Planning breast augmentation surgery involves careful discussion between patient and surgeon with decisions to be made regarding the type of implants to be used, the degree of enhancement desired, and the positioning of the breast implants. Augmentation is different for every woman just as every woman's desires and expectations for breast augmentation surgery vary. This makes the rapport between patient and surgeon extremely important to encourage optimum results.
The shell surrounding breast augmentation implants is an important choice that needs to be made during pre-surgical consultation. There is a choice between smooth or textured silicone, micro-polyurethane-coated silicone, and nano-textured breast implants.
There are various advantages to each, with textured implants considered better for reducing the likelihood of capsular contracture and undesirable migration of the implant, whereas smooth implants may offer less likelihood of rippling than textured implants.
Micro-polyurethane-coated silicone implants offer the lowest risk of capsular contracture as the breast tissue can actually grow into the coating; this also reduces the risk of rotation.
However, smooth implants are associated with the lowest risk of breast implant associated anaplastic large cell lymphoma (BIA-ALCL), and so in our practice we only offer smooth or nano-textured implants. Textured and polyurethane-coated implants are not offered.
Breast implants' size and shape are not the only decisions to be made during pre-surgical consultation.
Breast implants will have either a silicone or saline filling which can create a different look and feel to the breast after augmentation as well as giving rise to differing concerns over safety, deflation, implant palpability, and rippling.
Cohesive silicone gel implants are generally considered of particular benefit to women with small initial breast volume, providing a more natural look and feel than saline breast implants. In our practice we only use cohesive silicone gel implants; saline implants are not offered.
The shape of breast implants can create a significant difference in the end result of breast augmentation surgery.
Round implants are the most popular type of implant, and they can have any type of shell.
Teardrop-shaped (anatomical) implants require a textured or polyurethane-coated shell to minimise the risk of rotation in the pocket, and for this reason they are not offered in our practice.
Implants also differ in profile, which can be moderate, high or sometimes extra-high, depending on the characteristics of the breast and the desired volume.
There are several manufacturers producing breast implants and, inevitably, after the scandal regarding PIP implants there was suspicion about safety. During the consultation it is possible to discuss in more detail the characteristics of the implants in relation to particular manufacturer choices and identify the products that you feel comfortable with.
For additional guidance regarding breast implants and safety aspects, we have added links to web resources from the MHRA in the UK and the FDA in the US:
MHRA - Breast implant associated anaplastic large cell lymphoma (BIA-ALCL)
MHRA - Symptoms sometimes referred to as Breast Implant Illness
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