflated, then filled with a saline solution during surgery. They are adjustable and, because they are inserted deflated, they require a smaller incision. However, many women do not like the way they feel, as they are the firmest implants available and have the highest risk of rippling. One aspect of the saline implant that some women may like is that if the implant ruptures, it just deflates, and you know immediately.
Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion.
Dr. Schwartz is an expert surgeon and national educator on the use of cohesive gel (“Gummy Bear”) implants. These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.
Because of their shape, these implants require precision measurements to find the implant that best fits your frame and are more difficult to position during surgery. Dr. Schwartz lectures across the country on the use and safety of these implants.
When determining what implant would be most appropriate to use, there are many factors that should be taken into consideration. Your consultation is vital for allowing him to understand your goals and expectations for this procedure. After discussing your goals and desired outcomes from your breast augmentation, Dr. Schwartz will examine you so that he can take into account your frame and natural shape.
Measurements of your chest wall and current breast size will be taken to help determine the optimal size and projection of implant that will best fit your frame and meet your goals. Your specific chest wall anatomy is a very large component of this decision, because the implant must fit your frame in order to produce an aesthetic result. Dr. Schwartz’ precision measurements and sizing technique facilitates an active consultation from which you should come away feeling confident that all are on the same page regarding what your goals are for the procedure.
Below are photo examples of Dr. Schwartz’ precision measurement technique for breast implant sizing:
Breast implants can be placed over (subglandular) or under the muscle (submuscular). Under the muscle is generally preferred because it better disguises the implant by hiding its edges under natural tissue. It also reduces the risk of capsular contracture, and provides better long-term breast support. (What is capsular contracture?) Negatives to this method of implant placement include a more painful recovery and the potential for a complication called animation deformity. (What is animation deformity?)
Subglandular implant placement is when the implant is placed under the breast tissue but above the chest muscles. This method often offers a less painful recovery, but may result in more palpable implants, greater likelihood of capsular contracture, and increased difficulty in imaging the breast with mammography.
There are 4 sites available for implant placement. The two most common approaches are either through an incision around the areola or at the inframammary fold since they give ideal access for precise implant placement.
The inframammary fold (IMF) incision, which places the incision in the crease under the breast, is generally less concealed than the periareolar, but it may be associated with fewer complications that can occur with breast implants. (What are complications that can occur following breast augmentation surgery?)
This technique also allows for the easiest revisions.
The periareolar site is typically more concealed than the IMF incision, but it may be associated with reduced ability to breast-feed, and, possibly, changes in nipple sensation as compared to other incision sites. Additionally, if your surgery includes the use of shaped (“gummy bear”) implants, the periareolar incision may not be a viable option because a longer incision is required for the placement of these implants.
The transaxillary approach, which goes through the underarm, is an option, but it also makes accurate placement more difficult and, in case of revision, usually requires a different approach. Additionally, the axillary incision is generally less concealed than either the periareolar or inframammary sites.
Finally, transumbilical augmentation goes through the navel and leaves a nearly invisible scar, but it also makes placement very difficult and impossible to use silicone or gummy bear implants. Neither the transaxillary, nor the transumbilical approaches are recommended sites for optimal results. Furthermore, the transumbilical approach has been associated with intraoperative damage to the implant shell.
The surface of the implant may be smooth or textured. Smooth implants are standard and can move more freely within the breast. Textured implants have the benefit of reducing capsular contracture, but they may feel firmer; textured implants are normally used to prevent anatomical implants from shifting in the pocket.
Implants come in three different profiles for each size of implant: Moderate, Moderate Plus, and High. Moderate implants have a wider base with less forward projection, which tends to be better for more broad frames, while high-profile implants have a narrow base and a high projection, which is useful for narrow-framed women. Please see the above section on implant selection to learn more about how Dr. Schwartz determines the most appropriate implant style for you.
Dr. Schwartz is a consultant and advisor for Mentor Corporation and often chooses to use MENTOR® implants because of his trust and experience with the product and their warranty program. If applicable, our Client Concierge will assist you in enrolling in the warranty program. (Click here to learn more about implant warranty.)