Breast Augmentation Options

Side by Side Comparison of the Many Options You Have

I created this page to help you navigate the many options you face and help you decided which breast implant will best fit your needs

Breast augmentation is a procedure that has many options from which you can chose to get the best possible result.  Because there are so many options, it is easy for you to get confused and overwhelmed.

There is a lot of information on the internet, not all of it correct, and not all of it applicable to your particular situation.

Breast augmentation is one of the most common cosmetic surgeries world wide, but it is also one that creates greatest amount of pre-surgery anxiety as there are many different options you can chose from and the diversity of these option can be overwhelming (biostable).  There are multiple combinations that one can chose from and so you wouldn’t be alone if you get overwhelmed and do not know how to proceed.

Options:
  • Implant type: – Silicone vs Saline
  • Implant shape : Round vs Anatomic
  • Implant Projections: low, moderate, high (and everything in between)
  • Implant surface: smooth vs textured
  • Implant position: over the muscle, under the muscle, dual plane
  • Implant volume: an endless range of volumes – this is where most women spend time obsessing about the exact volume they want even though anything less than 50cc increments are almost invisible
  • Incision site: breast fold, areola, armpit, belly button

Implant type

Whether you chose a silicone or a saline implant, both types have the EXACT SAME outer surface.  The outer shell (the bag that is filled with either saline or silicone) is exactly same – a solid silicone polymer.  In on instance, the silicone shell is filled with saline – salt water, in the other instance the shell is filled with medical grade silicone.  But on the surface, they are both made of silicone.  The difference is in the feel.  Most women ask which one looks better, and the truth is you can’t really tell a silicone implant from a saline one.  Some people may tell you silicone looks better – I have yet to prove that theory.  Silicone ripples less, but once implanted into a body, the difference is imperceptible.  The difference between them is in the way they feel.  Silicone implants feel soft and are supposed to feel very much like natural breasts.  Saline feels different.  A saline implant is adjustable, and can be made super soft to a point where you totally do not feel that there is an implant in your body, to a very hard feel.  It depends on how much the implant shell gets filled.  Under-filling a breast implant makes it very soft, but it ripples a lot.  Most people overfill saline implants to minimize rippling, but that then makes them feel harder which is why you will read on the internet that saline implants feel harder than silicone.  Truth is, the feel is adjustable and you want to chose the best balance of softness and rippling.

TABLE Silicone vs Saline
Features Saline Silicone
Scar size Smaller Larger
Correction of breast volume asymmetry Better suited Limited
Feel/Softness Adjustable Soft
Feel/Softness Adjustable Soft
Rippling More Less
(yes, even silicone implants ripple!)
Rupture Saline leaks out, harmlessly absorbed by your body Silicone not absorbed by your body, stays in place
You may go on for years without realizing it ruptured (Silent Rupture)
Ultrasound or MRI is required to diagnose a rupture
Capsular contracture Slightly lower than silicone Slightly higher than saline
Risk of silicone granulomas (small droplets of silicone diffused out of the breast implant) None Uncommon but possible
HealthCanada/FDA approval Yes Yes
Fill Volume Adjustable
Fine adjustments can be made during surgery for optimal symmetry and look
Set volume, no adjustable
A decision to select a specific implant volume is made before surgery. It is not possible to adjust volume of a silicone implant. The only way to change is it to replace it with another silicone implant
Warranty against implant leak or rupture Lifetime warranty Lifetime warranty
Risk of rupture or leak 7% 6%
Implant Shell Medical grade silicone Medical grade silicone
Implant content Saline
Saline is salt water, the exact same solution that is given intravenously to patients who are dehydrated, or who need intravenous fluids, medications.
Medical Grade Silicone
Medical grade silicone differs from industrial silicone in that toxic components have been removed. The silicone is made ‘cohesive’ meaning it sticks together like a gummy bear candy. It feels soft.
Implant insertion Implant is inserted empty
Because they are inserted empty, smaller incisions are required. Once inserted, they are filled with saline to any volume desired.
Pre-filled implant is inserted
A larger incision is required
We use a “Keller Funnel” to be able to squeeze the implant in through a smaller incision than traditional silicone implants require, but it’s still a slightly larger incision than saline implants would require.
Appearance Same Same
(Impossible to tell if an implant is a saline or silicone by just looking at it)
Detectability to touch More
(if you have more than 2cm pinch thickness of skin over the implant, you won’t be able to tell the difference)
Less
(if you have more than 2cm pinch thickness of skin over the implant, you won’t be able to tell the difference)
Palpable 'knuckle" Rare Possible
Spontaneous deflation Possible (7%)
Requires implant replacement (covered by the implant warranty)
Does not occur
However if the implant is ruptured, it should still be replaced (covered by the implant warranty)
Silent rupture Never 5%
Recommended follow up None required Periodic Ultrasound or MRI
Surgery cost Less More
Monitoring None required Ultrasound or MRI
Appearance Adjustable
Can look very natural, but can also be made to look very round and fake (if desired)
Depends on the selection of the implant profile
High/Full profile implants look less natural then Moderate profile

Implant Shape

The shape of the implants can be ROUND or ANATOMIC.  Another term of Anatomic Implants is ‘Shaped’ or ‘Teardrop’ implants

  Round Anatomic
Upper pole fullness Better Less to none
Incision options Any Breast fold or Areola
Appearance May look less natural
(can be made to look very natural if size not excessive)
More natural
Softness Softer Harder
Implant size selection Great
Wide variety of sizes can be used
Limited
Implant size selection is restricted by your existing breast dimensions
Implant rotation Has no impact Required correction
(may require additional surgery)

Implant Projection / Implant Profile

BreastImplantProfiles

A low projection implant is usually used in women who are undergoing a breast lift and just need a little extra volume.

Moderate implant gives a natural augmentation without really affecting the overall breast shape.

A Full/High profile implant creates a rounder look, and although is less natural than the Moderate profile, many women chose this because it creates more cleavage, and has more upper fullness (push up bra look)

Extra high profile implant are used when a woman wants a large volume but does not have a wide enough rib cage to handle a large implant. This implant has a very fake look, but more importantly, if it ever flips it looks weird. For that reason we do not offer this implant profile/shape to our patients.

Implant Surface

Implant shell is made of a solid silicone polymer that can have smooth surface or a ‘textured’ surface.  The textured surface feels like velcro and it has been developed to lower the risk of capsular contracture, and it also functions to create adhesions between the implant and the surrounding tissue so that it sticks to it like velcro.  This limits the implant mobility

  Smooth Surface Textured Surfaced
Implant 'stuck on' No Yes
Implant moves, feels more natural yes No
Implant can move out of position (bottoming our or lateral displacement) More likely Less likely
Rippling Not made worse by the smooth texture More obvious
Risk of capsular contracture Unchanged Decreased
(if implant over the muscle)
Risk of ALCL (anaplastic large cell lymphoma) None Very rare

Implant Volume

Implant volume refers to cc’s or ml’s of fill.  Some women think in terms of cup size and wish to achieve a certain cup size as their end result.  Surgeons (and implant manufacturers) think in dimensions: volume, width, height, and projection of implants.

The ideal implant is the one who’s dimensions closely fit your existing breasts.  More you deviate from this rule, more fake the breasts will look.

Another important fact to remember is that as implants get bigger, they get wider.  As they start getting too wide, ‘side boob’ becomes significant and some women do not like the feeling of their arms rubbing against their breasts as they walk or reach forward.

Breast Implant Placement

Breast implants are place under the muscle, over the muscle, or in ‘Dual Plane’. They are never ‘inside’ a breast. The breast tissue always sits on top of the implant and is pushed forward by the implant.

  Sub-Glandular Sub-Muscular Dual Plane
Implant position Above the muscle Under the muscle
(very rarely is a sub-musclar augmentation truly completely under the muscle, there is almost always a part of the implant that is exposed thus really making it a dual plane)
Upper part of the implant is covered by the muscle, the lower part stick out from under the muscle and is covered by the breast tissue
(Most sub-muscular augmentations are really dual plane, but surgeons and patients just refer to them as ‘unders’)
Upper pole fullness More More Least
Round look More likely Less likely Less likely
Risk of Capsular Contracture 3% 1% 1%
Rippling More visible More visible Less visible
Animation deformity
(implant moves outward and upward when flexing your pec muscle)
No Yes Minimal

Incision Site

  Breast fold Areola Armpit Belly Button
   Inframammary fold Periareolar Transaxillary Trans-umbilical
Silicone implants Any size Only if areola >3cm Not ideal
(possible up to 450cc)
Not possible
Saline implants Any size Only if areola >2cm Any size Any size
Scar Hidden in larger
overhanging breasts
Ideal for women with darker areolas Ideal for saline implants,
scar are virtually invisible
Scar invisible
Accidental scar visibility If your bikini top slides up Only when naked When you lift your arms up None
Ideal patient Women with B+ cup size,
well developed breast fold
Women with areolas >2-3 cm,
dark coloured areola, tubular breasts
Women with small breasts
wishing saline implants
Women with small breasts
wishing saline implants
Poor candidate small cup size with no existing breast fold
Tuberous breasts
Small areola (<2cm)
Pale coloured areola
Thick glandular tissue
Women wishing silicone implants
Sagging breasts
Asymmetric breast position
Tubular breasts
Women wishing sub-glandular implants.
Women with larger breasts
Women wising sub-Glandular implants or silicone implants
Breast asymmetry
Tuberous breasts
Breast fold asymmetry correction Good Good Difficult Impossible
Shaped implant use Possible Possible Very difficult Impossible
Round implant use Easy Easy Easy Easy

What is Implant Rippling?

Implants are a silicone bag filled with either salt water or gummy-brear like silicone polymer.   If these implant bags (shells) were filled 100% or even overfilled beyond 100% of their normal capacity, they would feel very hard.  So the manufactures (for silicone implants) and surgeons (for the saline implants which are filled during the breast augmentation surgery) attempt to keep their implants soft by underling them.  As a result, the implant bag/shell is not fully filled, is not fully stretched out and when standing upright or leaving forward, these implant bags collapse as demonstrated in the image on the right, thus creating ripples and folds.

While all breast implants ripple, rippling is NOT seen in all women.  Typically, rippling of the breast implants is seen in women who are thin and have very little fat padding the implants.

Steps to minimize rippling are: going under the muscle, using silicone implants or overfilling saline implants, fat grafting, or using alloderm

ImplantRippling
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