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Breast Implant Options

Saline vs. Silicone Gel

Breast implants are silicone bags filled with saline (salt water) or various forms of silicone gel. A basic difference between silicone and saline involves the softness of the implant relative to natural breast tissue.  It is a majority opinion that silicone feels much closer to breast tissue softness than saline. Dr. Barnett compares the implants to a bag of water versus a bag of jelly.  At your consultation you will be able to compare the softness for yourself.

Another issue that Dr. Barnett feels is important to compare involves the results of implant leakage.  Neither material is hazardous to your health. A leaking saline implant will immediately go flat as water is absorbable rapidly into your circulation. This situation demands a second surgery. Silicone gel remains in the breast pocket due to its inability to gain access to your circulation. A ruptured silicone gel implant can be impossible to detect by physical exam alone. Imaging studies such as an MRI may be the only way to detect implant leakage.

At Alpine Plastic Surgery, breast enhancement is performed using silicone gel implants in over 90% of all cases requiring breast prosthesis.


Textured or Smooth

Breast implants can be chosen with a smooth bag or a fuzzy feeling textured bag. Some surgeons feel that a smooth bag feels softer than a textured bag. The implant texturing causes interaction with your body’s surrounding tissue. The result of this interaction is the formation of a tissue adhesion that is grossly similar to a Velcro-like attachment to the implant. This attachment has obvious benefit when using a shape specific implant (gummy-bear implant) that cannot be allowed to rotate. The textured implant is stuck in its position and allows a more dependable final position for the implant. Smooth-walled implants form no such attachment and rotate freely inside the breast capsule pocket. The ultimate implant position and associated breast shape, changes more dramatically than with a textured implant during pocket maturation.

This phenomenon translates to a more dramatic drop of the smooth breast implant during healing.

Along with stabilizing implant rotation, texturing decreases the formation of a capsular contracture. Capsular contracture is the tightening of tissue around the implant making it hard and unnatural in appearance and softness. Textured implants placed deep to the pectoral muscle have a better chance of not forming capsular contractures.

At your consultation, you will be able to judge implant softness for yourself.  Dr. Barnett uses both smooth and textured devices.  It is his preference-more often than not-to use a textured implant due to its positioning dependability. Preventing capsular contracture formation also figures into his recommendation.

Gummy Bear vs. Cohesive Gel

The latest improvement in breast prostheses is the development of the gummy bear implant.  This is a form stable silicone gel held in a textured silicone bag.  The material inside maintains its basic shape regardless of normal outside forces.  Gravity has less effect changing this implants appearance.  The result is a more dependable upper pole fullness or cleavage.  In a properly chosen patient the gummy bear implant can give an exceptional result.  See the associated photos.

Shaped implants can be deforming if they rotate or are not placed perfectly.  The pocket development must be significantly more precise.  As noted above, adhesion formation is also important.

Cohesive gel implants are the gold standard silicone implants used today.  The material inside the bag resembles warm cookie dough. The bag itself can come in different projections from a low-profile to a high profile bag.  Its ultimate shape is more dependent on forces such as gravity and surrounding tissue tightness. These implants represent the majority of prostheses used today.