Breast Implants

Patients often ask what size breast implant they need relative to bra size (i.e. for a “C cup” or a “D cup”). Unfortunately, bra sizes are not standardized, so it is difficult to make this determination precisely. However, breast implants are measured in both volume and profile, or height, which represents how far the implant will project off the chest wall. As shown in the diagram, breast implants with the same volume but different profiles will have different base diameters. Dr. Zuckerman will guide you through several methods to help you determine a size implant that may best suit your body and surgical goals at your cosmetic consultation. His patients’ most commonly selected breast implant volume is approximately 350cc, but implants are available to Dr. Zuckerman in a variety of sizes from 200cc to 800cc.

Dr. Zuckerman takes great care to understand each patient’s desired breast size in detail before surgery. Patients seeking reoperation with Dr. Zuckerman often state that their prior surgeon did not fully understand their goals, lacked experience, or did not “listen” and therefore placed a breast implant of unsatisfactory size. Consequently, Dr. Zuckerman attempts to gain a full understanding of a patient’s preferences prior to surgery and views such as paramount to patient success. He brings multiple sets of breast implants to the operating room within a narrowly identified range of volumes options and uses a temporary sizer intraoperatively to decide which size to place with the patient’s preferences in mind.

Dr. Zuckerman also makes meticulous breast measurements at the cosmetic consultation including breast width, base diameter, notch to nipple distance, nipple to inframammary fold distance, and others. These allow him to make a precise recommendation of implant profile and base diameter. It is essential that the plastic surgeon place a breast implant of the appropriate base diameter to avoid the appearance of widening the distance between breasts, the cleavage, and for an overall aesthetically appealing result. A prior surgeon’s suboptimal implant base diameter or profile selection is a reason patients may seek reoperation with Dr. Zuckerman.

Traditionally, breast implants were filled with either silicone gel or saline surrounded by a thin shell made of silicone. Now, there exist a range of firmness options for silicone gel breast implants and a relatively new saline implant with a unique construction, which improves on some of the weaknesses of traditional saline implants. However, Dr. Zuckerman is able to achieve high-quality augmentation outcomes with either type of breast implant.

Silicone Breast Implants

Silicone breast implants are significantly more popular than saline nationwide. Benefits of silicone implants include:

• They are softer than saline and have a more natural feel.
• They are pre-filled by the manufacturer, so there is no risk of filling asymmetry or leakage during placement.
• Silicone breast implants have a lower risk of implant wrinkles and rippling, which can be visible externally with saline implants. (For this reason, Dr. Zuckerman recommends silicone if a patient is exceptionally thin with little natural breast tissue.)
• Silicone is advantageous if undergoing breast reconstruction.

Other aspects of silicone breast implants to consider are:

• Silicone breast implants are FDA-approved for use in patients 22+ versus 18+ for saline.
• Silicone is slightly more expensive than saline implants.
• Breast implant rupture or leakage must be detected via MRI.

Silicone Breast Implant Leaks Are A Rare, Non-Toxic Event

Leak or rupture of a silicone breast implant is a very low probability event. However, when either a silicone or saline breast implant is placed into the body, fibrous tissue known as a capsule forms around it. Most often, leaks or ruptures are contained within the capsule. It is possible for this capsule to then become inflamed causing the patient pain, swelling, soreness, or changes in breast firmness. In this case, a patient would possibly need to have the implant replaced. Leaks or rupture can be detected via an MRI scan. However, neither saline nor silicone breast implants are intended to be lifetime devices and may need replacement later in life.

In the very rare case that the silicone gel from an implant escapes the fibrous capsule, which would require a blunt force trauma to the chest of similar intensity to a car accident without a seatbelt, the silicone gel has been shown to be biologically inert. It has been shown not to increase the risk of breast cancer and not to increase the risk of autoimmune disease. And, it does not leach out into breast milk while breastfeeding.

Saline Breast Implants

If a patient is interested in saline breast implants, Dr. Zuckerman discusses the aspects below:

• Saline implant rupture or leakage is easily absorbed by the body.
• They are FDA-approved for use in patients 18+ versus 22+ for silicone.
• They are slightly less expensive than silicone implants.
• Saline implants can be inserted via a smaller incision, because they are inserted rolled and filled with saline by the plastic surgeon while inside the breast pocket.
• Saline implants are often easier to replace upon rupture, a rare event.

However, some of the drawbacks of saline breast implants include:

• Saline breast implants are typically more firm and have a less natural feel.
• There is a risk of visible saline implant wrinkles and rippling.
• There is a higher risk of rupture or leakage than with silicone implants due to inherent structural weakness around the fill port of saline implants.
• Implant deflation or leakage can be visible.
• Saline breast implants require filling by the surgeon intraoperatively.

Cohesive Silicone Gel Breast Implant (Gummy Breast Implants or Gummy Bear Implants)

Since 2013, the FDA has approved a more cohesive type of silicone gel breast implant. Also known as form stable breast implants, the major manufacturers now offer varying cohesiveness options in their silicone implants. The benefit of these implants is that upon a leak, the gel acts more like a solid and will remain in place instead of leaking out of the implant. However, as noted above, this is a rare and non-toxic event, and even upon leakage the silicone gel would likely be contained by the scar capsule around the breast implant. In addition, this more cohesive gel also minimizes subtle changes in implant shape and can help maintain upper pole breast fullness. However, cohesiveness translates to firmness, and Dr. Zuckerman finds that the most cohesive gel options are too firm for many patients.

Allergan, the makers of Botox, offer a line of implants with three different firmness options as seen at in the picture. Dr. Zuckerman most often uses the softest implant, the Natrelle Inspira Responsive, but also commonly employs the Natrelle Inspira SoftTouch implants. He has used the firmest implant, the Natrelle Inspira Cohesive, for patients who specifically desire breasts with a firmer, but natural, feel.

Note: “Gummy bear implants” may also be used to mean shaped, or anatomical, implants as described below. These shaped implants are filled with a more cohesive gel to maintain their shape, but cohesive gel implants are available in both round and anatomically shaped breast implants.

Ideal Implants: A New, Structured Saline Breast Implant

Dr. Zuckerman is one of only a few hundred plastic surgeons nationwide and in New York City who are able to use the newer Ideal Breast Implants. Approved by the FDA in 2015, Ideal Structured Breast Implants are filled with saline but have a more complex structure consisting of multiple shells. This design helps avoid excess movement of the saline filling, which is otherwise a drawback of traditional saline breast implants. Ideal Implants are made to behave similarly to silicone gel implants without the possibility of silent failure.

As you can see in the picture, Ideal saline breast implants maintain their shape more than a typical saline implant but still somewhat less than silicone. Ideal implants are more expensive than most other silicone and saline breast implants and add operative time, because they require filling from two different ports during surgery. The differences are relatively subtle, but Dr. Zuckerman recommends these implants for those who wish to avoid silicone and want more natural movement and structure than traditional saline.

Dr. Zuckerman’s Recommendation for Your Breast Implants

If you do not have a breast implant preference, Dr. Zuckerman generally recommends that patients select silicone breast implants, because they have the most natural feel and lowest incidence of wrinkles and rippling. However, saline breast implants are less expensive and are approved for younger patients. Saline implants may be a good option for those who wish to avoid silicone. In addition, for those with significant natural breast tissue, a well-performed augmentation using saline breast implants will be virtually indistinguishable from that with silicone.

Both kinds of implants are FDA-approved, and both are made by three of four major breast implant manufacturers. Dr. Zuckerman is happy to perform your surgery with either type after discussing your goals.

Round versus Shaped Breast Implants (Anatomical)

Round breast implants are used in the majority of augmentations, and Dr. Zuckerman also recommends that most patients select round. However, shaped, or anatomical implants, were first introduced by Natrelle (Allergan) to help avoid an overly augmented appearance, which may be characterized by more upper pole breast fullness than a natural breast. Shaped, or tear-drop, implants partially ameliorate this issue, because they have less volume at the top of the implant. These implants may be a good option for those patients with little natural breast tissue, where added upper pole fullness from a round breast implant would be excessive. However, a natural-looking result is easily achievable with a round silicone implant in Dr. Zuckerman’s hands for most patients. Anatomical implants are typically filled with a more cohesive silicone gel to avoid changes in shape, which gives them a firmer feel.

Both round and anatomical breast implants are FDA-approved, and both are made by three of the four major breast implant manufacturers. Dr. Zuckerman will make a recommendation to you based on your existing anatomy, but most patients select smooth round implants for their surgery. However, Dr. Zuckerman is happy to perform your procedure with the implant style of your choice.

Smooth versus Textured Breast Implants

Breast implants are also available with either a smooth or textured surface. Under magnification, a textured breast implant will appear rough, similar to sandpaper. It is thought that the textured surface helps anchor the breast implant in place to prevent movement within the breast pocket and may possibly lower the risk of capsular contracture. As a result, textured implants are more commonly used in breast revision surgery. Round implants are available in both smooth and textured form, but shaped breast implants are all textured. This is due to the fact that movement of an anatomical implant is a more significant problem because of its asymmetric shape.

Textured implants do have an association with a rare type of cancer known as Anaplastic large-cell lymphoma (ALCL). This cancer is extremely rare, but medical research is ongoing. Dr. Zuckerman urges prospective patients to consider the relative weight of this risk, but he may also recommend selecting a smooth breast implant.

There are three large breast implant manufacturers: Mentor, Natrelle, and Sientra. Each of these produces silicone and saline breast implants over a range of different sizes. A fourth newer entrant, Ideal Implants only produces their structured saline implant. Each manufacturer’s products went through the strenuous approval process with the FDA and are extremely safe. Some manufacturers such as Sientra demonstrate their commitment to ethics and quality by only selling to board-certified or board-eligible plastic surgeons such as Dr. Zuckerman.

Dr. Zuckerman tends to use Natrelle or Mentor implants in most cases but can perform your procedure with the implant of your choice. Natrelle were the initial creators of anatomically shaped implants, so if you are interested in that shape, Dr. Zuckerman will generally recommend their product. Dr. Zuckerman will be happy to discuss your preference at your cosmetic consultation.

Below are the answers to some questions Dr. Zuckerman most frequently receives from prospective patients regarding breast implants. If you don’t see your question below, feel free to contact Dr. Zuckerman’s office, and a member of his staff will be glad to reach out to you.

What size breast implant will get me a C cup? A D cup?

Unfortunately, bra sizes are not standardized, so it is not possible to say what size implant may achieve a certain bra cup size. However, at your consultation, Dr. Zuckerman can give you an estimate based on existing breast tissue. The most common implant size Dr. Zuckerman uses is around 350cc. Most patients desire a “full C cup or small D cup”.

Can you place two different size breast implants if my breasts are different sizes?

Yes, it is fairly common for Dr. Zuckerman to place two different size implants to correct breast asymmetry. However, he generally does not place a single breast implant on one side, because the appearance and shape of the breasts would differ significantly.

Are you ready for your cosmetic surgery consultation with Dr. Zuckerman? He will perform a thorough evaluation of your desired outcome and needs based on your anatomy and medical history. Dr. Zuckerman will also address any questions or concerns you may have about the surgery and discuss with you the details of his approach: incision location(s), procedure length and techniques, likely operative outcome, etc.

Contact his office by clicking the button below or by calling (212) 231-9897. Dr. Zuckerman also offers consultations via Skype and a process for out-of-town patients to visit New York City to have surgery with him.