Choosing implants

Saline versus silicone? Teardrop or round? Will high profile give enough projection? Choosing implants has been a popular topic in the Prophylactic Mastectomy Facebook group this week. While reviewing feedback of some of the other Ladies, I found myself questioning the choices I’ve made. After looking over my little list yet again, I reaffirmed that I have made the best decision for me. Here are the winners upvote and the losers downvote.

QuestionDisclaimer: Each person may give different levels of importance to the factors I list below and should discuss their options with their plastic surgeon. It is not my intention to convey that choosing anything different than what I chose is wrong. I am just presenting my logic. Right, wrong, or just plain stupid. 🙂 As always, I welcome your feedback!

Implant type

Factor Saline Silicone
Durability downvote upvote
Incision size upvote downvote
Chance of rippling downvote upvote
Natural feel downvote upvote
Sloshing downvote upvote
Leak detection upvote downvote

All the hoopla about the link between silicone implants and connective tissue disease, breast cancer, or reproductive issues is just that .. hoopla and unproven. It still caused the moratorium on use of silicone implants in the US in 1992, though. Because of this, breast implants are the most tested medical device out there. The moratorium was lifted in 2006. See FDA’s Update on the Safety of Silicone Gel-Filled Breast Implants for more details.

BreastReconstructionGuidebookTab6_1In any case, both types of implants are encased in a silicone shell. The one encasing the silicone implant is solid, but the saline one has a port (salines are inserted deflated and filled with fluid; silicones are pre-filled). Also, salines are more prone to ripple, causing folds in the shell. These two vulnerabilities are the causes of higher failure rates of saline implants. Although they come out on the bottom here, problems with silicone implants are more difficult to detect. Regular MRI screenings for “silent ruptures” are recommended for patients with these types of implants.

On the aesthetic side of the equation, the incisions needed for salines are smaller, but they are firmer and have been reported to produce a “sloshing” noise.

Implant shape

Factor Round Anatomical
Natural appearance downvote upvote
Natural feel/motion upvote downvote
Higher projection upvote downvote
Complication due to turning upvote downvote

From the various photos I have seen, I am not convinced that there is much difference in the aesthetic outcome, but in my head it makes more sense that anatomical (teardrop) implants have a more natural shape, so I gave them the upvote. While both shapes are filled with cohesive gel, the degree of viscosity varies between the round and teardrop versions. Teardrops may look better, but they are firmer due to the gel being more form-stable (read: solid). This consistency is what gives the implants the “gummy bear” moniker.

Whether saline or silicone, implants come not only in different shapes, but also either smooth or textured surfaces, as well as different projections. Due to the distribution of the gel within the implant shell, the same volume of silicone produces a higher projection in a round implant versus a teardrop one. The higher the projection, the narrower the base. With a 29″ rib cage, I need narrow implants and the round version offers the highest projection: ultra high.

And lastly, the fact that corrective surgery is required if the implant turns is a big one for me. When a round implant turns, you can’t tell, but if a teardrop is loose within its pocket, it is obvious. With the current state of my expanders (one sits higher than the other), I am nervous about this possible issue and want to avoid it.

So there you have it: I chose round silicone implants.

Check out this awesome video showing the difference between regular round silicone implants and their anatomical counterparts.

This is a video of me playing with a round implant that has been ruptured. You can see that this type of implant is also cohesive enough to not leak outside of the shell. It retracts just as the anatomical implant in the above video.

Source of Table 6.1: Steligo, Kathy. Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. Maryland: The Johns Hopkins University Press, 2012. Print, third edition.

14 thoughts on “Choosing implants

  1. dglassme

    Mogatos, thank you for seating this information in an informative all-in-one fashion. Very helpful. Have my expander in now, first fill will be next week, ee gawd, not looking forward to it 😦 I assume your implants are under the pectoral muscle, correct? I so did not want my muscle cut…

    Think I’m going with the anatomical and form stable silicon. Not sure I can even shift gears at this point, unless I want to do tissue flap procedure, since I assume there are different types of expanders for the two breast shapes. I just feel overwhelmed at this point and want to be done, almost to the point I don’t care, I’m exhausted. Feel like we’re talking about looking on a menu at a restaurant to determine what to eat for dinner. When I try to think about all this crap, it brings to the forefront I haven’t even decided if I’m going to truly forgo radiation.

    1. Mogatos Post author

      I was nervous about the first expansion, but found that it was really a piece of cake. The feeling was more pressure than pain and ibuprofen did the trick. I hope it’s the same or even less for you! Yes, my recon is under the pec major. My PS snipped the nerves that feed it rather than the muscle itself. So far I can’t say that it was good/bad decision as I have been taking it easy and not pushing myself. Is yours over the muscle?

      There are different shapes of tissue expanders. I have teardrop shaped ones (didn’t have a say in it and didn’t even know that this was an option). We’re doing round implants, so I’m assuming that it won’t be a problem. Not sure if you could go the other way around. I know that the anatomical implants require a very tight pocket, so you most likely won’t need to over-expand like I did.

      I’m with you on wanting to be done. Do you have an idea how long the expansion process will take and when you’ll have the exchange surgery? This year? Hope it goes by quickly for you!

      1. dglassme

        Mogatos, thank you for your response to my post. “Piece of cake”, yeah right  Pressure pain same difference…

        My expander is under the muscle. PS cut the pectoral muscle and sewed a piece of Alloderm to the lower portion to make a pocket for the expander since the muscle would not cover the entire expander. My understanding is the skin from the nipple sparing mastectomy does better if it is laid up against tissue or like tissue rather than foreign object such as an expander. Yeah, I have the tear shaped expander, at least I think so because its high up toward my collar bone, rubs the area where my chemo port was located. Good to know there may still be choices going forward, round vs anatomical, was hoping to get by with limited to no impact to good breast, thus, anatomical. May have to over-expand it due to radiation but, have truly decided whether I’ll forgo rads which will apparently shrink the good PS’s master piece.

        Think the fills will take something like 5 weeks, then depending on rads which would be another 6 weeks before exchange surgery, and I think this gets delayed until skin is healthy enough to undergo surgery. Long process…

  2. The Savvy Sister

    So informative! My surgeon didn’t even give me this much info! I chose saline, just because I felt better about them. I love the way they feel and so far (6 years later) I have no complaints 🙂
    Good luck!

    1. Mogatos Post author

      Those surgeons seems to be holding things back from us :). Ah, the power of Google! It’s awesome that you have such great results. Happy to read that.

  3. Ray

    First time to comment… Thank you for your blog! My exchange surgery is coming up in two days (Monday!). I’m amazed that you could get your breasts this big. I mean they are definitely bigger than mine. My original breasts were small (A?) and my doctor placed the smallest expanders. I am happy with the size so the size is not the issue but I’m more surprised that you did not have any issue during the process! One time my muscle spasm was so bad that I was screaming in pain and had to go back to the office to take some saline out of me. It felt like a semi-truck was going back and force slowly on my chest. After 250cc, I was happy that I was done with the process.

    Anyway, your breasts look wonderful!! hopefully mine turns out great too 🙂

    1. Mogatos Post author

      Thanks for your note. Sorry to read you had some issues during the expansions. Any pain involving an analogy to the semi truck is definitely not something that anybody wants to experience!

      I hope that your surgery goes well today! Wishing you a speedy recovery and no complications. I’d love to get an update from you on how you’re feeling post-op and how everything is looking. I bet you will look great! I’m sure you’ll at least feel better. Getting these rocks out of my chest is definitely something I am very much looking forward to.

  4. A.K.

    I can’t tell you enough how much your blog has helped me. You have such great information, and the way you share your experience gives me an idea of what to expect. Thank you for writing about your journey. Thank you for being brave enough to post pictures. I’m not there yet, but I have to tell you how much you inspire me.

    1. Mogatos Post author

      Thank you so much for your kind words! I really appreciate you taking the time to do that. It puts a smile on my face to know that all this is useful.

      Sending you some virtual positive thoughts in hopes that your new GM spots magically disappear!


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