The New Ideal Breast Implant: Ideal for some...

The Ideal saline breast implant was developed to address some of the issues that saline implant have as compared to silicone implants.  These issues include the feel, the motion sensation, and the surface wrinkling of the implants.  My opinion is these issues are most concerning in the very small breast sizes (A cup or less) where the Ideal implants can improve results.  I am the first Plastic Surgeon in the Fort Wayne region and second in Indiana to offer the Ideal Implant.

I have been doing saline breast augmentation for over 20 years and my patients have been very happy with their results.  You will better understand the Ideal implants in the context of implant history and choices so I am outlining it here.  At the end, I will describe the Ideal implant more specifically and what patients they are "ideal" for.

Saline implants are filled with saline solution.  Saline is essentially salt solution (NaCl) that is isotonic, or has the same concentration as the body fluids.  (You are sitting there at about 80% saline solution).  Most saline implants have a one way valve on the surface that is opened by a special filler tube.  The implant can placed through a small 1 ¼ inch incision because the implant can be deflated, inserted into the dissected implant pocket, then inflated to the desired size.

Silicone is an inert substance that is found everywhere in our daily lives.  Depending how it is processed, it can be made into a liquid, a gel, or a solid.  The silicone implants of the 1960?s to the 1990s were of a runny consistency.  The new silicone implants are more gel like.  The implant companies have avoided the name "silicone" and call their implants words like "Gels" or "Gummies".  This is a result of the very negative press silicone implants got in the mid 1990's when patient's complained of illnesses like rheumatoid arthritis, lupus, scleroderma, fibromyalgia and other systemic autoimmune ailments.  The main implant company at the time, Dow Corning Wright, was sued in a class action and the FDA restricted their use for cosmetic augmentation pending further studies.  Since then, tens of thousands of patient's have been studied and none have shown any systemic illness associated with silicone implants.

Silicone implants come pre-filled and require a 3 or more inch incision to insert the implants safely without damage.  Silicone implants have less of a tendency to ripple on their surface than saline, which allow an over the muscle approach.  On the other hand, the highest risk of capsular contracture (too much scar formation around the implant) is with a silicone implant on top of the muscle.

It is felt that silicone implants have an advantage over saline with a softer feel and less of a tendency to have surface wrinkling.  For the most part, appearance of saline and silicone is the same.  It is very rare to have a patient complain of saline implants being too firm or the subtle wrinkling seen in the outer breasts in the very thin, small breast patient.  I used to offer silicone implants in these patients but now offer the Ideal implants in patients who benefit from them the most.

Saline implants are recommend in my practice in more than 95 percent of patient?s for the following reasons:

Breast size: Saline implants are filled during surgery and can be adjusted to be just right for a given patient.  This is particularly helpful for asymmetrical breasts so that different fill volumes can be placed.  Also, it is not uncommon for patients to wish they were bigger following surgery (especially those who where adamant that they didn't want to be too big).   This can be done in our office under local anesthesia and oral sedation ($2250 for our own breast augmentation patients, $2500 for patients from other practices).  The filler tube valve is located and the change in volume is made using the same small incision.  With silicone implants, once the box is opened, the implants are yours without any ability to change their size during or after surgery.  To change your size, new silicone implants would have to be used (about $1500 just for the implants, plus all the other surgical fees.)

Incision size: Saline implants can be deflated and placed through a smaller incision than silicone.  Silicone implant incisions need to be at least twice as long as the saline implant incision. There is increased risk of implant damage in silicone implants that are ?forced? through incisions the surgeon is trying to keep too small.

Implant failure: When a silicone implant ruptures, there is no easy way to tell as the silicone substance remains in the pocket within the breast.  Typically, a patient with silicone finds out there has been a rupture with symptoms of capsular contracture; a hard and often painful breast implant area.  Removing a ruptured silicone implant often involves having to remove the associated scar encapsulation, requiring a general anesthetic.  Until recently, the FDA mandated that all patients with silicone implants have MRI scans every 2 years to detect the "Silent Rupture".  To me, it is ridiculous for a cosmetic elective procedure would lead to an expensive MRI scan every other year typically used to detect severe medical illness.   When a saline implant ruptures, the patient knows because the saline is absorbed and the breast deflates.  A saline implant can be replaced in the office under local anesthesia and oral sedation in our practice.

Longevity: There is the notion out there that implants have to be replaced every 10 years.  This is false and based on studies that have shown that about 50% of patients have a procedure related to their breast augmentation in the first 10 years.  My rate is more like 5% and the most common reason being "I wish I were bigger".  I believe most of my saline implant patients will have these for life and certainly won't have any procedure just because 10 years have passed.  The new silicone implants have not been around long enough to be sure of their longevity but most recent rupture rates are of a concern.

The Ideal implant is a saline implant and have all the advantages I listed above.  There are some other advantages based on their design.  Their overall shape allows the implant to sit and hug the chest wall leading to less wrinkling along the sides.  They have two chambers and two fill valves on the back and the front of the implant.  The back chamber is like a saline implant and is filled to a certain amount. The front chamber has baffle membranes to prevent "slooshing" of the saline, much like a water bed design.  This chamber has a range of saline that can be placed so they are also adjustable like the typical saline implants.  The design also prevents wrinkling of the perimeter of the implant that might be seen in the very small breast patient (flat to A cup) on the outer and/or the lower breast surface in the naked state.  These wrinkles may also be palpable.  The Ideal implant gives a more natural feel than the saline implants approaching that of silicone implants.

In the B-cup or greater size breast augmentation, I will continue to recommend Mentor's Moderate Plus Profile Saline implants.  These patients have adequate soft tissue coverage of the implants where the issue of wrinkling and feel of the implant should be minimal.  For the flat to A-cup breast, I will offer the Ideal implant as an option for breast augmentation.

The cost for Ideal implants are in the range of silicone implants.  The Indiana Plastic Surgery Center offers typical saline implants at $4995 and Ideal saline implants at $5995.

All my best!