Tag Archives: Saline

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.

Fifth expansion

WARNING: NSFW / graphic content below.

In other news: I had my fifth expansion. 50ccs have been added to each expander, for a total of 400ccs/side. We’re getting there.

184ccs vs. 400ccs

184ccs (pre-op) vs. 400ccs

I am very happy with how these things are looking so far. Compared to how expanders usually look on women, mine have a pretty natural shape. A bit lop-sided, with righty higher up than lefty, because of how the internal pockets healed post-op. The right pocket closed up a little bit on the bottom, so the expander sits higher in my chest, but it’s not too bad. This will be fixed during the exchange surgery in September.

I have a few more decisions to make before September. Mainly: will I get silicone or saline implants, what shape will they be, and what am I going to do about my nipples. If you’ve been following me for a bit (or can tell from the photos), you know that I lost one of my nipples to necrosis. I need to figure out what I’m going to do about it. The options are:

  • Nothing
  • Reconstruct the lost nipple via skin graft or skate flap
  • Get a 3D tattoo
  • Remove the other nipple

I can’t decide what is best. On one hand, I went through all this trouble, so why give up now, but on the other, I just don’t think I’m going to like the aesthetic result if I do nothing or reconstruct/tattoo just one. What’s more awkward than two hard nipples? ONE! I like symmetry. I think I’m going to remove the other one and maybe reconstruct them both. Not 100% on that though. We shall see.

Here are the pics. Big difference between what 100ccs looked like after my mastectomy in January and the 400ccs I have today.

2013_5_24 fills

100 + 50 +75 +75 + 50 + 50 = 400ccs