While there once was a limited selection of breast implants, the range of sizes and styles today is almost bewildering. Size alone is a consideration, but beyond that, there is fill type, manufacturer, and profile. While a given patient may have several possible options that would fit, in which case personal choice then kicks in, that same patient may not be a good candidate for some of the other options. It is important to know which options are equally good before resorting to personal choice, in order to avoid a mismatch that could limit the success of your result.
IMPLANT SIZE- Implant size is measured in cc, or ml. 1000ml is a liter, as in a 1 liter bottle of soda. Half of that is 500cc, which is a very large implant. On average, most surgeons commonly use implants between 200cc and 450cc. Some routinely use larger implants, although this is very rare in my practice. In my patient population, I tend to use between 180cc and 350cc size implants. I find that most breasts do not fit very large implants well, and they end up causing multiple side effects and being hard to wear. Having very large implants has also become less fashionable in recent years, as the natural look has become all the rage. In some cases, patients only want a very discreet augmentation, something around 160cc or 180cc. I find that these cases give a particularly elegant result, as the perky shape of the implant looks very different from a flatter small breast. This is where shape comes most into play.
IMPLANT PROFILE- Most implants used today are round, which means that the base of the implant is a circle. This circle has a certain diameter, or width. The width of the implant should be about the same as the width of the breast in order for the implant to fit well. As a result. There are limitations to which implants can fit into which breast based on diameter alone. The profile is how tall the implant is when lying on a flat surface, which translates into how much it projects out from the chest wall when being worn by a patient. In cases where the base of the breast is narrow, only a narrow implant will fit well, limiting how big the implant can comfortably be. In order to fit more volume in that augmentation, the implant will have to be tall (high profile) because it cannot be wider at the base. In cases where the breast base is wide but the patient wants a small implant, then the implant must be flatter so that the volume is not overwhelming.
Very low profile implants can sometimes be less satisfying because they don’t have the projection and perkiness often expected from augmentation. Very high profile implants can look pointy and fake; but more importantly, they can over-stretch the skin and breast, and in some cases even flatten the ribs. Long-term deformity from very large implants is often under-estimated when planning a breast augmentation, and can lead to various issues down the road. As with most things, moderation usually yields the best outcomes.
IMPLANT FILL- Most breast implants are filled with either saline (salt water) or silicone gel. In either case, the shell of the implant is generally the same, and it is a solid silicone. Saline filled implants are heavier than gel, and they tend to be more round and less fluid in terms of shape. As a result, they can sometimes look and feel less natural. Silicone filled implants tend to be very soft and their shape changes with position. This usually mimics natural breast better. In either case, the smaller the implant and the better the implant coverage (amount of skin and breast covering the implant), the less obvious the implant will be. A moderate implant with a good tissue envelope can often wear either without much of a difference in performance.
IMPLANT MANUFACTURER- There are a few very well-established implant manufacturers in the US. Mentor and Allergan are the leading ones, with decades of implant experience. Overall, they tend to perform similarly, although they do have a slightly different feel from one another. Most surgeons have their go-to favorite, and it is usually one of these. The IDEAL implant is a multi-chambered saline implant that provides an updated profile shape to traditional saline implants. It has some limitation in terms of profile and size options, but it is a good alternative for patients who want a saline implant with more projection. Choosing the right implant is crucial to your breast augmentation outcome. This cannot be done in a vacuum! Start with a board certified plastic surgeon with full plastic surgery training, and who specializes in cosmetic breast surgery. Ideally, your surgeon should be familiar with most implant types and should have experience with using all of them. They should also measure you and assess your skin and breast quality, as well as your personal breast history. In order to get a great result, the fit must be on point, and this requires a lot more experience than it would seem. Event the most beautiful gown will look odd on the most beautiful body if the size is off.