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Michael Law MD Aesthetic Plastic Surgery

Why Ideal Implants?

Prior to 2015, women considering breast augmentation had two choices of implant type: cohesive silicone gel breast implants and conventional saline implants. Both cohesive silicone gel implants and conventional saline implants consist of a single, solid-but-flexible silicone elastomer shell which is filled with either silicone gel or saline. Silicone gel implants are prefilled and are therefore of fixed volume, while conventional saline implants are shipped filled with air and then are filled intraoperatively with sterile saline solution; the fill volume of saline implants can vary within a range recommended by the manufacturer. There are significant pros and cons with both types of implants, and the Ideal Implant is essentially an attempt to create a ‘happy medium’ between the two.

Silicone Gel Implants: Pros and Cons

One great advantage of silicone gel implants is their very life-like feel. Cohesive silicone gel implants so closely simulate the feel of natural breast tissue that many of my patients report to me at their six-month or twelve-month postop appointment that they tend to forget that they have breast implants. Their augmented breasts feel like a natural part of their body. The major downside of silicone gel implants, however, is that the implant shell status, i.e. whether or not the implant shell is intact or has ruptured, is usually not apparent to the patient. In most cases the breast does not look or feel any different following failure of a silicone gel implant shell.

Because silicone gel implant shell failure is usually not detectible by the patient, the only way to detect shell failure over time is by means of a radiologic study which can clearly image the implant shell. Currently the recommended test for silicone gel implant failure is an MRI scan (eventually it will likely be high-definition ultrasound). MRI scanning is widely available, easily performed and does not require the administration of an intravenous contrast agent as is done for breast MRIs that are designed to detect or rule out breast cancer. The cost of a breast implant MRI, however, is significant, ranging from $1,000 to $2,000 depending on where the study is performed. And imaging procedures for breast implant surveillance are not covered by most health insurance policies.

Conventional (single-chamber) Saline Implants: Pros and Cons

Until recently the only alternative to cohesive silicone get implants has been conventional, single-chamber saline implants, which gradually have become much less popular with breast augmentation patients since the FDA approval of cohesive silicone gel implants in 2006. The shell of saline implants is more easily palpable and the feel of conventional saline implants is not nearly as ‘breast-like’ as cohesive silicone gel implants. So small breasts (preop A to B) augmented with saline implants do not feel nearly as natural as small breasts augmented with cohesive silicone gel implants.

There are two significant potential advantages, however, to saline implants. First, the implant status is always obvious. If the shell of the saline implant fails, the implant deflates almost immediately. When the saline within the implant leaks out it is immediately absorbed by the body, so a patient knows right away that their implant is no longer intact. The second advantage is that for the minority of breast augmentation patients who still have concerns about the safety of silicone gel breast implants, or for patients who do not like the prospect of wondering about whether or not their silicone gel implants are intact, the choice of saline implants completely eliminates those potential sources of anxiety.

I think it is also important for prospective patients to know that in some patients with a fuller breast volume preoperatively – those with a full B volume and essentially all patients who preoperatively wear a C cup bra, conventional (single-chamber) saline implants can feel very natural. The more natural breast tissue and subcutaneous fat you have to conceal the implant, the more natural the augmented breast will feel. I have many conventional saline implant augmentation patients in whom the augmented breast feels very natural to the patient and their partner, and the implants are as difficult to detect by palpation as silicone gel implants.

The Ideal Implant Option

So if you choose silicone gel breast implants, you have the distinct advantage of a very natural-feeling breast which will still appear augmented if the implant fails, but the disadvantage of needing an MRI scan if you are interested in knowing whether or not your implants have ruptured. If you choose saline implants, then you have the significant advantage of always knowing the status of your implants, but the disadvantage of having implants that feel, at least in most patients with small starting breast volumes (A or B), a much less natural-feeling breast augmentation result. And if your saline implant shell fails, within a few hours you will have a breast augmentation on one side only – and the sudden need for a trip to the operating room to remove and replace it.

The Ideal Implant was designed and developed by board certified plastic surgeon Dr. Robert Hamas, who was interested in developing a breast implant that provided a ‘happy medium’ between silicone gel breast implants and conventional single-chamber saline breast implants. The Ideal Implant is the result of a long research and development process, and the product that Dr. Hamas and his associates determined to be “Ideal” is a two-chamber implant with multiple sheets of solid silicone elastomer (the same material that the shell is made of) between the inner and outer chambers.

The inner saline chamber is the larger of the two, and there are several solid silicone elastomer baffles (sheets of the silicone shell material) between the larger inner chamber and the smaller outer chamber. Instead of having one fill port as with conventional, single-chamber saline implants, there is an anterior fill port for the smaller outer chamber and a posterior fill port for the larger inner chamber. As with conventional saline implants, the structured Ideal implant is inserted deflated with one fill tubing attached to the outer chamber and another fill tubing attached to the inner chamber. Both chambers are filled once the implant is in place.

When a completely new implant option for breast augmentation becomes available, an important question to ask is: ‘How does this new implant perform over time?’ In the most recent data published on the initial clinical trial of the Ideal Implant, a capsular contracture rate was observed that is actually lower than the rate reported in most studies for silicone gel and saline implants. Additionally, an implant deflation rate was observed that is lower than the rate that has been reported in most studies for conventional, single lumen saline implants, and lower than the rupture rates reported for silicone gel implants. So the Ideal implant appears to be a very attractive implant selection based on long-term outcome criteria.

Is the Ideal Implant the Best Choice for You?

By creating a structured saline implant with two separate chambers and internal “baffles” between the two chambers, Dr. Hamas and colleagues have been able to produce a saline-filled device that feels less like a traditional saline implant and more like a silicone gel implant. If you are prospective breast augmentation patient and your preference is to not have an implanted device that requires an MRI scan in order to determine its status, but you prefer an implant that feels more natural than a conventional single lumen saline implant, the Ideal implant is probably the ideal choice for you.

There is one major caveat at this point in time regarding the Ideal implant: it is only available as a high-profile device. The Ideal implant is similar in base diameter and projection to high-profile implants available from the other three FDA-approved implant manufacturers. So the Ideal implant is a reasonable choice only for patients who are well-served by a high-profile device. Many patients are best served by a moderate or moderate plus implant profile, and a handful are best served by a low or low-plus profile implant, and for those patients the Ideal Implant is not an appropriate choice.

All of our Ideal Implant patients have been extremely pleased with the results of their breast augmentation surgery, and I have been quite pleased with the performance of the Ideal implant as well. There will be an inherent limitation on the overall usefulness of the Ideal Implant in my practice, however, until it is available in a wider range of profiles.

Be sure to ask any surgeon that you are considering for your breast augmentation procedure which implant companies they work with and why. If the practice works with all four implant companies, you have the best chance of finding the implant fit that is perfect for you. As I say to all the patients I see who are considering breast augmentation surgery: There is no perfect breast implant. There are, fortunately, lots of implant options and each option has its own particular pros and cons. It is really a matter of figuring out, with the help of an experienced, board-certified plastic surgeon, which particular implant in which particular profile is the best fit your individual needs.

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