For over fifty years since 1962, breast implants have been used to enhance female physiques and improve self-images. While there are many factors that contribute to a successful breast augmentation result, one of the major considerations is the implant itself. Long being the conceptually simple design of a containment bag (shell) with some form of liquid inside, the breast implant has undergone a long lineage of improvements to both of its two components.
Much attention over the years has focused on saline vs. silicone gel fill which is understandable as it obviously is responsible for the volume effect which is the primary goal of the surgery. But what holds it together in a shape is the containment bag which is just as important although less recognized as such. For the physical features of the bag is what gives an implant and the overlying breast to some degree its shape and dimensions.
The breast implant shell has two components, its surface quality and its shape. Both have undergone historic as well as more recent changes.
Initially, and still most commonly, implant shells were smooth and composed of a flexible but solid silicone elastomer. But the development of capsular contracture (scar thickening and hardening around the implant) in the early years of breast implant use led to the development of the concept of a textured surface. A textured surface means that there is an extra layer of material applied on top of the smooth shell to create irregularities, interstices or pores. This surface has been shown to result in less compact fibrous capsular tissue translating into a lower risk of capsular contracture. Studies have shown that the risk of capsular contracture is 3X lower with textured implants as opposed to smooth surface implants. It also improves stability within the breast pocket due to a less slick surface which engages the surrounding tissues more firmly.
But textured breast implants have traditionally been used in the U.S. as a treatment of an existing problem, most commonly capsular contracture, and not commonly as a first choice implant in elective breast augmentation. This is because textured implants will have a firmer consistency due to the thicker shell and may have edges that are easier to palpate if not placed under the muscle. They will also cost more than smooth implants. Therefore their use has been limited to the treatment of a problem rather than the prophylaxis of it
One of the more recent changes to the breast implant shell is its shape. While traditionally perceived of as round, new shell designs come in shaped or tear drop forms. Such shaped implants are only available in silicone and not saline fill. Shaped implants have a greater density of gel to support its contour and also increases the ability of the surgeon to control the shape of the breast. It is the potential shape of the breast that is most appealing to potential patients. By having a shaped breast implant, up to 2/3s of the volume is in the lower pole, avoiding the risk of having a very round looking breast augmentation result. While this look may be desired by some, many older women undergoing breast augmentation (greater than 40 years old) often want a more ‘natural’ breast look with less upper pole fullness.
But because a shaped implant must lie in the proper orientation to achieve its external shaping effect (and to avoid a breast shape deformity should it rotate), a textured surface is always used in shaped breast implants. The textured surface grips the surrounding tissues and allows the implant to remain how it was placed during surgery. Textured shaped breast implants are available in a variety of volume sizes and also has the option of a round, oval or oblong base shape to optimally fit one’s body type and chest shape.
Dr. Barry Eppley
Dr. Chris Ueno