Types of Breast Implants

All breast implants utilize a silicone shell but the fillings differ, either gel-filled or saline-filled. The outer silicone shell, which give the prosthesis its elasticity and integrity, may be smooth (shiny polished) or textured (finely rough) surface.
There is no doubt that the breasts, augmented with textured implant, providing a disruptive surface for collagen interface, have a lower tendency to develop contracting capsules than the breasts augmented with the smooth implants.
Breast implants may not last a lifetime and the rates of rupture in saline filled implant is higher than the gel filled one.
The implant I always use is Siltex from Mentor cooperation (USA) which is high cohesive & memory gel with texture surface. The implants from Mentor cooperation normally last for life and there is a Lifetime Product Replacement Policy: In my experience, there is no patients who underwent breast implant surgery with me coming back for the problem of quality of this implant at all.

Which Breast Implant Placement is Least Likely to Cause Sagging?

Which of the following method is less likely to cause sagging of the breast implants, above the muscle or behind the muscle?

 Which breast implant placement is least likely to cause sagging?"

 All other factors being the same - SUB PECTORAL.

 Not to belabor the point or lapse into sarcasm or philosophical musings on the meaning of life and aging, CLEARLY unless we die early, we all age and our tissues weaken and obey gravity's irresistible song and droop. So - without doing anything your breast will thin and droop with age.

How can you help gravity pull your breasts down?
Long list.... Become pregnant a few times, gain and lose weight a few times,
do not wear a bra much of the time, smoke, eat poorly, spent time in the sun and tanning booths,
have large breast implants put in and fail to support them, among others.

While ALL breast augmentations of the cables anchoring the breasts to the chest wall (Cooper's ligaments), placing the implant over the muscle divides many more of them. The only thing left to keep your breasts up is your skin (which may or may not be beat up by tanning, smoking etc) and a good support bra which may or may not always be there.

 In short - SUB MUSCULAR + wearing a bra.

How Much Do Breast Implants Weigh?

A very common question that most breast augmentation patients ask during a consultation is...how much do breast implants weigh....and which weighs more, silicone or saline breast implants? This question is one of more interest than importance as there are many more relevant issues in deciding between these two implant filler materials than their weight.

By weight measurements, silicone gel implants weigh more than saline. This is somewhat obvious by having one in each hand and feeling the weight difference. Although it is a common misconception than saline implants weigh more. The fact that weight differences exist can be gleaned from a simplistic look at the periodic table of elements.

Silicon occupies the 14th position and is of the metalloid category of elements. Hydrogen is the first element and oxygen is number 8. Silicone gel is a combination of silicone (14) and oxygen (8), silicone dioxide, for a total atomic weight of 30 compared to saline (water) which is a combination of hydrogen (1) and two oxygens (8 x 2 = 16) for an atomic weight of 17. Although saline also includes the elements of sodium (Na) and chloride (Cl), which would add more weight than just hydrogen and two oxygen alone, its concentration is only 0.9%. For the sake of simplicity, we will discard this minute amount elements and treat the weight as pure water. (at higher concentrations such 3% as in the Dead Sea, this would be a different matter)

 But how significant are the weight differences?

One cc of silicone gel weighs 0.0375 ounces. For example, a 400cc silicone gel implant would then weigh 15 ozs. (0.94 lbs) and a pair would weigh 30 ozs. or 1.875 pounds.

Conversely, a cc of saline weighs 0.0325 ozs. A 400cc saline implant would then weigh 13 ounces (0.81 lbs.) and a pair would weigh 26 ounces or 1.62 lbs.

The difference at 400cc would be around 0.2 pounds or about 3 ozs.


Breast Implant Under the Muscle

Breast implants are frequently placed under the pec or chest muscles to increase the amount of soft tissue covering the implants.  The more of your own tissues covering the implants, the more natural your breasts will look and feel. The extra coverage helps prevent visible rippling in the upper half of the breast that lower cut clothing and bathing suits may expose. There is also a lower risk of capsular contracture.

One disadvantage is that contraction of the chest muscles can create some distortion of your breast shape.  This is not typically visible in clothing and usually does not bother patients. There is slightly more discomfort post operatively after a breast augmentation under the muscle because it is necessary to release some of the chest muscle fibers to make a pocket for the implant. The muscles will still function after surgery and you can work out after your recovery.

Because many women seeking breast augmentation do not have much breast tissue, this is a great choice for the majority of patients.

Breast Implant Over the Muscle

Over the Muscle - In front of the muscle, and behind the breast tissue.
  • Implants are very easy to place. Virtually all surgeons can perform this procedure with ease. 
  • Avoidance of a breast lift, or mastopexy, due to mild sag (ptosis), however, this is usually a "quick fix", and a lift will, many times, be needed in the future, especially when larger implants are placed. Keep in mind that the only thing supporting the implant is the skin and breast tissue. 
  • Less recovery time, with less post-op discomfort/pain, since the muscles are left in tact, and only skin and fat are cut. 
  • Larger implants may be placed, versus attempting to use a very large implant with partial or complete sub-muscular placement (during the first augment). 
  • Cleavage is more easily created with overs, particularly if the breasts are naturally spaced wide apart.

  • Ripples are more easily seen and felt, especially in women starting with little or no breast tissue. In these cases, there is very little tissue to help camouflage the implant. This is especially true for textured breast implants placed over the muscle. See photos of rippling here. 
  • More pictures/views will need to be taken when doing mammograms, and sometimes, insurance companies will not pay for these extra images, which means you will have to pay for those out-of-pocket. However, his can be true no matter where the implants are placed.
  • Capsule contracture rates are highest in women with implants placed over the muscle. 
  • Bottoming out is a larger risk with overs and partial unders than with implants placed in the complete submuscular position.
  • Many women who lift weights opt for over the muscle placement. This is mostly due to the fact that when the pectoral muscles are flexed, the implant does not become distorted in shape. 
  • Overs can give a more "fake", augmented look. There tends to be more of a pronounced "roundness" to the breasts, versus the look that unders give, which is a more natural slope. Again, this is not the case for ALL sub-glandular implants, but does seem to be truer for those who have little to no breast tissue to start with. There is nothing at all wrong with this look. It's simply a matter of personal preference.


What is capsular contracture?

When breast implants, or any other foreign object, are placed in the body, the body forms a lining around it.  This lining, or capsule, is formed by your own living tissue.  Many people refer to this lining as the "capsule", "tissue capsule", or "scar capsule", although it is not exactly the same thing as scar tissue.  This is the body's natural response to a foreign object.   

Capsule contracture, the most common complication of breast augmentation surgery, can happen at any time, but seems to be more common in the first several months after surgery. At the time of the initial surgery, a pocket is made for the implant. During the healing process, a capsule forms, which is comprised of fibrous tissue. The body is genetically programmed to shrink scar tissue somewhat. Under normal conditions, the pocket remains open, thus allowing the implant to look and feel natural. However, in some people, the capsule will tighten, and squeeze the implant. This makes the breast implant feel hard, and distorts the appearance of the breast. In the later stages, the implant feels very firm, and may take on a "ball-like" look. It is important to remember that it is not the implant that has hardened. The shrinking of the capsule compresses the implant, causing it to feel firm/hard.   However, once the implant is removed, it is just as soft as it was the day it was inserted.

What causes capsular contracture?

Currently, the causes for capsule contracture are still very unclear. The following are thought to put you at greater risk for developing capsule contracture:
1)  Transient germ contamination.  Germ contamination and/or long-term bacterial contamination of the implant shell can cause an inflammatory reaction, thus leading to the shrinking of the capsule.
2)  Subglandular placement.  Breast implants placed above the muscle tend to have higher capsular contracture rates, versus breast implants placed in behind the muscle, also known as submuscular placement.
3)  Infection.  Capsule contracture seems to be more likely following an infection.
4)  Seroma.  If you have had seroma, you may be at more risk for capsular contracture.
5)  Hematoma.  Hematomas can cause an inflammatory reaction, which can lead to capsule contracture.
6)  Smoking.  Smoking decreases the oxygen levels in the blood, which could result in delayed healing, and possibly an inflammatory reaction.

Breast Augmentation - Dr. Troy Andreasen

Often there is a desire to improve one's appearance throughbreast augmentation. One of the reasons women may choose to have breast augmentation is to enhance their body contour because, maybe for personal reasons, they feel that their breast size is too small. They might also want to correct a reduction in breast volume after pregnancy, or possibly balance a difference in breast size. Some women may even opt for this procedure as a reconstructive technique following breast surgery or correct a previous surgery with breast augmentation revisionRiverside breast augmentation surgeon Dr. Troy Andreasen is a highly-qualified cosmetic surgeon dedicated to helping his patients achieve the look they desire.

What is the best bra after breast augmentation?

Finding a good bra after breast augmentation can be challenging. Here are a few tips.

For the first 6 weeks to 3 months (depending on the surgeon) the bra should be comfortable, without underwire, and clasp in the front. We use a simple post surgical sport bra. After the first 6 weeks, patients are excited to wear new, prettier bras.

 I recommend wearing a bra nearly all the time, including at night. This is to prevent the implant from “bottoming out” or falling to the sides. This is unlikely in most patients, although some patients have less internal support for the implant (weaker scar tissue). These patients are at higher risk for implant displacement. It is impossible to tell which category you fall into until there is a problem, so I recommend support for everyone.

Breast Implant - Wikipedia

This is a very comprehensive article.
breast implant is a medical prosthesis used to augment, reconstruct, or create the physical form of breasts. Applications include correcting the size, form, and feel of a woman’s breasts in post–mastectomy breast reconstruction; for correcting congenital defects and deformities of the chest wall; for aesthetic breast augmentation; and for creating breasts in the male-to-female transsexual patient.
There are three general types of breast implant device, defined by the filler material: saline, silicone, and composite. The saline implant has an elastomer silicone shell filled with sterile saline solution; the silicone implant has an elastomer silicone shell filled with viscous silicone gel; and the alternative composition implants featured miscellaneous fillers, such as soy oilpolypropylene string, et cetera. In surgical practice, for the reconstruction of a breast, the tissue expander device is a temporary breast prosthesis used to form and establish an implant pocket for the permanent breast implant.

Breast implants- TS Roadmap

Your consideration of breast implants, for reconstruction or for augmentation should be based on realistic expectations of the outcome. To help you get an idea of what results may be possible, look at before and after pictures of patients who have had this surgery. Your doctor may have some to show you. There's a commercial site listed at the bottom of this page that has 120 examples. You may also want to talk with other women who have had this surgery at least a year before with the same surgeon. Keep in mind, however, that there is no guarantee that your results will match those of other women.

Your results will depend on many individual factors, such as your overall health; chest structure and body shape; healing capabilities (which may be hindered by smoking, alcohol and various medications); bleeding tendencies; prior breast surgery(ies); infection; skill and experience of the surgical team; the type of surgical procedure; and, the type and size of implant.

Breast implant procedures can be performed on an outpatient (not hospitalized) basis or at a hospital. Breast implant surgery can be done under local anesthesia, or under general anesthesia.  Breast implant surgery can last from one to several hours depending on whether the implant is inserted behind or in front of the chest muscle, and whether surgery is performed on one or both breasts. 

Breast Augmentation - Myth vs Reality

There is a lot of excellent information on the Internet about breast augmentation.
They provide interesting background, but personal and medical 
referrals are best.

 The following are explanations to answer what is fact verses myth about the procedure.


Types of Breast Implants

There are variety of implant types: silicone gel-filled, saline-filled,  silicone/saline combination, PVP-Hydrogel, and plant oil. There are round implants and anatomic implants. The anatomic type of implant may also be described as a teardrop or tapered implant. The rounded implant gives a fuller upper chest and cleavage. The tapered implant is sometimes suggested for thinner individuals because it may result in a more natural looking upper chest. The outer surface of the implant may be either textured or smooth. Although conclusive evidence does not exist, textured implants may help reduce the adverse effect of capsule formation around the implant. 

There are also variations within the surgical procedures used to insert them. The relative value of implant types is debated amongst plastic surgeons and other medical authorities who study the possible adverse reactions to implants. 

Breast implants have the same basic type of outer envelope made of a solid, rubber-like form of silicone called an elastomer. Implants come in many sizes; the size used depends on the amount of augmentation desired. The volume of the filling contained within the outer envelope may range from 200cc to 400cc, to even larger. A fluid ounce equals approximately 30cc.