April 29, 2020 - Dr. Markarian

Gummy Bear Implants have been available for the last decade. And while advancement in Breast Implant technology is exciting, patients are often confused by the variety of Breast Implant types and which would be suitable for them. Breast Implant procedures are consistently popular with 95% of patients posting on RealSelf stating their procedure was worth it.What are Breast Implants?What are the different Breast Implant Types?Silicone or Saline ImplantsGummy Bear Implants or Round ImplantsTextured or Smooth ImplantsAllergan Natrelle® or Mentor® ImplantsWhat are the risks of Breast Implants?How do patients choose a type of Breast Implant?ConclusionDisclaimerWhat are Breast Implants?Breast Implants are used in Breast Augmentation procedures to enhance the size, shape and volume of a patient’s breasts. Plastic surgeons may also use breast implants for breast reconstruction procedures for patients who have suffered with breast cancer.According to the American Society for Aesthetic Plastic Surgery, during the procedure, the Plastic Surgeon will place the Breast Implants through a small incision and insert implants into a pocket either under or over the pectoral muscle. You can learn more about incisions and Breast Implant placementin our blog – BreastAugmentation Boston: The FAQs.Why are there different Breast Implant types?Prospective patients considering this surgery will, with the advice of their Plastic Surgeon, will need to choose the best implant for them. This often is not an easy task as there is so much information available about different Breast Implant types and sizes. According to verywellhealth.com 41% of Breast Revision surgeries were performed on women who had regretted their chosen implant and size. So, it is important for patients to honestly and thoroughly discuss their preferences with a Board-Certified Plastic Surgeon in Boston during a consultation.Breast Implant types typically differentiate by the:Liquid contained within the implantShape of the implantSize of the implantFirmness of the implantImplant Manufacturer. The Aesthetic Society suggests the implant type and size a patient chooses is usually determined by their desired increase size, breast anatomy, skin elasticity and body type.What are the different types? Patients considering Breast Implants should contact a Board-Certified Plastic Surgeon in Boston to discuss the outcome they are looking for and the risks and benefits of each type of implant. Below is a guide for some of the frequently asked questions and debates surrounding Breast Implants.Silicone or Saline ImplantsAccording to webmd.com, there are two broad types of breast implants available in the U.S – silicone and saline implants. Silicone implants are filled with an elastic, silicone gel, whereas saline implants are filled with sterile saltwater. Both silicone and saline implants have an outer shell made of silicone. Recent data from the American Society of Aesthetic Plastic Surgeons demonstrates that the majority of breast implant surgeries use silicone implants (88%). It has been reported that many women say that silicone implants feel and look more natural than saline implants and that the silicone gel feels more like natural breast tissue. There are surgical differences to consider when choosing between silicone and saline implants. Silicone implants are pre-filled and inserted with the gel already contained in the implant. So, the implant size cannot be adjusted following surgery. Saline implants may be filled after they have been positioned and therefore require a smaller incision than silicone implants. Depending on the surgeon, webmd.com suggests there may be the potential for saline implants to be increased or decreased in size months after surgery. The FDA has approved both saline and silicone implants. However, any surgery with Breast Implants carries its own risks (see Breast Implant Risks for a list below). Risks pertaining to the actual breast implants themselvesinclude:CapsularContractureLeakageRuptureWrinkling.According to the MayoClinic, there are subtle differences between the rupture and leakage of each implant should this occur. A saline implant rupture will likely cause the implant to noticeably deflate, whereas a silicone breast implant rupture may not be visibly noticeable as silicone tends to remain in the tissue. They also suggest that a saline implant leakage will notcause health risks as the body absorbs the saline, however the silicone shellof the implant may need to be removed. A leaking silicone implant may causepain and changes in the appearance of a patient’s breasts. The FDA recommendsthat patients receive MRI screening for “silent rupture” 3 years after receivingsilicone implants and every 2 years after that for the rest of their life.Saline implants have been considered to be more prone to wrinkling than silicone implants.Patients considering Breast Implants should speak to a Board-Certified Plastic Surgeon in Boston about the risks of the procedure and implant types. Their surgeon will be able to advise on how to monitor their implants over time. Gummy Bear Implants or Round ImplantsRound Implants tend to be the most common shape of Breast Implant. According to Healthline.com, both saline and silicone implants have traditionally been round, in part due to the fact that patients will not suffer from the problems of implant rotation.Round Implants also offer different levels of projection. Theprofile of a breast implant measures the distance an implant projects outwardsfrom the chest wall. A high-profile implant, for example, will have greaterprojection than a low-profile implant. Patients must consider the breastaesthetic they are hoping for before choosing their breast implant profile. Round Implants are typically beneficial for patients whowant to achieve more fullness at the top of the breast and the cost for RoundImplants is usually less than that of shaped implants.Gummy Bear Implants, also referred to as “shaped breast implants” or “anatomical breast implants” were FDA approved in 2014. The American Society of Plastic Surgeons states that “Form-stable implants are sometimes referred to as gummy bear breast implants because they maintain their shape even when the implant shell is broken.” One of the main benefits of Gummy Bear Implants is that theymimic the national shape of the breast. In contrast to Round Implants, GummyBear Implants are thicker at the bottom and tapered towards the top – giving themthe shape of a teardrop. Gummy Bear Implants also contain a thick silicone gelto maintain the implant shape and offer additional firmness. During the rise in popularity of Gummy Bear Implants in 2013, Earl Campbell, MD, stated that “there is some evidence to suggest that the patient’s risk of developing a capsular contracture around the implant could be lessened.”There are some common concerns surrounding Gummy Bear Implants. Unlike Round Implants, they may rotate over time and this can distort a patient’s breast shape. Due to the thickness of the silicone gel, the incision a Plastic Surgeon needs to make to insert Gummy Bear Implants may be longer than that of other implant types. Gummy Bear Implants have also been reported to be far more expensive than other Breast Implant types.Textured or Smooth ImplantsRealSelf.com reports that 90% of silicone Breast Implants used in the U.S. have a smooth outer shell, and only 10% have a textured outer shell. Smooth Breast Implants do not attach to the surrounding tissue and can usually move freely within the breast tissue or a capsule that forms around the implant. Textured implants have a rubber shell and attach to the tissue capsule around them.Smooth Breast Implants may have more natural movement thanTextured Implants, whereas Textured Implants are less likely to move around andbecome repositioned.According to Healthline.com, Gummy Bear Implants have a Textured Shell, as these have been shown to have a lower chance of a patient developing capsular contracture. It has also been thought that Textured Implants may reduce the rate of Capsular Contracture recurrence.A 2019 FDA report stated: “The FDA has identified an association between breast implants and the development of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a type of non-Hodgkin’s lymphoma… BIA-ALCL develops more frequently in people with textured implants than in those with smooth-surfaced implants.”Patients should contact a Board-Certified Plastic Surgeon in Boston to discuss any concerns they have around a Breast Implant procedure and the Breast Implant type they are considering.Allergan Natrelle® or Mentor®Many patients considering Breast Implants are overwhelmed by the number of Breast Implant types. Some of these implants are differentiated only by their manufacturer. Two brands that patients inquire about are Allergan Natrelle® and Mentor®. The differences between the brands may be subtle, and a Plastic Surgeon may prefer a particular brand. If patients have a preference themselves, they should discuss the Breast Implant Brand with their surgeon and seek advice.What are the risks of Breast Implants?Major surgeries carry some common elements of risk, such as bleeding, infection, pain and anaesthesia issues. There are also some risks specific to the Breast Implants, some of which have already been covered above. It is essential that patients discuss the risks of Breast Implant procedures with a Board-Certified Plastic Surgeon in Boston. Compiled from RealSelf, The American Society of Plastic Surgeons and BreastCancer.org, the list below shows some of the potential risks and complications of Breast Implant procedures:CapsularContracture: Implants may sometimes have a hard-capsule form aroundthem. This capsule can make the breasts uneven or asymmetric and may cause painin the chest area for women.Rippling: This typically refers to the folds or wrinklesof Breast Implants being visible on the skin of women. Rupture: Implants may develop holes or tears that canlead to leakage. (See Silicone vs. Saline Implants for how leakage may vary fordifferent Breast Implant Types.)Nipple Sensation: Sometimes, the Breast Implant procedure can damage nerves in the nipple and reduce sensation, though feeling typically returns within a few months.BIA-ALCL: The FDA identified an association between Breast Implants and a rare form of lymphoma – Anaplastic Large-Cell Lymphoma (ALCL). In 2019, Allergan announced a global recall of Biocell textured breast implants and tissue expanders after the FDA requested the recall. According to Healthline.com, the FDA doesn’t advise all women without symptoms to have their implants removed. Patients with or considering implants should speak to their healthcare provider or plastic surgeon to discuss the safety of their implants.Among other concerns is the potential need for breastimplant revision surgery, pain and scarring. How do patients choose a type of Breast Implant?Deciding on a particular Breast Implant is a very personal choice for a patient and should be finalized only after an open, honest and thorough discussion with a Board-Certified Plastic Surgeon in Boston. There are a lot of factors for patients to consider when choosing a Breast Implant. Among these are the:ContentsThe size of the surgical incision, the feel of the BreastImplant and the potential complications in the future can be affected by thecontent of the Breast Implant. (See Silicone vs. Saline)Profile and ShapeDifferent Implants can produce a variety of aesthetics. RoundImplants may offer more opportunities for patients wanting to achieve fullnessat the top of their breasts, whereas Gummy Bear Implants attempt to replicatethe natural breast shape. (See Gummy Bear Implants vs. Round Implants)SafetySome safety concerns and risks have been discussed in sections of this blog. Patients should contact a Board-Certified Plastic Surgeon in Boston to discuss the full list of benefits and risks of Breast Implant procedures, both generally and specific to the implant type and brand of interest.VolumePatients often find it useful to try on implant sizersduring their consultation to help them decide on the volume or cup-sizeincrease they desire.Dr. Markarian always suggests the first step in choosing a Breast Implant type is to have a detailed discussion about the desired outcome and safety of your surgery with a Board-Certified Plastic Surgeon. ConclusionInformed patients are the best patients.All patients considering a Breast Implant procedure shouldbe sure to do their research and find a Breast Implant specialist who has impressivecertifications, experience and results. The next step is to book a consultation with a Board-Certified Plastic Surgeon in Boston to discuss the procedure and ask as many questions as may be necessary.DisclaimerPlease note: All materials on the Site, such as text, treatments, outcomes, photographs and images and any other material provided on the Site are for information purposes only and are not a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding treatments. Never disregard professional medical advice or delay in seeking it because of something you have read on this Site.Though the content of this blog has been carefully prepared, the author of this content is not a medical doctor and the content has not been reviewed by a Board-Certified Plastic Surgeon. Unless specifically stated, patients referred to in this blog have not received a Breast Implant procedure by Dr Mark Markarian. This blog does not endorse the work of any doctors or surgeons mentioned. Stories relating to patients’ personal experiences of a Breast Implant procedure should be treated as anecdotal only.Any application of the material provided is at the reader’s discretion and his, her or their responsibility.

MD, MSPH, FACS

HARVARD-TRAINED BOARD
CERTIFIED PLASTIC SURGEON

Day: April 29, 2020

Gummy Bear Implants and other Breast Implants Explained