Which Breast Implant Is Right For Me

When women come to their consults for breast augmentation, their main focus is on “which breast implant should I choose?” They may have some idea about what look they want, but that cosmetic goal can get confused as they see so many online reviews and discussions about different types of implants. Their friends might tell them that “you have to get high-profile silicone implants”, or their mom tells them to get saline like she has. Patients are usually more confused that enlightened by the “research” that they do about breast implants before their consults.

In reality, the choice of which breast implant a given patient “should” choose has everything to do with the patient and almost nothing to do with everyone else’s opinions. The breast appearance after breast augmentation is not just about the implant. It is about the new breast that is made up of the skin, fat, breast tissue, muscle, and then the implant. In other words, the final appearance results from interplay between the implant and the breast itself, with the person’s own tissue usually being the more important and limiting factor.

One way to think about breast implant choice is by breaking it down into 3 parts:  implant size, implant proportions (profile, or projection), and implant fill material (silicone vs. Saline).  A couple of years ago, we would also have included the options of shaped vs. round implants and textured vs. smooth implants.  Currently, though, we do not offer textured implants (because of the risk of ALCL, or Anaplastic Large Cell Lymphoma). 

Furthermore, all shaped implants (those with a gradual slope at the top for a more natural, less push-up bra look) require a textured surface like Velcro so that the implants don’t spin upside down.  Therefore, choices are simpler and revolve around size, proportions, and fill material.

In my experience, size is the number one concern of women when I meet them.  Patients generally describe their goals in terms of bra cup size.  This is not very helpful, because all bra manufacturers are different.  For instance, most people must go up at least one size for Victoria’s Secret. 

Additionally, women have very different impressions of cup sizes, and women who I think are a small B will tell me they are a full C.  Since I am on the topic, I will add that most women specifically do tell me they want to be a “full C”.  In reality, though, once they try on sizers and pick what they like, their concepts of what a full C is are all over the place. 

So, I usually just ask how many cup sizes they would like to increase.  Even better, I want to know what look they like and not worry about the cup size at all!

Implants don’t just come in different sizes, but they come in different “projections” or “profiles”.  Some are flatter and others are more spherical.  Part of the reason that these options exist is because some people want a more conservative, natural look that doesn’t project very far in front of them. 

Other women desire a rounder, “fuller” shape that has more of a push-up bra shape at the top.  As you can imagine, a 400cc flatter implant (moderate profile) gives a very different effect than a 400cc extra-full profile.  Another reason to offer different projection implants is that sometimes people have wide breasts and need a wide implant even though they do not want to be very big. 

Other patients might want a large implant, but their breasts are very narrow.  These women can only get the volume implant they like by using a narrower implant that is more projected forward and rounder.

Most important of all is the reality that these implant decisions cannot be made solely based on what the patient “wants” or has in her mind.   Sometimes we see women who want large, round, tight-looking, push-up type breasts… but they themselves are tiny with tight skin and almost no breast tissue.  Now where am I going to put an implant like that?  I must be careful to avoid stretch marks, drooping of the breast over time from a disproportionately heavy implant, and nipple numbness from over-stretching the nerves. 

In contrast, I see women with very loose empty skin after breastfeeding and weight loss but who want very small, narrow implants.  This is a problem too because that tiny implant might look like just a mass in her breast and will certainly not look like it is the breast itself. 

Additionally, it would not be big enough to fill that empty “bag” of skin to make it look more youthful.  As you can see, what the patient ideally wants must be tempered by what breasts they bring to the table.

Finally, we come to saline vs. silicone.  I have written about this in a previous blog, but here is a short synopsis.  They look the same.  There is no difference in appearance.  The major differences are these: Saline implants have a higher rate of leaking or rupturing, but silicone implants have a higher rate of capsular contracture (hard, tight scar tissue forming around the implant and making them look and feel unnatural). 

Also, silicone does feel more natural, but saline implants are far less expensive.  So, which is better?  It depends on the patient.  If she has a lot of soft-tissue coverage from breast tissue, fat, and muscle, it will be harder for her to feel the difference. 

On the other hand, a very thin woman with almost no breast and loose skin would definitely benefit from the feel of silicone.  But that might not be important to her.  

Like I said- the best choice is different for each woman.