Several criteria are decisive when choosing a breast implant. In order to achieve the desired aesthetic result, the practitioner must take into consideration the choice of the positioning site and point of incision as well as the implant’s shape, volume, external texture (and therefore its adherence to the tissue), filler material and profile.
Implant shape: They can be anatomical or round. An anatomical implant has a shape close to the original shape of the breast. It is often chosen for its natural effect with a breast filled at the lower pole and slightly curved at the top, but the latest generation of moderately shaped round implants can give a similar effect. The round implant will be more suitable for patients with sagging breasts in order to fill in the volume at the top.
Choice of the positioning site: The position of the implant will depend on the patient’s morphology and thickness of the breast tissue. There are two main types of positioning:
Retropectoral: The implant is placed under the main pectoral muscle. The main advantage is that the implant is less visible, less palpable and the breast retains its natural appearance. There is also less risk of developing capsular contracture (or adhesive capsulitis) and mammograms are easier to perform.
However, the procedure for implant placement may be longer and more painful. Recovery is also more complicated. This type of intervention is more appropriate for patients with thin breast tissue.
Prepectoral: The implant is placed on top of the pectoral muscle and under the mammary gland. This procedure is faster, less painful, with a shorter recovery period. Due to the position of the implant, recovery is simpler.
On the other hand, however, the implant is more visible to the naked eye, the risk of capsular contracture is greater and mammographies are more difficult to perform. This procedure may be contraindicated if the breast tissue is too thin.
Choice of the point of incision: The point of incision can be periareolar, axillary or inframammary.
Periareolar: The incision around the nipple is relatively invisible but can lead to a loss of sensitivity and a risk of infection or breastfeeding problems.
Axillary: The incision under the armpit allows the surgeon to use less invasive instruments. The procedure will not affect the patient’s ability to breastfeed. On the other hand, since the procedure is more complicated, it can lead to the incorrect positioning of the implant or even alteration of it at the time of placement.
Inframammary: Access to the implant positioning area is greatly facilitated, but the scar on the sub-mammary fold is generally more visible.
Volume: A large volume implant does not necessarily guarantee very large breasts after surgery because the result depends in particular on other factors, such as the patient’s figure or morphology. The plastic surgeon is the only one who can determine the best implant volume to choose according to the patient’s wishes. The volume will also depend on the weight of the implant.
External texture and adherence to tissue: Breast implants can be smooth or textured. The adhesion of the implant to the surrounding tissue depends on the external texture, which prevents the risk of rotation of the prosthesis.
Filler material: There are two types of filler material for breast implants:
A silicone envelope filled with saline: the saline solution is radiolucent, making the implant more compatible with the screening and diagnosis of breast diseases.
A silicone envelope filled with silicone gel: silicone gel is more viscous and less liquid than saline, which allows the implant to remain stable and maintain its shape better.
Profile: This is the prominence towards the front of the implant with regard to the chest wall. There are different profiles available (low, moderate, moderate plus, high, ultra high).