Breast Augmentation: How to Select the Best Breast Implant for You

by Dr. Jason Martin 

April 21, 2020

Which Breast Implants are best for me?

Even with a plastic surgeon helping you with your decision, deciding which type, style, shape and size of breast implants to use with your breast augmentation surgery is confusing and really nerve racking.  Therefore, to make you more confident and to reduce your anxiety with this decision, we have created a useful resource for breast implant selection.  It will provide you with many of the tools you need to pick the perfect breast implant for you.  

First and foremost, breast implants are divided into two groups, saline or silicone breast implants.  Both have similar silicone elastomer shells (outside covering) and only differ by how they are filled: saline breast implants are filled with sterile saline at the time of surgery and silicone breast implants are filled with silicone gel during the manufacturing process.  Saline filled breast implants have the benefits of being less expensive, can be placed through shorter scars and their size can be adjusted at the time of surgery for more even results.  Silicone filled breast implants have the benefits of feeling more natural, being manufactured with more desirable shapes and projections and usually have less visible rippling after surgery.

As of 2019, in the United States, there are three main companies that manufacture breast implants: Allergan, Mentor and Scientra. Each of these companies manufacture many different sizes and shapes of saline and silicone breast implants.  In the past 10 years, much of the research and development in breast implant technologies has centered around the development of new silicone breast implants. These newer implants are made with advanced silicone gel, referred to as cohesive gel implant. Cohesive gel implants, aka ‘gummy bear’ implants, have more sticky silicone gel than the older versions.  Why is this important? This gel is less likely to leak and move to other areas. It also holds its shape better, allowing for silicone breast implants to be made with more appealing contours and projections.  Lastly, there is less visible rippling after surgery.  As almost all silicone breast implants these days are filled with cohesive gel, you can feel confident that you will most likely get the newest breast implant technology with your surgery.  See the chart below that shows the available names, shapes and sizes for breast implants from the three main manufacturers. 

(Insert chart of available breast implants)
To find which size of breast implant is right for you, we start first by getting a few measurements of each breast.   This includes the distance from your nipple to the base of your breast, the width of your breast and the distance from top of your chest bone (base of the neck) to your nipple.  These measurements give us a good idea of the breast implant dimensions that will fit perfectly under your breast.  With these dimensions, you can adjust the size of your breast by just changing the shape of your breast implant implant.  Specifically, if you keep the width of the breast implant the same as the width of your breast, you can increase the size of your breast just by increasing the fill of the implant in a forward direction.  This is referred to as projection.  In general, less projecting implants will appear more natural and will result in less of a visible change while more projecting breast implants will appear more perky and result in more of a change.  More projecting implants will also change the contour of the breast above the nipple and areola more.  Take a look at the photo below from a breast implant exchange surgery.  The old and new breast implants have the same width but differ by their projections.  The newer breast implant on the right has around 40% more projection and is 50% larger in size.

Once the dimensions of the breast implant have been decided and you have a rough idea of the size that is best for you, other factors should be considered that will help you and your surgeon finalize the decision.  These factors include the quality of your skin, the degree of your sagging if present, your overall breast shape, your symmetry, your activity level, your body shape and most importantly, the breast shape and size you desire.  It is these factors that will help you narrow down the desired shape of the breast implant for your surgery.  This will include decisions on the amount of projection, the level of cohesive gel, and the overall shape of the breast implant.  Most often, the shape of the breast implant will either be round versus teardrop (anatomic).  

One quick note about anatomic shaped breast implants.  These exciting new shapes have transformed the way we approach breast augmentation surgery, especially for those that want a more natural result.  With that said, the breast implants have a few drawbacks.  They are often more difficult to implant correctly during surgery than round breast implants.  These breast implants also often do not fill the area of your breast above the nipple and areola enough to result in a youthful change.  Lastly, they are usually the most expensive of all breast implants offered.  These factors must be considered before choosing this style breast implant.  

With the style, size and shape of the breast implant narrowed down, demo breast implants offer a great way to complete your selection.  Using demo breast implants or bra inserts in the clinic or in your home, gives you a real world idea of how your breast will look in different types of clothes after surgery.  Also, by looking at pre- and post-operative images with similar breast implants to the ones you have selected, you can start to create a final image of how your breast will look after surgery.  It is these two final steps where you will start to feel really confident about your decision.  There is one final addition that really does make patients feel better, even if they aren’t 100% sure about their decision going into surgery.  In most cases, a narrow range of breast implants will be ordered for your surgery that corresponds to the style, size and shape of the breast implant you selected.   Having multiple choices of breast implants to use during your surgery really does allow for one final tweak. By sitting you up during surgery and inserting breast implant sizers, the perfect breast implant can be selected before selecting the permanent breast implant.

Breast augmentation surgery offers an amazing way to transform your breast. Once you have made the decision to move ahead with surgery,  use this resource to empower you to make the best decision for you.  You are going to love your results!

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