Marina del Rey
Dr. David Stoker
4640 Admiralty Way #1000
Marina del Rey, CA 90292
Patients considering breast implants in Los Angeles now have more breast implant options than ever before. Two brands of silicone gel implants received FDA approval in 2006 after more than a decade of careful clinical studies. Saline implants, which I now use less commonly, are still a smart choice for some. There are now far more implant styles, sizes, shapes and textures available to accommodate the needs of every breast augmentation patient.
The two main categories of breast implants are silicone gel or saline-filled implants. Silicone gel implants have been popular since the early 1960's, and they have gone through multiple generations of improvements since that time. From 1992 to 2006, the FDA restricted the use of gel implants while carefully controlled studies were performed to confirm their safety. The extensive studies demonstrated that the silicone gel implants are safe, and the FDA has now approved the implants for use in patients age 22 years and older.
The main advantage of silicone implants is that they feel more natural than saline implants. Gel implants are less prone to rippling than saline, which makes them particularly advantageous for thin patients. The current generation of silicone implants is cohesive, meaning that the gel is viscous enough that even if the implant ruptures the gel tends to remain in the same place. The cohesive gel implants are an important advance in implant technology.
I am one of several surgeons in Southern California conducting a clinical trial on a new generation of cohesive gel implants. The gel is firmer than the current FDA-approved options. In theory, the implants may be even less likely to ripple or rupture. This newest generation of implant is most popular outside of the United States. In the U.S. we will await the FDA ruling on the current clinical trial to determine if the implants will become widely available. Participants in the clinical trial must be at least 18 years of age. Other restrictions apply as well.
Saline implants have a long record of safety and are less expensive than silicone gel implants. Because they are placed when they are empty and filled once they are inside the breast pocket, the access incisions may be even smaller. When a saline implant leaks, most of the saline from the implant is rapidly and harmlessly absorbed by the body. The deflation is usually obvious, and the patient returns for removal and replacement of the saline implant. This may be done under local anesthesia if the patient is an appropriate candidate. The primary disadvantage of saline implants is that they don't look or feel as natural as the silicone gel implants. This is a particularly important issue for women who are thin or have decreased elasticity of their skin.
Breast implants come in a large variety of sizes and shapes. In choosing an implant shape, it's important to understand that the implants look different when they are placed behind a breast than when they are sitting on a shelf. Round implants, for instance, take on a more anatomical shape when they are placed under the muscle. The pectoralis major muscle compresses the upper portion of the implant, creating a teardrop shape. Gravity has a similar effect on the implant when the patient is in the standing position. I believe round implants under the muscle are the best option for most patients.
Anatomical implants may have some advantages in select cases. In theory, because the implant has the shape of an ideal breast, it should give the most natural result. In practice, however, there are many other variables that affect the final outcome of the surgery. It is uncommon for the anatomical implants to appear more natural than round implants, in my experience. The anatomical implants also require an incision underneath the breast for appropriate positioning, and this limits incision options for patients choosing these implants. There's a small chance that the anatomical shaped implant may rotate, creating an unnatural bulge that may require the implant to be repositioned with another operation. Round implants do not have that disadvantage.