Choosing the Right Breast Implants: Size, Shape, and More!

Determining the right implant type in preparation for a breast augmentation can be overwhelming during a time when plastic surgery is increasingly customizable. Over six decades have passed since Thomas Cronin and Frank Gerow of Houston Plastic Surgeons used the very first silicone implants for Timmie Jean Lindsey’s (who is still alive and well, implants intact!) breast augmentation in 1961. Gerow came up with the idea after squeezing a plastic blood bag and remarking how much it felt like a breast. Now, as cosmetic procedures have been brought to the masses in tandem with increased technological innovation, Cronin and Gerow’s brainchild went from having four options (petite, small, medium, and large) to over four hundred. 

One major revolution in the world of breast implants is the introduction of saline implants as an alternative to silicone. New shapes, sizes, and textures were also created over time, along with different insertion methods, allowing patients to curate their breast augmentations for what best suits them. But, with so many different options comes a slew of necessary choices the patient and surgeon must make. So, where does one even start when considering breast implants? First, finding a board-certified surgeon with a history of successful testimonials will significantly decrease the chance of ill-suited implants. Dr. Barrett Plastic Surgery in Los Angeles prioritizes choosing implants tailored to the patient’s needs while ensuring natural-looking results.  

During the initial consultation, the surgeon works closely with the patient to determine their surgery goals before providing the best-suited implant options. However, patients who want to have an idea of what to expect before stepping into the doctor’s office can narrow down an idea of their options based on their body type and desired results.

What is the difference between silicone and saline implants? What are the major pros and cons of each option?

First, it's essential to understand the difference between silicone and saline implants, which are both safe, FDA-approved options: 

• Silicone is a polymer with no known human allergies or sensitivities. It is a safe option for patients over twenty-two. The implants are already filled before the surgeon inserts them. However, it is often the more expensive choice.
• Saline, which is sterilized salt water, is used in implants for patients as young as eighteen. The saline solution fills the inside of a silicone shell to the patient’s desired volume during the procedure and is post-operatively adjustable. 

The ability to tweak the shape or size post-op makes saline an attractive option for reconstructive surgery. But, since these implants are primarily water, the shell can sometimes be seen rippling under thinner skin. Conversely, silicone flows like breast tissue — the molecules stick together, similarly to a gummy bear — creating a natural look and feel. For breast augmentations with implants in Beverly Hills, Dr. Barrett recommends silicone implants as they look and feel the most natural, and there is no rippling while staying in place. Unlike saline, which the body can safely absorb, silicone implant ruptures require surgical correction, can lead to capsular contracture, and may be linked to Breast Implant Illness. 

Are there specific brand options for implants? Is one better than the other?

There are two major implant manufacturers used for breast augmentation: Sientra and Mentor. You may hear them mentioned during your consultation with your surgeon. Both are FDA-approved, have a reputation for high customer satisfaction, and offer saline and silicone options in various shapes, sizes, and textures. Sientra boasts the lowest rapture rate amongst the competition with a specially formulated microtextured surface, while Mentor uses a unique MemoryGel® silicone that surgeons have chosen as one of the most natural-feeling implant choices. 

While both Sientra and Mentor are safe and reliable options, it all comes down to what feels suitable to the patient and what the doctor recommends to achieve the desired results. 

How do I determine my implant size? Should I have a goal cup size?

Finding the shape and size of implants is a considerably daunting choice since it dramatically impacts the body’s silhouette for years to come. Typically, patients come to their doctor with a particular look or goal, ranging from increasing size to changing their breast shape and projection. The ideal results vary from patient to patient, with body aesthetics being a deeply personal preference influenced by factors like social norms and surgery trends. 

Above all, it is important to choose an implant shape and size that is realistic to the patient's natural body proportions. Though having a general size goal is recommended, it’s best to work with individual measurements rather than a pre-determined cup size or implant CC number. Instead, the surgeon will use shoulder width, height, ribcage width, and similar measurements to narrow down the best dimensions for an implant. Disproportionately large implants not only lead to unnatural-looking results but can also increase the chance of surgical complications.

What are the different shape options?

There are two primary choices for breast implant shape: rounded or teardrop. 

• Rounded: For years, the standard implant shape was a simple, round capsule, leading to a spherical final result. This is still the most common choice, with round implants coming in varying projections depending on the patient’s surgery goals. The rounded shape of these implants gives the breasts fullness and improves the look of sagging.
• Shaped: The newer option for implants is the teardrop/shaped implant, which is shaped to mimic the natural anatomy of the breast, fuller on the bottom with a narrow top. This is the preference for those seeking a very natural look. Shaped implants are popular due to their durability compared to traditional silicone and saline gel implants. They may also reduce the risk of capsular contracture. 

What are the different textures of implants?

Aside from a difference in shape, teardrop implants differ from smooth implants in texture. Teardrop implants require a rigid textured surface to maintain their form, creating friction but reducing the chance of the implant moving around or rotating. Rounded implants have a smooth shell, leading to more natural movement and feel, allowing the implant to rotate without distorting the breast's appearance.

How will my doctor insert the implants? Are there different methods?

Once the best implant size, shape, and texture are selected, the surgeon will use a method based on the specific implant. Insertion methods vary further based on the placement and patient’s preferences. The three different surgical insertions are: 

• Transaxillary: inside the armpit
• Inframammary: beneath the breast
• Periareolar: around the areolar

Regardless of the incision technique, your surgeon will carefully perform each pocket dissection to avoid bleeding. Each pocket is irrigated three times with a triple antibiotic solution to help reduce the risk of capsular contracture. Next, the implant is placed into the breast pocket using a Keller funnel, proven to decrease incision size and the risk of capsular contracture significantly. Implants are placed in two locations: above (subglandular) or below the chest muscle (submuscular). 

Above-the-muscle insertion allows the option for future breastfeeding, and patients often experience less movement of their implants and less discomfort during healing. This technique can lead to an artificial look and may increase the chance of capsular contracture. Under-the-muscle placement leaves the implant partially under the pectoralis chest muscle. Patients tend to have more accurate mammograms and a more natural appearance with a decreased chance of capsular contracture. Periareolar insertion may happen above or below the muscle and involves reshaping the areola. 

After the surgeon places the implants, on-table sizing ensures the implants successfully achieve your goals and avoid any asymmetries. Incisions are then closed using a layered closure technique to minimize tension and decrease inflammation, ensuring minimal scarring and optimal healing.

If you’re interested in a breast augmentation with implants in Beverly Hills, Dr. Barrett Plastic Surgery offers consultations to determine if the procedure is correct for you. To learn more about Barrett Plastic Surgery, subscribe to our blog and follow us on social media at TikTok, Instagram, Realself, and YouTube for updates. Are you interested in fixing your capsular contracture? Call us at (310) 398-2648 or fill out this virtual consultation form, and we will contact you as soon as possible. We’re excited for you to take this next step!  

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