What is the best breast implant?

THE mammoplasty of augmentation is today the most performed surgery among Brazilian plastic surgeons. In a recent survey by Datafolha, it surpassed liposuction, which for years was preferred among plastic surgeries. But after all, among so many options, what is the best breast implant?

This is an ever-recurring question in our office. Apparently a simple and straightforward question, its answer is quite complex. Let us now try to consider several factors that influence the choice of ideal breast implant.

the patient

We all know that each patient has a different biotype, weight, volume and breast shape. Also the expectation of size of the prosthesis varies a lot. This leads us to believe that a good prosthesis for one patient may not be ideal for another.

The type of prosthesis

The prosthesis can vary in shape: round or anatomical (“drop-shaped”). In projection: low profile, moderate, high. On the surface: smooth, textured or polyurethane. Contents: silicone gel or saline (saline solution).

the placement plan

The prosthesis can be placed under the mammary gland (subglandular), under the muscle (submuscular) or partly under the muscle and partly under the gland (dual plane).

The incision for placement or scar

Axillary, submammary, periareolar, umbilical. Ufa! There are many variables…

Trying to make it easier to understand, I will try to give some guidelines that apply in most cases. The most used prosthesis is the silicone gel. Modern gel is cohesive and does not spread if the prosthesis breaks (which is very rare in this type of prosthesis). the resistance of silicone gel prosthesis it is much bigger than saline, which breaks and loses volume more easily, as well as it can make noise if an air bubble gets inside it.

The consistency on palpation is also more natural. For this reason, it is almost never used saline prosthesis in Brazil. In the US they still use it because the silicone gel prosthesis was banned for a while (for no reason) and now that they have been released, American surgeons are still not familiar with silicone. Therefore, the umbilical scar is not common in Brazil, because to use it, the prosthesis must be saline, which is inflated after placement. It makes no sense to use a worse prosthesis just to put it through the belly button…

THE smooth prosthesis presents a higher degree of capsular contracture (commonly known by patients as “rejection”). Textured and polyurethane have less risk. This is the reason that the smooth prosthesis was practically abandoned. THE polyurethane prosthesis it is difficult to place, and therefore it is placed more through the submammary scar, which has better exposure and shorter distance to the place where it will be inserted.

THE round prosthesis projects the cervix more than the anatomical one. This on the one hand makes it more sexy, on the other hand it marks the breast more and can leave an artificial, very rounded look. This is more evident especially in thin patients, where the absence of a gland makes the prosthesis closer to the skin and more evident. For this reason, in patients with very small breasts and who like the round shape, the choice of plane is usually submuscular. The muscle in these cases partially hides the edge of the prosthesis, leaving the breast rounded and sexy, but without marking as much and thus more natural.

THE anatomical prosthesis, can be placed below the gland in these cases, as its anatomical shape keeps it looking more natural. Patients with small areola cannot use the periareolar route to place the prosthesis, as there would be no space for its introduction.

Aside from these general “guidelines”, there is still an infinity of variations and combinations between breast shape, prosthesis, placement plan and scar site. So, to really know what the best breast implant for each case, consultation with a surgeon Specialist by the Brazilian Society of Plastic Surgery is essential. Only by evaluating the biotype and weighing the preferences of each patient can the ideal prosthesis be safely chosen.