Breast Implants

Breast Impants

Implant Types: Silicone vs Saline

Fillable Saline Implant

All Breast Implants consist of an outer casing (called the ‘shell’ or ‘wall’) plus an inner filler material which is either saline or silicone.

Silicone and saline implants have different characteristics as set out in the following table:

Please slide to the right to see full details

Saline Implants Silicone Implants
Filler Material Saline (Salt Water) Cohesive Silicone Gel
‘Feel’ of the Implants to Touch Less natural
(more of a ‘waterbed’ feel)
More natural because they feel more like breast tissue
Consequences of Wall Rupture Saline Implants simply deflate and breast volume is lost. The saline is absorbed by the body without any harmful effects Cohesive Gel has a shape-retaining memory, so breast volume is not lost. The leaked Silicone could migrate to regional lymph glands but as silicone is an inert material this is not considered a risk to health.
Chances of Spontaneous Deflation Possible None
Silicone Gel “Bleed” through the Shell & Risk of Silicone Granuloma None Possible
Chances of Surface Wrinkling/Rippling Greater Less
Approximate Chances of Capsular Contracture 3% Textured Implants have been reported to generally have a lower risk than Smooth Implants. The percentage risk reported has varied with different studies.

Shapes, Surfaces & Size

Breast implants also differ in a number of other ways: their shape (Round or ‘Tear-Drop’), their surfaces (Smooth or Textured) and finally their size and projection (the amount by which they project forwards).

Implant Shapes

Implant Shapes - Round

Round Breast Implants

  • Deliver more upper breast fullness.
  • Are sometimes the preferred shape to restore upper breast volume lost through breast-feeding or weight loss.
  • Can be inserted through any incision location.
  • Being perfectly round, implant rotation cannot produce any deformity of breast shape.
Implant Shapes - tear drop

‘Tear-Drop’ Breast Implants

  • Provide more fullness in the lower half that tapers off towards the top.
  • On profile, they deliver an attractive and natural straight-line drape of skin from collar-bone down to nipple.
  • Can only be inserted through an incision under the breast.

Implant  Surfaces

Breast implants also vary in their surfaces, essentially Textured (also called ‘Rough’) and Smooth implants.

Implant Size

The final choice as to size of implant should be entirely yours. By all means, listen to your surgeon’s recommendations but don’t allow him/her to make the final choice for you.  Instead, choose the size that you feel gives you the ‘look’ you want and not what you think others may like.

Based on many chest and breast measurements, our Surgeon will hand you all the various implant shapes and sizes that suit your measurements and have you insert them one at a time into a ‘crop-top’ to see in a mirror the degree of correction each can give you. This is by far the most reliable way to choose the size and shape of implant that will best deliver the ‘look’ you’re after.

Most importantly, although we’ll insert whichever size YOU want – provided, of course, it’s surgically possible – we always recommend you choose a size that is in proportion with your overall figure and makes you look ‘great but not fake’.

Frequently Asked Questions

Brands aside, implants basically differ in terms of:

  • What they are filled with: Silicone or Saline;
  • Shape (Round or Tear-Drop);
  • Surface (Smooth or Textured; and
  • Size.

With all those choices, there are so many combinations for every patient. And because we don’t offer only one brand or one type of implant, we can customise your implant choices to exactly what you like and what best suits your breast measurements.

Silicone-filled implants are far more popular with patients than Saline implants because they:

  • have a more natural ‘feel’ because they feel more like breast tissue.
  • cannot spontaneously deflate.
  • have less chance of visible surface wrinkling/rippling.
  • enable patients to choose a very natural ‘tear drop’ shape whereas all saline implants are ‘round’.

This is largely a personal choice because every patient has in mind an image of how she wants her breasts to look. The basic differences in appearance are:

  • ‘Tear-Drop’ Implants deliver a more natural appearance because they are tapered towards the top and thus allow a straight-line drape of skin from collar-bone down to nipple.
  • Round Implants, on the other hand, are fuller at the top than ‘Tear-Drop’ Implants. Although this can be an advantage for women who have lost much upper breast fullness through breast-feeding, in other women they can sometimes produce a ‘stuck on’ look, especially if the woman has insufficient tissue coverage.

Our Surgeon will show you both types at your Initial Consultation and have you insert each into a ‘crop top’ to see which ‘look’ you like best.

If there was a simple answer to this, all implants would have the one type of surface! In reality, each type of implant surface has its pros and cons and you need to ask your Surgeon what these are before making your choice.

Breast Augmentation Incisions

Incisions

Breast Implants can be inserted via any of the above four routes. Naturally, there are pros and cons with each approach and our Surgeon will explain these to you in detail at your Consultation.

Essentially, the differences are as follows:

Please slide to the right to see full details

Advantages Disadvantages
Infra-Mammary
(incision in the fold under the breast)
The most popular choice with patients.

Provides unrestricted pocket visibility for the surgeon.

Any size implant can be inserted.

Drains are not necessary.

Any future revision surgery can be performed through the same scar.

Leaves a scar in the fold under the breast.

Although the scar should hide well in the fold when standing, it can be more visible when lying down.

Asian or brown skin has a higher risk of forming brown pigmented scars.

Pigmented, thick or keloid scars could mar the appearance of an otherwise beautiful result if you are prone to them.

Trans-Axillary
(via the armpit)
Scar is placed in an inconspicuous skin crease within the armpit.

No visible ‘tell-tale’ scar on or around the breast.

An option worthy of consideration for those with brown or Asian skin who may form brown pigmented scars, or those with a history of thick or keloid scars.

(Please note that the same type scars could still result, the only difference being that they would be hidden in the armpits rather than being more visible under or on the breasts).

Although any size fillable saline implant can be inserted via this route, the small incision does limit the size of a silicone implant.

Only round implants can be inserted via this route.

‘Tear-Drop’ (Anatomical) shaped implants of any make cannot be inserted via this route.

Drains are always used – these are usually removed on the following day.

Any future revision surgery would likely need the infra-mammary route thereby creating a second scar.

Peri-Areolar
(half way around the edge of the areola i.e. the pigmented area around the nipple).
Scar can be less conspicuous than with the infra-mammary incision. The small incision limits this approach to small silicone implants or any size fillable saline implants.

The dissection could sever some of the milk ducts around the nipple and interfere with future breast-feeding.

It has also been suggested that this route may cause ‘seeding’ of the resident nipple duct bacteria into the implant pocket and thereby cause a pocket infection.

Any future revision surgery would most likely need the infra-mammary route thus creating a second scar.

Trans-Umbilical
(through the navel)
Scar is very small and located well away from the breast. Not popular or commonly performed in Australia.

Only suitable for fillable saline implants.

Difficult to create an aesthetic and refined implant pocket from such a distant entry point.

The passage of the surgical instrument can leave grooves under the abdominal skin.

Any future revision surgery would need to be done through the infra-mammary route.

 

Frequently Asked Questions

Four different approaches exist. They are:

  1. Infra-Mammary (in the fold under your breast)
  2. Trans-Axillary (via the armpit)
  3. Peri-Areolar (along the edge of your areola)
  4. Trans-Umbilical (via the navel)

  • Infra-Mammary is the commonest approach, the advantages being that it allows excellent visualisation of the implant pocket and any size/shape of implant can be inserted via this route.
  • Trans-Axillary is ideal for those who do not want a scar anywhere on or under the breast. The smaller incision does limit the size of a silicone implant that can be inserted but inflatable saline implants of any size can still be inserted via this route.
  • Peri-Areolar is not a commonly requested approach. The small incision does limit the size of silicone implants that can be inserted but inflatable saline implants of any size can still be inserted via this route.
  • Trans-Umbilical, commonly called TUBA for short, is not at all popular in Australia mainly because only inflatable saline implants can be inserted, and saline implants are far less popular than silicone implants. As it is more difficult to create a beautiful breast shape when working so far away from the breast implant pocket, our Clinic does not offer the TUBA approach.

The only approach which is slightly more expensive is Trans-Axillary. Infra-Mammary and Peri-Areolar have the same standard Surgical Fee. Our Clinic does not perform the Trans-Umbilical technique.
The main reason patients request the Trans-Axillary approach is to avoid any scar on or under the breast which could mar an otherwise beautiful result. This is especially important in those with Asian or brown skin because of their higher risk that the surgical scars could end up permanently pigmented. Admittedly, the same pigmented scars could occur in the armpit but at least in that location they would be hidden within a skin crease and not under or on the breast.

Breast Implant Positions

Implants can be placed in any one of four positions.

Each position has its specific advantages. Which implant position is best for you will depend on your breast appearances, breast measurements, physical activities and the ‘look’ you’re after.

1. Sub-Muscular (‘under the muscle’)

The implant is placed behind the pectoral muscle.

The advantages of this position are:

  • It creates a more natural appearance because the muscle provides additional coverage over the edges of the implant and thereby helps to avoid a ‘stuck on’ look and visible ‘step’ along the upper edge of the implant.
  • There is less chance of visible Rippling/Wrinkling.
  • There is less chance of Capsular Contracture.
  • There is less interference with Mammograms.
  • There is less chance of interference with future breast feeding.
  • The implants are further away from the breast tissue and are therefore less likely to be involved in any breast diseases or be damaged during any fine needle biopsy of a breast lump.
Breast Implant

2. Sub-Glandular, (‘in front of the muscle’) – sometimes called ‘Pre-Pectoral’

The implant is placed immediately under the breast tissue itself, between it and the underlying pectoral muscle.

It is preferred to sub-muscular:

  • In those with impending or mild sagging of the breasts, constricted lower breast poles and tuberous breast deformities.
  • In those engaged in heavy, repetitive pectoral muscle exercises e.g. body builders, weight lifters.

However, it is not a good option for those women with thin chest wall tissues as the insufficient coverage of the implant edges would create a ‘stuck on’ look.

Sub-Glandula

3. Sub-Fascial (‘in front of the muscle’ but ‘under its sheath’)

  • This is simply a variant of the ‘in front of the muscle’ position with basically the same advantages and disadvantages.

4. ‘Dual Plane’ Placement

A combination of positions 1 and 2 where the upper half of the implant is placed ‘under the muscle’ and the lower half is in direct contact with the lower breast:

  • The upper half of the implant is placed ‘under the muscle’ to help hide any ‘step’ along the implant’s upper edge that could occur if the implant was entirely ‘in front of the muscle’
  • The lower half of the implant is in direct contact with the breast to provide ‘fill’ and ‘lift’.
  • This implant position is preferred in special situations such as mild sagging, constricted lower poles and ‘tuberous breasts’ when there is insufficient chest wall tissue coverage to allow the implant to be placed entirely ‘in front of the muscle’. Whereas mild sagging, constricted lower poles and ‘tuberous breasts’ could be equally corrected with an implant ‘in front of the muscle’, the latter position could produce a ‘stuck on’ look due to visibility of the implant edges in those with insufficient chest wall tissue coverage.

 

Dual-Plane

 

Frequently Asked Questions

There are basically four:

  • Sub-Muscular (‘Under the Muscle’)
  • Pre-Pectoral, sometimes called Sub-Glandular (‘In Front of the Muscle’)
  • Sub-Fascial (‘Under the Sheath of the Muscle’)
  • Dual Plane (Partly ‘Under’ & Partly ‘In Front of the Muscle’)

Each position has its pros and cons but unless a specific alternative placement is indicated, we always recommend the Sub-Muscular position because it delivers a more natural ‘look’ due to the extra tissue coverage over the implant. Unfortunately, in contrast, the ‘In Front of the Muscle’ position often delivers a ‘stuck-on’ appearance when there is insufficient tissue coverage to hide the implant edges.

Admittedly, ‘Under the Muscle’ does take a little longer to do than ‘In Front of the Muscle’, but our aim has always been to deliver the best possible ‘look’ for each patient and we don’t charge any more for the Sub-Muscular position. Some surgeons use the ‘In Front of the Muscle’ position routinely. It’s quick and easy, but for us, it’s about placing the implant where it will deliver the best ‘look’, not what’s easiest and quickest!

The other positions, Sub-Fascial & Dual Plane, are reserved for special circumstances. Our surgeon will explain which position you would serve you best, and why, at your initial consultation.

The Sub-Muscular position has the following distinct advantages:

  • It delivers a more natural ‘look’ because the muscle provides additional coverage over the edges of the implant and helps to avoid a ‘stuck-on look’.
  • There is less chance of visible Rippling/Wrinkling.
  • There is less chance of Capsular Contracture.
  • There is less interference with Mammograms.
  • There is less chance of interference with future breast feeding.
  • The implants are further away from the breast tissue and are therefore less likely to be involved in any breast diseases or be damaged during any fine needle biopsy of a breast lump.

There is no cost difference between ‘Under the Muscle’ (Sub-Muscular) and ‘In Front of the Muscle’ techniques.

However, special techniques such as Dual Plane Placement (Partly ‘Under’ & Partly ‘In Front of the Muscle’) may involve a slightly higher surgical fee depending on what else needs to be done.

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