There are a variety of different types of implants on the market and they all have their strengths and weaknesses.
Everybody wants to have the ‘best’ implant but the fact is that there are pros and cons of all of them, otherwise we would all be using one type.
Unlike many clinics, we are not tied to any particular make or manufacturer of breast implant and so we are free to use any type of implant as long as the hospital is able to get hold of it.
A breast implant is made up of a shell and contents and the different types of implants that are available are as follows:
Saline – saline implants are filled with salt water rather than silicone gel and saline implants are not commonly used in the UK.
Pros – some patients feel that they do not want to have any silicone implanted in their body (although saline implants still have a silicone shell).
if the implant leaks it is just salt water that leaks out, which is easily absorbed by the body.
they can be inserted empty and filled during the operation allowing a smaller scar (can even be placed through a small scar in the belly button – TUBA or transumbilical breast augmentation)
Cons – more likely to ‘deflate’ over time
more likely to have visible rippling and so usually need to be placed under the muscle
not available in the teardrop shape
Silicone – the majority of breast implants that we use in the UK are filled with silicone gel.
Pros – silicone gel is made to feel similar to the consistency of natural breast tissue and can give a better ‘feel’
the gel is called ‘cohesive gel’ and has a firm consistency known as ‘form stable’ or ‘gummy bear’, which means that it does not leak liquid silicone if the shell ruptures and will keep its shape. It is safer in the event of implant rupture, although the implants can feel a bit firmer than the older, more liquid silicone implants
Cons – some patients feel that having silicone in their body makes them feel ill (known as breast implant illness), although in these cases, it may be best to avoid breast implants all together.
The main difference between breast implants is the shell of the implant and it relates to how rough it is. They range from a completely smooth shell (smooth implants) to a very rough shell (polyurethane foam implants) with micro and macrotextured implants in between.
Smooth Implants – this is how implants were first made back in the 1960’s and these have a glassy smooth surface. They were found to have a risk of rippling and of going hard (capsular contracture) and it was found that by making the surface of the implant rough, it would break up the scar tissue that forms around the implant and make it less likely to contract and go hard. However, more recently, there has been a very rare cancer associated with breast implants called Breast Implant Associated – Anaplastic Large Cell Lymphoma (BIA-ALCL) and this seems to be related to the roughness of the implants and so does not occur with smooth implants.
Pros – less risk of BIA-ALCL
Cons – increased risk of rippling
increased risk of capsular contracture
no teardrop shape – there is no adherence between the implant and the pocket which means that there is no teardrop shape available for smooth implants (although they do tend to settle in to a teardrop shape when in the body)
Microtextured implants – these are relatively new implants and fill the gap between traditional macrotextured silicone implants and smooth implants. The surface is gently roughened. In the classification of implants, they are classified as smooth but they have a slightly roughened surface in order to give some of the benefits of the textured surface while still being classified as ‘smooth’
Pros – slight roughness to the surface may reduce the risk of capsular contracture
may be seen as a compromise between completely smooth and traditional (macro)textured implants
Cons – relatively new on the market
no teardrop shape (although come in a less cohesive type which is more likely to settle in to a teardrop shape when in the body)
Macrotextured Implants – these have probably been the most common type of breast implant used in the UK. They have a roughened (textured) surface which helps the implant to adhere to the surrounding breast tissue and reduces the risk of capsular contracture. However, it is this roughened surface that has been implicated in the development of the cancer, BIA-ALCL
Pros – textured surface offers better adherence
less chance of capsular contracture (compared with smooth or microtextured)
Cons – increased risk of BIA-ALCL
more chance of capsular contracture (compared with polyurethane foam implants)
Polyurethane Foam Implants – these implants have been around since the 1960s but have had a controversial history. They have the lowest rate of capsular contracture of all implants and integrate with the breast tissue securely and so are less likely to migrate or rotate.
However, a by-product of the polyurethane (2,4 TDA) was found to cause cancer in rats and so these implants were not used in the UK for a long time. However, they continued to be used in other parts of the world and this cancer has never been found in humans.
More recently, polyurethane foam implants have been implicated in BIA-ALCL as it seems that this rare cancer which occurs in the capsule around the breast implants (it is not breast cancer) seems to more common in implicated in implants with a rougher surface and polyurethane implants have the roughest surface of them all.
Pros – low risk of capsular contracture
low risk of migration or rotation
Cons – increased risk of BIA-ALCL
theoretical risk of cancer caused in rats
|Microtextured Silicone Implants
|Macrotextured Silicone Implants
|Polyurethane Foam Implants