Once upon a time breast implant choices were limited to saline or silicone as well as different sizes. The traditional silicone implants achieved most patients’ goals, but there were patients who experienced complications such as rippling, rupture, and capsular contracture. A variety of new silicone breast implant designs have been introduced to meet each patient’s unique needs.
Today, there are now three different silicone breast implant family options, which include Classic round gel implants, Inspira gel implants, and anatomically shaped “gummy bear” gel breast implants, which are also called 410 implants or form stable implants. While the silicone in traditional classic round gel implant has been improved upon over time, the highly cohesive “gummy bear” gel breast implant was developed to meet the demand of patients looking for a more natural shape to their breast as well as lower rates of rippling, rupture, and capsular contracture. Part of reducing risks and creating a teardrop implant that retained its natural breast shape required the silicone inside to be more cohesive, which allows the implants to better resist the effect of gravity and to have lower rates of rupture.
Along with the development of the more cohesive gel, the implant manufacturers at Allergan also developed a line of “overfilled” implants, which means there is more gel inside the implant. This improves fullness, and most of our patients prefer the “Inspira” line of round gel implants over the previous “Classic” style silicone implants. The Inspira implants are referred to as “overfilled” because they are filled to 95% capacity with silicone gel rather than 89% capacity for Classic implants. This allows patients to achieve more fullness in the upper part of the breast.
The Inspira “Responsive” implant is filled with generation 4 silicone gel just like the Classic implant line. This represents the 4th improvement in gel over the original silicone implants from the 1960s with each generation improving the cohesivity, which means the gel becomes more solid than liquid. Both the “Classic” implant and the Inspira “Responsive” implants are filled with gel that is 91% cohesive. For reference, the original silicone was 20-30% cohesive, so it was much more liquid than any of today’s options. This means it didn’t keep its shape well and was likely to “bleed” into the tissues if the implant ruptured.
The Inspira line also offers two lines of round smooth implants with generation 5 silicone gel, which is more cohesive and is known as the “gummy bear” gel. This is for patients who want even more fullness in the upper breast or who experience visibility of the implant through thin tissues. The Inspira “Soft Touch” has 94% cohesivity and the Inspira “Cohesive” implant has 97% cohesivity. This is usually reserved for breast reconstruction, but it appeals to some patients for cosmetic use as well.
All of the “Inspira” implants are offered in 5 different projections vs 3 projections for their “Classic” implants. Projection refers to how far out the implant sticks compared to how wide it is. As you can see in the image below, the projection increases from low to high profile. Basically the low profile implants are more like a pancake and the extra full profile implants are more like round balls. This can affect the shape and size of the breast, but your final result is also equally determined by your breast shape and size before surgery.
Round implants come in a smooth or a textured surface, and anatomic shaped implants (tear drop implants) all are textured. A textured surface allows for the implant to stick to the capsule of scar tissue the body forms around the implant, which causes less movement of the implant on the chest over time. This can be helpful for keeping anatomic implants from rotating (an upside-down teardrop doesn’t necessarily look good!), and it can minimize settling of the implants to the bottom and sides of the chest over time. For some patients, the “stuck in place” feeling that can last for up to a year after surgery with textured implants can feel unnatural. Also, round implants with a high profile can sometimes look less natural than smooth implants. But for patients who want a very round, high look or who have had malposition problems with smooth implants, round textured implants can be very useful.
Choosing saline or silicone can depend on a few factors. First, many patients are concerned about silicone and consider saline to be a safer option. Since both implants come inside a silicone shell, you will still have silicone in your body, and there are decade long studies proving that there is no increased risk of cancer or autoimmune disease with silicone implants. This said, if you feel anxious about silicone, saline may be the right option for you.
Budget can be a consideration. Saline implants are less expensive than silicone per pair by a few hundred dollars, but this doesn’t necessarily mean that saline are a better bargain. Rupture rates and capsular contracture rates are slightly higher with saline implants, especially when compared with the new cohesive silicone implants. So over your lifetime, when revision surgeries are taken into account, saline may not end up being less expensive.
In general, saline implants tend to look more artificial and have higher rates of rippling and visibility. But for women with at least an inch of tissue to pinch over top of the implant, the difference may not be that easily detectable. While thinner patients tend to have a more natural look and feel with silicone, this depends more on your anatomy and the size/profile of implant used.
The final consideration is what happens when your implant ruptures. Both are contained within a layer of tissue called the capsule, which forms around the implant over 1-2 months after surgery. When a saline implant rupture occurs, the implant deflates within 1-2 days in most cases, and the silicone shell stays inside the capsule. While slow deflation is possible, it’s actually pretty uncommon. That means you will have a smaller breast on one side (or both!) until your implant can be replaced. Usually the manufacturer warranty pays you back after surgery, and it may be several weeks before you can schedule surgery.
With a silicone rupture, the breast often will not look or feel any different. Even an exam by a doctor is only about 85% accurate for detecting rupture. This means it could be years before you notice anything has changed. Some people feel reassured by the fact that they won’t notice a sudden change, and some do not like the idea of something going on they can’t detect. After many months to years it is possible for your capsule to harden around the ruptured implant or for silicone to come into contact with the breast tissue. While this isn’t dangerous to your general health, surgery to replace the implants may be more complicated with a ruptured implant. A screening MRI every few years can detect most ruptures.