Breast augmentation is one of the most popular plastic surgery procedures, with over 300,000 breast implant surgeries performed in the U.S. each year. While breast implants can dramatically improve breast size and shape, all surgery carries some risks. When considering breast augmentation, it’s important to understand the different types of breast implants available and evaluate their potential risks and benefits. This article provides an overview of the main breast implant options and analyzes key factors like safety data, risks of complications, and patient satisfaction to determine which breast implants have the lowest overall risk profile.
Types of Breast Implants
There are two main types of breast implant devices used in augmentation surgeries:
Silicone Gel Implants
Silicone gel implants have a silicone outer shell filled with a viscous silicone gel. They mimic the look and feel of natural breast tissue more closely than other alternatives. Silicone used in implants today is more cohesive (“gummy bear” gel) which makes it less likely to leak out of the implant shell even if it ruptures.
Saline Implants
Saline implants have a silicone outer shell filled with sterile saline (saltwater). They feel firmer and are typically inserted empty then filled during surgery to the desired size. If a saline implant ruptures, the filler saltwater is harmlessly absorbed by the body.
Implant Shapes
Both silicone and saline implants come in different shapes:
– Round implants create more volume in the upper breast for a fuller look.
– Anatomical “tear drop” shaped implants are tapered to look more natural and proportional.
– Smooth or textured shells – textured surface is designed to adhere to surrounding tissue.
Implant Safety Data and Risks
Implants have evolved significantly over decades of use and research. Here is an overview of safety findings and potential risks with both types:
Silicone Gel Implant Safety
– Extensively studied for over 50 years. No increased risk found for autoimmune disorders or connective tissue disease.
– Silicone gel leakage (“silicone bleeding”) can occur slowly over time. But leak does not always mean rupture.
– MRI can detect “silent ruptures” where outer shell tears but gel remains intact. About 10% rupture within 10 years.
Saline Implant Safety
– Saline considered safe for the body if ruptured. But the ruptured shell and surgery to replace can cause problems.
– 1-3% rupture in the first 3 years, 15% rupture within 10 years. Rupture rate higher than silicone gel implants.
– Rippling or wrinkling more noticeable with saline implants, especially for smaller breast shapes.
Complications for All Implants
Some risks occur independently of implant type:
– Capsular contracture – scar tissue tightens around implant, distorting shape (up to 20% of cases)
– Infection – generally around 1-2% risk within first few weeks post-surgery
– Implant displacement or malposition
– Visible skin wrinkling or rippling
– Need for implant removal or replacement surgery
Implant Risk Factors
These factors impact the relative risks and likelihood of complications:
Surgical Approach
Implants placed under the chest muscle have a lower risk of capsular contracture and implant displacement versus placement above/over the muscle. But under-muscle placement has a longer recovery time.
Implant Placement
Sub-glandular placement behind the breast tissue but over the chest muscle. Higher risk of capsular contracture and implant visibility issues.
Sub-muscular placement beneath the chest muscle. Reduces capsular contracture risk and can look more natural.
Implant Surface
Textured surface implants encourage tissue to grow into the shell. This reduces risk of movement, displacement and capsular contracture vs smooth implants. But textured surface is linked to a very rare type of cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).
Implant Size
Larger implants increase risk for complications like infection, displacement, and capsular contracture compared to smaller implants.
Patient Age and Tissue Quality
Older patients and those with less elastic chest muscle tissue and skin have higher complication and rupture risks.
Patient Satisfaction and Quality of Life Factors
Beyond safety data, patient-reported satisfaction and quality of life impacts are important to evaluate. Key considerations:
Silicone Gel Implants
– Softer, more natural look and feel than saline
– Less visible rippling/wrinkling
– Higher patient satisfaction with gel vs. saline in most studies
Saline Implants
– Firmer feel, can appear less natural
– More noticeable implant edges and rippling
– Rapid size decrease after rupture
– Lower satisfaction in some patient surveys
– But lower implant cost can improve access and value
Shape Options
– Round, “classic” shape preferred by some patients
– Teardrop shape preferred for looking more natural unclothed
– Choice impacts overall patient goals and satisfaction
Surgeon Expertise and Certification
The experience and skill of your plastic surgeon significantly influences the risks and success of any breast implant surgery. Key credentials to look for:
– Board certification from the American Board of Plastic Surgery
– Years of focused training and hands-on breast augmentation experience
– Hospital operating privileges for plastic surgery
– Breast implant manufacturer certification for product knowledge
– Member of industry groups like American Society of Plastic Surgeons (ASPS)
Conclusion
While all types of breast implants carry low risks compared to most surgeries, silicone gel implants appear to have the lowest risk profile based on safety data, rupture rates, and higher patient satisfaction scores. But the ideal implant choice involves assessing your anatomy, goals, lifestyle, and surgeon recommendation. Finding an experienced, credentialed plastic surgeon you trust is the most important factor for minimizing your risk and getting the results you want safely. Be sure to follow your surgeon’s pre and post-operative instructions carefully to reduce the risks of complications.