“Cohesivity,” “texture,” “teardrop” and “adjustable” are among the buzzwords in breast implant technology. So, what’s really important to surgeons who are charged with helping breast augmentation patients achieve optimal outcomes? And what’s better? Silicone gel or saline?
To help sort through the marketing hype, we asked three experienced plastic surgeons what they look for in implant technology and why.
When silicone gel implants re-emerged around 2006, after being taken off the market for augmentation patients due to health concerns in 1992, the newer versions were more cohesive, according to Michael S. Kluska, D.O., a cosmetic and plastic surgeon practicing in White Sulfur Springs, W.V. and president elect of the American Academy of Cosmetic Surgery.
The newer silicone-gel implant designs helped to prevent gel leakage with outer shells that were less likely to fracture or rupture.
“From 1992 to then, the biggest implant in the country that was used for cosmetic purposes was the saline-filled implant. Since 2006, the number one implant in the country has become the silicone gel-filled implant, with higher cohesivity,” Dr. Kluska says.
Allergan has since introduced the Natrelle 410 Highly Cohesive Anatomically Shaped Silicone-Filled Breast Implant, a true gummy bear implant, with a highly cohesive internal content — meaning, you could literally cut the implant in half and have two solid halves, Dr. Kluska says.
“That was a game-changer,” he says.
The advantages include low to no chance of fracture, and the implant’s teardrop shape helps with the anatomical deficiencies primarily in the inferior pole of the breast. The shape is also a plus for patients who want a more natural, gradual, tapered look to the breast. In addition, the implant is textured, so once in position, it tends to stay there, Dr. Kluska says.
The downside of the 410 and one of the reasons it’s not a go-to device is that it’s patient specific, Dr. Kluska says.
The teardrop shape, for example, doesn’t suit many patients who want a more rounded look. A round saline or silicone-gel implant offers more superior pole thickness. And the highly cohesive implant is not a good choice for people who want a D-sized cup for their first breast augmentations, he says.
“Using a silicone gel implant or a saline implant which is more round tends to allow you to have that fuller D appearance,” Dr. Kluska says.
NEXT: Go Smooth or Go Home
Go Smooth or Go Home
Another problem, which is considered a selling point to some, is implant texture, according to Boca Raton, Fla., plastic surgeon Hilton Becker, M.D.
“Texturing was introduced in an effort to reduce capsular contracture but is being used less frequently due to several problems,” Dr. Becker says.
Dr. Kluska says his go-to implant is the smooth, round silicone-gel filled. His second choice is the Allergan 410.
Dr. Becker, who designed the Becker 50 adjustable gel-saline implant, by Mentor, says he uses the adjustable saline for breast reconstruction, as well as in patients with severe breast asymmetry and to correct implant issues. But his go-to for breast augmentation is the smooth, round silicone-gel implant.
“I found that the smooth implant is the most natural feel. I also like the fact that it’s easier to use and is easier to insert,” Dr. Becker says. “If a patient develops an infection, it’s easier to treat with a smooth implant than a textured implant.”
Seattle, Wash., plastic surgeon Richard Baxter, M.D., agrees that smooth, round and silicone gel is the way to go for many patients.
“I believe most patients do best with a smooth round silicone gel implant, such as Allergan Inspira and Sientra 106 series. These have a higher fill ratio, so there is less rippling, and a wide range of profiles for accurate sizing,” Dr. Baxter says. “I use form-stable implants for breasts with an oval base shape with a shorter nipple-to-fold distance, which I see in about 15% of patients.”
Dr. Baxter looks for these elements when choosing an implant: high fill ratio, low rupture rate, and level of clinical support from the manufacturer, which includes warranty coverage for capsular contracture and rupture.
Dr. Baxter says that saline implants and underfilled gel implants, such as Allergan’s style 10/15/20, are passé. He also doesn’t see any indication for textured implants.
“Textured implants cause more irritation of the tissues; there’s an increased risk of seroma formation; and, more recently, with the highly textured implant, there is some evidence that they are related to anaplastic large cell lymphoma, so I don’t take the risk,” Dr. Becker says.
Dr. Baxter has a consulting relationship with Allergan and clinical trial participation with Allergan and Sientra but has no current conflicts of interest.
Dr. Becker is a paid consultant of Mentor Worldwide and receives royalties from Mentor Worldwide.
Dr. Kluska reports no relevant disclosures.