Breast augmentation continues to be the most popular and frequently performed aesthetic surgery and has been since 2006, according to the American Society of Plastic Surgeons (ASPS). In 2016, more than 290,000 breast augmentation procedures were performed in the United States (1). These statistics issued in the 2016 Plastic Surgery Statistics Report reflect a 37% growth relative to the number of breast augmentation surgeries reported in 2000. Similarly, in Texas, breast enhancement surgery is the top cosmetic surgical procedure and has a long and successful track record in satisfying women who wish to enhance, regain or restore balance to their figures. Most of the consistently popularity of breast augmentation is due to the technological innovations and improvements in procedural techniques, which resulted in the myriad of options available nowadays to women looking to add volume to their chest. My work is based on the philosophy that every patient is unique. Therefore, depending on their medical history, body shape and aesthetic goals, there are three main choices I typically discuss with my patients: Silicone implants, saline implants, and autologous fat transfer.
In 2016, silicone implants were used in 84% of all breast augmentations in America, as stated by the ASPS, and are the leading option among my patients. There are two principal categories of silicone implants: silicone gel-filled breast implants, and cohesive gel silicone gel-filled breast implants. The traditional silicone gel-filled breast implants are filled with soft, elastic gel and are available in a wide range of shapes, sizes and profiles, making them quite appealing and convenient to many of my patients. However, an alternative classification of silicone implants are filled with a cohesive gel made of cross-linked molecules of silicone, which makes them thicker and firmer than traditional silicone implants. These innovative prosthetic implants are denominated cohesive gel silicone-gel filled breast implants, and are commonly known as “gummy bear” implants. Although more costly than their conventional counterparts, women tend to like gummy bear implants due to their tendency to have a superior natural look and feel and because the risks of complications, like capsular contracture and gel migration in the case of implant rupture, are considerable reduced. One downside to consider while choosing breast implants is that all silicone-gel prosthesis are pre-filled and may require a longer incision for implant placement (2).
Saline-filled implants rank second in popularity among women who opt for a breast enhancing procedure. In 2016, saline implants were used in 16% of all breast augmentation procedures performed in the U.S. Saline prosthesis may be sub-divided in two main categories. The first group, traditional saline-filled breast implants, are filled with sterile salt water. They may be prefilled at a predetermined size, or filled at the time of surgery to allow for minor modifications. The second classification of saline implants are the fairly new FDA-approved structured saline-filled breast implants, available in the U.S since 2015. These implants are also filled with sterile water, but contain a structure inside so they behave as if filled with soft, elastic silicone gel. This structure enables them to hold their shape better than traditional saline implants. Although saline-filled implants are not as popular as their silicone competitors, the former appeal to certain women due to the faculty to customize the sizing on a fairly pinpointed scale. Furthermore, in the case of a potential implant shell rupture, saline breast implants wouldn’t pose a risk as significant as silicone-gel implants, since they would release only salt water into the patient’s body.
Autologous Fat Transfer (AFT) is another option available for women who desire to improve the appearance of their breast. This procedure, also known as fat grafting, removes fat through liposuction from an specific area of your body in which there are abundant fat cells, such as thighs, abs and hips. After a process of purification, the autologous fat cells (from your own body) are injected into your breast. This breast enhancing procedure can be used independent from implants to achieve a small volume increase (about one bigger cup size), or combined with implants to accomplish a considerable augmentation in your breast size. While AFT procedures do not pose a risk of allergic reactions to foreign substances as both silicone and saline implants do, fat grafting is still undergoing clinical studies and research for safety and effectiveness (3).
“Plastic Surgery Statistics Report 2016”. American Society of Plastic Surgeons. www.plasticsurgery.org
“Types of Breast Implants”. American Society of Plastic Surgeons. www.plasticsurgery.org
“Breast Implant Complications”. U.S Food and Drug Administration. www.accessdata.fda.gov