Saline Breast Implants

Saline-filled implants became available within a few years of their silicone cousins. Early on, there were problems with a high deflation rate, and they fell out of favor with many surgeons.

But in 1992, when silicone implants were, for the most part, removed from the market, saline implants that had been greatly improved became the standard for breast augmentation. They are soft and can give very natural-looking results.

Shell Surface & Implant Placement

breast implant positionIn the early days of breast augmentation, all implants were smooth and placed in a subglandular position (beneath the breast tissue, but above the chest muscle). The scar capsule that develops around them is highly organized, so the capsular contracture rate is very high, perhaps as high as 70%.

More than twenty years ago, it was discovered that if smooth implants were placed beneath the pectoralis major muscles in the chest, the contracture rate dropped to around 9%. The muscle only covers about half the implant and no one knows exactly why it changes the contracture rate so dramatically, but it has become the standard in breast augmentation.

The rise and fall of textured implants

The first textured implants that were used were covered with a layer of polyurethane foam. As the capsule grew around them, scar tissue developed within the foam in a disorganized fashion. It was felt that this disorganization prevented the contraction of the scar around the implant, keeping the breast feeling soft. However, the company that made these implants stopped manufacturing them because it was learned that the human body would break down the foam coating.

Other manufacturers decided to mimic the physical characteristics of the foam by texturing the silastic shell of their implants so they felt rough. The capsular contracture rate fell to somewhere between 5 and 10%, but another problem arose: visible rippling, especially along the upper and inner aspects of the breasts. This may be due to the adherence of the capsule to the implant, which in my mind, is rather like Velcro. More recently it was learned that textured implants are associated with a rare condition called anaplastic large cell lymphoma. For these reasons, we do not use textured implants for any breast augmentation at LJCSC.

Shape: Round or Teardrop

Round Implants:

breast implantsRound implants have been the traditional shape since the beginning of breast augmentation. As the diameter of the implant is increased, the implant gets larger by the same amount in all directions. The distance the implant projects outward can also be selected. The low- or mid-profile implants are the most commonly used in cosmetic breast augmentation, and high-profile implants are more commonly used in breast reconstruction.

In my experience, I have found that the more the skin is stretched, the rounder the breast will look no matter what the shape of the implant. In women with some tissue laxity who do not desire a large increase in breast size, a round implant can have a very natural-looking result. In a woman with no tissue laxity, even a small implant will result in a rounded upper portion of the breast. Many woman are looking for just this shape.

Teardrop Implants:

Oval or teardrop implants have been tried off and on over the years with varying degrees of success. Today’s versions are sometimes referred to as “anatomical” because their shape closely resembles that of a “natural” breast with a straight slanted upper portion and rounded lower portion. The more the skin is stretched, the rounder the upper portion will look. I have been pleased with the appearance of the implant in very small-breasted woman with tight skin who want a natural shape. In the few instances when a woman has enough breast tissue to place the implant over the muscle, this implant has also given nice results.

Two recent studies took women with both shapes of implants, sat them up, took x-rays, and traced the shape of the implants. There was essentially no difference in shape between the round and the teardrop implants. This is certainly compelling evidence that spending the extra money on teardrop implants will not get you a better shape. Again, the relationship of the amount of tissue laxity to implant size makes the difference, no matter which implant you choose.

Read more of Dr. Saltz’s articles about breast augmentation: