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How to Choose the Right Breast Implants
There are a few different factors at play when it comes to deciding which type of breast implant is right for you, and the process of determining which combination of characteristics will create the most beautiful, natural looking breast can be complex. Thankfully, Dr. Lista is there to help. With more than 25 years of experience as a plastic surgeon, he can help you understand the subtle differences that will influence the outcome of your breast augmentation procedure. When patients visit The Plastic Surgery Clinic for free consultations, Dr. Lista spends the majority of the time talking about these various points so that each woman can feel confident in making the right decision for her body and her lifestyle. So what are some of the important characteristics that need to be considered?
The two primary categories of implant that are used in Canada are saline breast implants and cohesive gel silicone breast implants (sometimes these are also casually referred to as “gummy bear” breast implants). With a track record that spans more than 30 years, saline breast implants have been studied comprehensively, their safety and effectiveness standing the test of time. These implants arrive empty from the manufacturer and are placed in the breast unfilled. Because they are inserted when empty, they require only a very small incision. Once placed in the correct position in the body, the implants are filled with a solution of saline. We use this solution because it naturally occurs in the body—it’s the same fluid used in an IV to help hospital patients stay hydrated. Saline breast implants are a great choice for several women because they are safe, less expensive, and leave a very small, inconspicuous scar. When used on the right patient, they create a soft, natural looking and feeling breast.
In very rare cases, saline breast implants can develop a minor defect near the valve that can cause them to leak. If this occurs, the saline solution is naturally absorbed and processed by the body, and the deflated implant requires replacement. These implants come with a lifetime guarantee from the manufacturer, so in the event that a replacement is necessary, it will be provided free of charge. While some surgeons charge a fee for replacement in these cases, at The Plastic Surgery Clinic, Dr. Lista will perform the replacement without any surgical fee. He insists that if a complication arises after your procedure, no matter what it is, we will fix it if we are able to do so at no additional charge to you.
How often does this type of complication occur? The rate of deflation for saline implants is about 1% each year. If you took one hundred breast implants, after one year, one of them will deflate. Another way of thinking about it is to consider that, after 10 years with the same breast implants, a woman has a 10% chance of developing a leak. After 20 years, the chance of deflation will match at 20%, and so on. In the end, the odds are that the majority of women who undergo breast augmentation with saline breast implants will never require a replacement.
The incision used with a saline implant can be located in the bra crease, in the armpit, or around the bottom side of the areola. Dr. Lista is experienced in each of these approaches, so you’re free to choose whichever placement makes the most sense for your lifestyle. During your consultation you’ll be able to look through a variety of before and after photos to get an idea of just how inconspicuous the incision scar appears in each different location.
It’s important to remember that there are also disadvantages associated with a saline type of implant. Saline implants are typically best suited to a placement below the muscle, which covers the implant and reduces the appearance of rippling. Behind the muscle placement also helps prevent capsular contracture, a complication associated with breast augmentation. Some women—thin patients, in particular—can still feel a rippling texture in the area of the bra crease even if the saline implant is placed behind the muscle, but this kind of problem is pretty rare and not a common occurrence for most patients.
The other main category of breast implant is silicone. The most modern variation that is used today is known as a cohesive gel silicone implant. Cohesive gel means that the silicone filling is in a solid form as opposed to a liquid silicone. While they feel soft and malleable, if you cut them in half, they retain their shape without leaking out. That’s why some people refer to this type of implant as a “gummy bear” breast implant. If you think about what happens to a gummy bear when you puncture it or cut it in half, it’s the same result: no liquid leaks out and it keeps its shape, making it much safer than the earliest generation of liquid silicone breast implants. This new generation of implant has been used in Canada since the year 2000, and it has an even longer history in Europe.
Cohesive gel silicone breast implants don’t run the same risks of creating a rippling effect in the breast. They don’t totally eliminate this risk, but they certainly improve it. These are also the best implants for women who require a placement over the muscle. Which types of patients are best suited to an over-the-muscle technique? Women who have some droopiness in the breast require placement over the muscle unless they are also undergoing a breast lift. A breast lift improves the shape of the breast and position of the nipple for women who experience sagging, drooping, or deflation, which sometimes occurs after pregnancy and breastfeeding. Some women choose not to undergo a breast lift as it creates more scarring than breast augmentation alone, while others are not overly concerned with droopiness and simply wish to improve the overall volume of their breasts. These patients require placement over the muscle to create the most natural looking and feeling breast.
The other benefit of cohesive gel implants for women with breast droopiness is that they can opt for an implant in a teardrop shape with a textured shell that helps give the breast a slight lift without additional surgical intervention. The teardrop shape provides the right kind of volume in the right places to create this sort of lift effect and the textured, velcro-like shell helps to hold the implant in place to keep that proportional volume in the correct position. Dr. Lista is pleased to be able to offer this option to his patients since these silicone implants were particularly designed to create a very soft, natural result when placed above the muscle.
Patients who are thin or who have a less substantial amount of breast tissue to begin with can also benefit from a silicone breast implant that’s positioned behind the muscle. For these women, cohesive gel creates less rippling and helps eliminate the ability to see and feel the implant.
In terms of incision options for this type of implant, it can similarly be placed in the bra crease or at the lower edge of the areola. When the implant is being inserted under the muscle, the incision can be placed in the armpit, which creates a scar that looks just like a small wrinkle. However, one aspect particular to silicone implants is that they require a bit of a larger incision than saline implants. Since they can’t be placed when empty, like a saline implant that requires an incision about 1-2 cm long, the pre-filled silicone implant requires an incision more than double the length, about 4-5 cm in length.
Silicone breast implants also carry a slightly higher risk for capsular contracture than their saline conterparts. Capsular contracture is a complication that sometimes arises after a breast augmentation procedure. The body forms scar tissue around the breast implant and this can make the breast feel hard. It creates a less natural look and feel to the breast, and it can be quite uncomfortable for the patient, so our goal is to do whatever we can to keep this risk as low as possible. The risk is always there, but it’s slightly higher with cohesive gel.
One of the reasons we use drains after breast augmentation is that studies show they help reduce the risk of capsular contracture. Dr. Lista completed and published a scientific review of 1,300 patients who underwent breast augmentation with drains at our clinic, and he found that our rate of capsular contracture is 1.3%, the lowest of any published study.
If you're interested in breast augmentation and you’ve been doing research online, you’ve probably seen some people making claims that there is one type of implant that is always better than the other. That’s just simply not the case. There is no one type of implant, shape of implant, or placement of implant that is always best. Some women meet with Dr. Lista and discover that a cohesive gel implant will work best with their anatomy, the proportions of their body, and the pre-existing shape of their breasts. But there is also a significant number of patients who come to our clinic who could choose a saline breast implant or a silicone breast implant and achieve an equally great result. These women have the benefit of choosing what they personally prefer for their incision, placement, and overall price.
The other big myth out there that should be dispelled is that women are required to change their breast implants every ten years. This simply isn’t true. The only time a woman would need to change her breast implant is if a complication arises. Breast implants today don’t come with a best before date. In fact, as mentioned earlier, they’re guaranteed for life. They won’t have any effect on pregnancy, and they typically don’t interfere with breastfeeding in any way, especially if they’re placed behind the muscle. Countless scientific studies have been conducted and have conclusively proven that breast augmentation will in no way increase the risk of breast cancer. You can feel confident and comfortable knowing that, more than likely, your new breasts will last you a lifetime.
If you are considering breast augmentation, take your time and carefully review all options available to you before you commit surgery. Ask any question you might have and address every single concern that’s on your mind, no matter how big or how small it might seem. In the end, the most important thing is that you choose what’s right for you and that you don’t feel like you’ve been talked into something that won’t suit your lifestyle, your body, or your desires.
Find out more about breast augmentation in Mississauga.