Breast Augmentation in Salt Lake City, UT

The history of breast implants is an interesting one. The first implants were placed in the early 1960s and there has been a lot of improvement in techniques and implants since that time.

One of the most challenging and essential decisions for a patient is determining which size of breast implant to use. The degree of breast enlargement is dependent upon the volume of the patient’s breast tissue in addition to the size of the breast implant used.

We will use a variety of methods to arrive at the ideal implant volume including “trying on” breast implants of various sizes, dimensional analysis, reviewing photos brought by the patient of “ideal” breast size or aesthetics and 3D imaging.

Vectra 3D imaging is a confirmatory method of breast implant sizing. A 3D image of the body is taken, which can be modified with imaging software. We can simulate and visualize the changes that can be made with a variety of implant shapes and sizes as well as visualize the pros and cons of a breast lift.

Although we have had great success with teardrop-shaped breast implants, we rarely use them anymore because of a few unique complications that are essentially only seen with textured implants. Of note, all teardrop-shaped implants are textured.

• Seroma
• Implant rotation
• BIA-ALCL – a type of lymphoma associated exclusively with textured implants.

For some breast augmentation patients, these have the advantage of achieving a more natural breast shape. The increased projection in the lower breast can help with slight degrees of breast droop as well.

The ideal candidate for a teardrop implant is interested in a very natural shape and would consider a slightly greater expense and risks an acceptable trade-off. These teardrop-shaped implants are not for everyone, and generally, patients who prefer a “rounded” upper breast are better candidates for round implants.

Breast implants consist of a silastic shell filled with either saline (saltwater) or silicone. Silicone breast implants generally have a more natural look and feel. Silicone implants have a lower risk of rippling, rupture, and generally, have higher patient satisfaction. Saline breast implants are less expensive, more adjustable, and can be placed with a slightly shorter scar.

There is a concern with “silent ruptures” with silicone breast implants, but not with saline implants. A silent rupture occurs when there is a rupture of the implant that is not apparent to the patient. There is some controversy regarding the safety and method of diagnosis of silent ruptures. Current silicone breast implants are cohesive, meaning they are more solid than liquid. Cohesive silicone is much less likely to get into the surrounding tissues than previous implants and typically remains contained in the implant capsule. The trend in the U.S. has been greatly in favor of a preference for silicone implants.

Saline Advantages

• Cost
• Adjustable fill
• Length of scar
• Ease of diagnosis of rupture

Saline Disadvantages

• Higher rupture rate
• Feel firmer and less natural
• More rippling
• Less natural shape
• More likely to displace

Silicone Advantages

• Softer feel
• Less rippling
• More natural shape
• Rupture less common
• More stable in position

Silicone Disadvantages

• Cost
• Less adjustability (pre-filled)
• Length of scar
• Silent rupture is possible

Although differences exist between brands, most breast augmentation plastic surgeons are loyal to one brand or another. Some of us (like Dr. Yates) prefer to use all brands for a more precise implant fitting. There are subtle characteristics of each implant brand that can assist in picking the best breast implant for a given patient, not just one that works. There are four implant brands with FDA approval for use in the U.S.

Mentor Breast Implants

• Full line of saline and silicone implants with many profiles
• Mentor Round silicone implants are called MemoryGel ®, FDA approved in 2006
• Mentor round silicone implants are less cohesive than other brands (soft)
• Mentor round silicone implants have a lower fill ratio than both Sientra and Allergan implants which can lead to a more natural result
• Implant shells thinner than Sientra and Allergan.  Less palpable but possibly a little more chance of rupture
• Shaped implants are called MemoryShape ® which was FDA approved in 2013 and currently have five shape options
• Textured implants (Siltex ®) use a stamp manufacturing method and have less tissue ingrowth than Sientra or Allergan but a high coefficient of friction. There are no standardized studies comparing contracture rates and stability over time to know which texture type is best. Suffice it to say that all textured implants have a slightly lower contracture rate and position stability at the expense of a higher rippling rate.

Sientra Breast Implants

• Silicone implants only
• Round and shaped implants FDA approved in 2012
• Distribute ONLY to board-certified plastic surgeons
• Standard silicone is more cohesive than either Mentor or Allergan
• Shell thickness is between Allergan and Mentor and in Dr. Yates opinion is best.
• Textured implant (TRUE texture ™) and between Mentor and Allergan in terms of tissue ingrowth
• Shaped implants come in 5 shape options
• 20 year financial assistance warranty in the event of rupture (best warranty)

Allergan Breast Implants (Natrelle and Inspira)

• Full line of saline and silicone implants with the largest amount of profile and size choices
• Round Allergan silicone implants approved in 2006.
• Shaped implants (style 410) FDA approved in 2013.   Removed from the market in 2019 for association with BIA-ALCL.
• Inspira implants approved in 2015. These have a high fill ratio designed to give more fullness and less rippling. Inspire implants to have more size and profile choices than any other round implant. This can be helpful in correcting small degrees of asymmetry
• Textured implants (Biocell ) are manufactured with a “salt loss” technique resulting in very aggressive tissue ingrowth. This may help stabilize the implant position but has a higher risk of peeling the capsule away (double-capsule) and seroma. This Allergan Biocell texture has been implicated in a higher than acceptable risk of ALCL and these were removed from the market in 2019.

Ideal Breast Implants

• FDA approved in 2014
• “Structured” Saline implant that feels more like silicone than a standard saline implant
• More expensive than typical round silicone implants
• The selling point is that there are no silent ruptures as the entire implant is saline-filled
• Limited profiles and sizes

The Ideal Implant is a new saline implant with inner chambers that slows the flow of saline, creating a saline implant that feels a lot like silicone implants. The Ideal Implant® received FDA approval in November 2014. These implants are more expensive than traditional saline implants but have many of the advantages of silicone implants including a more natural feel, and lower rippling risk.

The major advantage of these implants as compared to silicone implants is there is no risk of “silent rupture.” This should be strongly considered in any woman who is very concerned about silicone or silent ruptures. One limitation is in implant sizing. There is only one profile in the Ideal Implant®, which closely matches a high profile silicone implant.

Every patient has about 100 cc range of implant volume that fits their breast dimension well, and these implants may be too narrow in very small sizes for most patients. We are one of a handful of offices that offer the Ideal Implant® in Utah.

Have you ever tried to rupture a breast implant with your bare hands? Of course you haven’t, but we have. Watch these educational, entertaining videos of my staff trying to do just that. Think breast implant tug o′ war.

Incisions made around the areola can sometimes impact breastfeeding, which is one of the reasons Dr. Yates prefers to avoid this incision choice. A more common problem is inadequate breast milk production. Though the milk ducts remain intact and the mother is capable of producing a normal supply of milk, at times nerve damage in the breast blocks the hormonal signals to the brain that triggers milk production. This is a rare problem, however.

As with any manufactured product, breast implants have a lifespan. At some point, the implants will rupture or begin leaking and will need to be replaced. How long will that be? Manufacturers warranty their implants for ten years, and will generally reimburse patients for failure prior to that timeframe. But how long your breast implants will last can vary wildly. You should expect to need to replace your implants every 10 to 20 years. Implant durability is increasing, so this could lengthen. Regardless, if you’re in your 30s, you’ll need to replace your implants at least twice in your life, possibly more than that. Replacement surgery is much easier than the original augmentation surgery, as Dr. Yates can enter through the original incisions.

For patients who want a no-maintenance option, fat transfer to the breast could be considered.

Yes, the manufacturer provides a free lifetime warranty against implant rupture or deflation. They also offer help with the surgical fees of replacement of failed implants for 10 -20 years. Implant manufacturers are also offering very generous limited warranties against capsular contracture.

Saline breast implant deflation is relatively easy to diagnose and correct. The saline is absorbed, and the breast deflates. Deflation generally requires a simple remove and replace procedure.

A silicone breast implant rupture is a little more difficult to diagnose and treat than saline implant deflation. The implant material is not absorbed and can cause hardening and deformity of the breast. It is also harder to correct surgically, as the implant material may need to be removed as well. For more information about the treatment of silicone breast implant rupture click here.

There is no evidence that breast implants have or could ever cause breast cancer. There is a newly identified type of lymphoma, ALCL that has been found in women with breast implants. As of the time of this writing, it has only been found to be associated with textured implants.

In the U.S. most of the cases of ALCL are in patients who have Biocell textured implants, but it has been found in patients with other types of textured implants as well. Although very rare and typically easily treatable with implant and capsule removal, this is a REAL issue and there is ongoing research. I wrote an update about ALCL on my blog.

As of July 24, 2019, Allergan has instituted a worldwide recall of all of their textured implant products. The FDA has not at this point recommended elective removal or exchange of these implants as the risk of developing ALCL is very small. The reason that Allergan, and not the other FDA approved implant manufacturers, has recalled their implants specifically is because their implants are a macrotexture product and are the primary implants involved in ALCL in the U.S.

If you have Allergan textured implants and want to have them exchanged for smooth implants out of an abundance of caution, it is reasonable to do so in our opinion. Certainly, if there are symptoms such as unilateral swelling, this should be examined thoroughly.

Good News. As of July 24, 2019, Allergan will be providing smooth implants to any patient who would like to exchange their current textured Allergan implants. They will not be providing financial support for replacement as the FDA has not recommended the removal of textured Allergan implants without symptoms. Nonetheless, Allergan should be applauded for stepping up and doing the right thing for the patients. Allergan is calling this the BIOCELL Replacement Warranty. This program will run for two years from July 24, 2019, to July 24, 2021. They will provide free smooth implants in the same size as the original implants. This warranty does not cover other revisions or additional surgery for size change. The covered devices include all BIOCELL textured implants which may have also been under the brands McGhan, Inamed, Natrelle, or Inspira. If you are interested in pursuing this claim, we would be happy to do the legwork for you.

We would be honored to have you as our next breast augmentation patient. To schedule a consultation, call the office at 385.526.5988 or if you would prefer an online visit fill out a virtual consultation form. Dr. Yates will respond in a timely fashion to your inquiry.