Breast implant types, shapes and textures

Types of implants

The type of implant used comes down to preference, by both yourself and your plastic surgeon. There are pros and cons to each basic type of breast implant. You can either opt for a saline or silicone gel-filled implant:

• Saline breast implants: There is a growing trend of surgeons opting to use silicone implants instead of the saline variety. The preference comes after the FDA (The Food and Drug Administration in the USA) approved silicone implants in November 2006 and many surgeons began to recommend these as a result. The saline implants contain a silicone outer shell which is filled with a sterile saline. These types of implants may either be pre-filled prior to surgery or be filled during the procedure of implantation. They are available in different sizes and have either a smooth or textured shell surface. Saline implants can be placed with integrated remote-fill ports (such as a trans-umbilical incision) and can also be adjusted postoperatively (adjusting the saline volume in the implant). These implants can be less costly than the silicone-filled type but can rupture or cause visible rippling on the surface of the breast (especially if a woman has thin breast tissue). Any ruptures are easily detectable and the fluid is absorbed by the body with no real issue as it is purely salt water. The bag however, will have to be removed and/or replaced.
• Silicone gel-filled breast implants: These implants are generally safe to use in women aged 22 years and older (or younger if the breast has stopped growing) or for reconstructive purposes in women of any age.  Breast augmentation may also be considered earlier for those with congenital conditions such as Poland's syndrome (a rare birth defect that is characterised by underdevelopment or the absence of chest muscle, known as the pectoralis, on one side of the body). In this instance, surgery may be considered around the age of 15 or 16 years. The implants have a silicone outer shell and are filled with a silicone gel. The gel is available in varying consistencies. The implants are available in different sizes and have a smooth or textured shell surface. The consistency of the silicone gel can help the implant to have a more natural feel than that of a saline-filled implant. The implant is best inserted via the inframammary incision (under the breast where the lower part of the breast meets the chest wall), but may also be done via periareolar (around the outside of the nipple) or transaxillary (through the armpit) incision methods.

A woman’s breasts will continue to develop well into her teens and early 20s. For this reason, saline-filled implants will only be considered once a woman is 18 or older, and at least 22 years of age to receive silicone-filled implants (unless a pre-existing medical condition exists as mentioned).

Implant shapes and textures

1. Breast implant shapes

Your cosmetic surgeon will likely offer you two options when it comes to the shape of your implant: round or teardrop.

• Round breast implants: This traditional implant shape remains a highly popular one and is still regarded the shape that provides the most desirable / attractive result. Round implants create a soft, well-proportioned breast. Round implants tend to provide more upper pole fullness (upper portion of the breast), yet feel softer than teardrop shape implants. This implant shape comes in a range of different diameters and degrees of projection, giving your surgeon flexibility when fitting it to any woman’s breast and body shape. Both saline and silicone-filled implants are available in round shapes.
• Teardrop breast implants: This shape is available as a silicone gel implant and implants are made to maintain their shape. They are often known as ‘form-stable’ and in some circles, particularly in the United States of America, were widely termed ‘gummy-bear’ implants because the gel is thicker than that of the traditional round variation. As with round shapes, teardrops are available in a wide variety or dimensions and shapes, these include tall, short and wide varieties. The cohesive silicone used is firmer (due to its thickness) than the traditional round silicone implants and can be more easily felt in thinner patients, in comparison to a round silicone gel implant. Anatomical implants may provide a more natural look with less upper fullness compared to round implants. There is a tendency for these implants to look more natural, but they may 'feel' more unnatural because of the firmness of the implant.

2. Breast implant textures

Breast implants are available as either smooth-surfaced or in varying degrees of texturisation.

• Smooth: These feel softer, like the sleek surface of a blown-up balloon, and are only available in a round shape. These implants have the lowest risk of 'breast implant associated anaplastic large cell lymphoma' (ALCL) and also don’t require a large incision for implantation. Smooth implants are becoming increasingly popular as capsular contracture rates are not as high as previously thought to be. There is no difference with capsular contracture rates when placing a smooth or a textured implant underneath the muscle. Smooth implants move freely within the breast and they feel soft and natural. They also have the lowest risk of producing seromas and breast implant associated anaplastic large cell lymphoma (ALCL - a type of cancer). 
• Textured: Textured implants have tiny grains in varying sizes on the surface of the implant shell. The texture can be felt when touched and resembles that of a very fine piece of sandpaper. These implants are available in both anatomical and round shapes with a firmer silicone-filled gel. Some surgeons feel that this improves shape for the long-term with a lower risk of moving around once implanted, however this is not entirely true. Studies have shown that there is a decreased risk of capsular contracture when placing textured implants above the muscle. There is, however, no difference when placing the implant below the muscle. Breast implant associated anaplastic large cell lymphoma has been reported as a rare complication following textured implants. It appears that this complication is not seen with smooth and nano-textured surfaces. To date, there have been just under 400 cases reported worldwide.
• Nano-textured: The newest of the texture options available are nano-textured implants. These implants offer an enhanced shell surface for silicone implants which may lower the risk of potential complications, including capsular contracture. The texture is designed to mimic the body’s own cell surfaces (the basal layer of the skin), making it easier for breast tissue cells to ‘grow on’ the surface of the implant (foreign object in the body) and not react negatively (such as adverse inflammation). Fewer foreign materials such as sugar or salt (as is used in textured implants) are used in this variety and this promotes better biocompatibility and a more natural interaction between the body’s tissues and the implant. These implants are favoured for a more natural look and feel (mimicking a woman’s anatomical shape with little risk of movement or rotation).

Which shape and texture should you choose?

A selection process should be one where a woman is well informed by her surgeon about the implant type (saline, silicone and the variations in shells) and size, and discussed in detail in relation to her desired expectations and the findings of her physical exam. The option is almost entirely yours as a breast augmentation candidate, as most surgeons are experienced in using either shape and all textures (although nano-textured implants are considered "next-generation" are often recommended by surgeons these days).

A selection of the type, shape and texture of implants is a critical step in your breast augmentation process and can be the lengthiest part of your consultation. Take your time, and ask as many questions as comes to mind. Your surgeon will be able to assist with any and every concern you may have, as well as give you all the information necessary, and pros and cons of each available variation, to help you make the most informed choice and achieve the results you’re after.