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What is the best breast implant and size for me?

Wednesday, June 22, 2011

What is the best breast implant?

It is easy to become confused about what is the best breast implant as there are so many different types of breast implants currently available in Australia.  Saline or silicone?  Smooth-walled or textured?  Round or tear-drop shaped?  No doubt your surgeon will have his preference and will explain his reasons to you.  It is important to realize that the result of your breast implant surgery is far more dependent on the surgical technique than on the type of implant used.  So long as the implants are placed under the muscle and so long as you have a reasonable amount of subcutaneous fat, then it can be very difficult to detect the difference between the various types of implants.  Around the world, millions of women are happy with their saline implants and millions are happy with silicone. The decision often comes down to safety and your tolerance of risk.  The manufacturers state clearly that breast implants are not life-time devices and that they may leak and require replacement.  The problem with silicone gel implants is that leakage can be difficult to detect and the silicone can spread to the lymph nodes and to other parts of the body before you realize a leakage has occurred. This is true even with the “high cohesive gel” implants which can lose their cohesivity after several years inside the body.  Often, the first sign of a leaking silicone gel implant, is a lump in the glands under the arms.  In the USA the FDA has stipulated that all women with silicone gel breast implants have an MRI examination 3 years post implant surgery and then every 2 years thereafter.  This is in an attempt to detect implant leakage before the silicone has had a chance to spread. There is no such ruling in Australia but clearly it is prudent for all women with silicone gel implants to have an MRI or at least an ultrasound scan every two years in an attempt to detect any leakage early. Saline implants have the advantage that any leakage is immediately obvious (the implant will deflate and the breasts will lose volume) and implant leakage is not at all dangerous because the saline is absorbed into the tissues and then excreted by the kidneys.

When one replaces a leaking silicone gel implant, it is often impossible to remove all of the silicone.  On the other hand, when one replaces a leaking saline implant, it is a little like changing a tube in a tyre.  The silicone casing is removed and the new implant inserted.  For these reasons many believe that saline implants provide far greater peace of mind than silicone gel implants.

Remember that the softness of your breasts will depend on many factors such as the amount of your own breast tissue, the nature of the capsule that forms around the implant, the thickness of the implant shell, the volume of the implant and, of course, the type of fill- high, moderate or low cohesive silicone gel, or saline (over- filled or under- filled). So even if you choose the softest silicone gel implant you may not end up with the softest breast. Even if you think that your breast will be, say, 5% softer, you have to consider whether this is worth the extra risk associated with silicone leakage.

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This woman has had 3 operations for breast augmentation.  Because she is a body builder she and her surgeon decided to place the implants on top of the pectoral muscles.  The surgeon used textured silicone implants with a tear-drop shape.  These implants have quite a thick wall and adhere to the surrounding tissues.  Because she is quite thin the edges of the implant are visible especially centrally in her chest but also towards her armpits.  This is called “rippling” and is best corrected by removing the implants and inserting new implants behind the pectoral muscles.

What size breast implants would be best for me?

It is quite normal to worry a lot about the size of breast implants you should choose.  You have a dilemma! On the one hand, if you have the operation, then you want the result to be worthwhile!  On the other hand, you probably don’t want it to be too obvious to everyone that you have had breast implants!  You have probably spent many hours admiring other women’s busts, looking at photos in magazines and searching the internet.  The reality is that we can be far more precise than just a B, C or D.  Your surgeon will choose a breast implant of a specific volume in millilitres.  The size of implant usually ranges from 200ml to 400ml with around 300 ml being the most common.  If you are currently an A cup, your breasts have a volume of about 150ml.  If a 300ml implant is inserted, then your total breast volume will be 450 ml (a perfect 12C cup).  One method that women find useful for determining the size of implant is to purchase a sports bra of the size you would like to be (say a 12C).  You then need some rice, a measuring  jug and some old stocking socks.  Start by measuring 250ml of rice and placing this inside the sock.  Tie a knot in the stocking and place the stocking with the contained rice in the bottom of the bra under the breast.  Do this on both sides and you will then have a very good idea of how a breast implant with a volume of 250 ml will look.  You should wear this for a week with different types of clothing in order to get a feel for how you will look.  You can then go up or down in increments of 25 ml until you find a volume that is just right.  This is the volume that you should ask your surgeon to insert.

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This woman is quite thin!  You can see her rib cage clearly.  Her breast volume was approximately 75 ml (a  AA).  Smooth-walled saline filled implants with a volume of 350ml were inserted behind the pectoral muscles and the inframammary folds lowered slightly (more breast skin is visible below the nipples).  She therefore has a total breast volume of 425 ml (a full C cup) and her breasts feel soft and natural.  The implants are not visible as they are hidden deep behind the pectoral muscles.

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This woman has breasts with a measured volume of 350 ml (a large B cup).  Saline implants with a volume of 250 ml have been inserted behind the pectoral muscles.  Therefore her total breast volume is 600 ml (a normal D cup).

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This woman has a breast volume of only 100 ml (less than an A cup).  Her breast volume has been lost following the breast feeding of her children. (This is common after pregnancy).  Breast augmentation with saline implants inserted behind the pectoral muscles added a volume of 350 ml.  Therefore her total volume is 450 ml (a C cup).  Note that the left nipple was slightly lower than the right prior to her surgery and that this has persisted following her surgery.  The breasts are soft and mobile and her implants are not visible.  The photograph is taken only 1 month following her surgery and her skin can be expected to soften a little more over the next 6 months.

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This woman has slightly sagging breasts with a volume of 275 ml (slightly less than a B cup).  As well as losing volume, her breasts sagged following the breast feeding and weaning of her children.  Saline breast implants with a volume of 325 ml were inserted behind the pectoral muscles giving a total breast volume of 600 ml (between a C and a D cup).  Note that the nipples have lifted slightly as a result of the operation without the need for a mastopexy (breast lift) surgery.

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This woman has had smooth-walled saline implants inserted behind the pectoral muscles.   Notice how soft the breasts are and how the implant can be displaced upwards into the space behind the muscle.  This shows the effect of a “push-up” bra and suggests that you do not have to have your breasts augmented to the maximum size possible as a C cup can always be made to look like a D or DD with the aid of a “push-up” bra!

The above are only a small selection of case studies to show what can be achieved by breast implants and to show some of the problems that can arise. Apart from cropping, none of the photographs has been digitally altered.

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