Breast Implant Manufacturers
The two manufacturers of FDA approved breast implants are Mentor and Natrelle (Allergan, Inc.). Both manufacturers market both saline and silicone-filled breast implants.  Although there are many variations based upon these two choices, below we will discuss the options available to you.  Variations we have outlined include surface, shape, profile and size.  We will also discuss cohesive silicone breast implants which are available in varying degrees of firmness and profiles offered via a clinical study

• Natrelle, made by Allergan, Inc. was formerly Inamed and before that it was known as McGhan.   
• Mentor Corporation

Other Breast Implant Manufacturers

• Silimed, Inc. (Sientra)
• Poly Implant Prosthese (PIP) of France:  PIP implants were recalled due to increased chance of rupture and higher than normal localized inflammation.  It was also discovered that an unauthorized silicone gel was being used as the filler. 

More About Breast Implant Fillers

• Saline-Filled Breast Implants: Saline, or a sterile form of salt water, is the most common option chosen for a filler material.    A saline implant is thought by some to be less natural feeling, and can be either made to feel softer (with possible wrinkling and folding of the implant shell which, in time, can cause shell weakness and failure) or firmer with a method called overfilling.  Overfilling (filling past the manufacturer's volume recommendation) can cause a firmer feel to the implant but can assist in less wear and tear.  However too much overfilling can cause scalloping of the implant edges.  Speak to your surgeon about what he or she prefers and why.  In the event of a rupture, saline is absorbed by your body with ill-effects as long as it was sterile when placed  in the implant during your surgery. In a saline-filled implant rupture, many times the rupture is apparent within a few hours to a few days.
• Silicone-Filled Breast Implants: Although silicone-filled implants were once available to everyone, in 1992 they removed from the general market.  For many years, silicone-filled breast implants were only available to patients in a clinical study.  In 2006, the moratorium on silicone-filled breast implants was lifted and were made available to patients were were 22 years of age or older.  Silicone-filled implants are thought by some to feel and look more natural, although in the event of a rupture silicone can empty into the capsule, called an intracapsular rupture.  In this case, removal of the silicone is easier than if the rupture is extracapsular.  An extracapsular rupture occurs when the tissue capsule is breached and silicone can empty into the body cavity. Silicone-filled implant ruptures may take weeks to years to become apparent.  Silicone implants are also more expensive and require a larger incision than saline implants. 
  • Cohesive Silicone-Filled Breast Implants: By definition, to be cohesive a material binds together to create a firmer consistency.   Technically silicone gel is cohesive as compared to silicone oil.  However, when related to breast implants, cohesive silicone is use to describe a Silicone-filled breast Implant which retains its shape in any position.  You may have heard it called the Gummy Bear Breast Implant, or Gummies.  This implant filler type is manufactured by Allergan (under their Natrelle 410 brand), Mentor, under their Mentor CPG brand and Silimed, Inc.  The cohesive form of silicone is more crosslinked than the standard gel available in FDA approved breast implants.  The cohesive silicone-filled implants only come in an anatomical shape for patients in the United States, although they are available in Europe in a round shape (we will only discuss products available in the U.S. at this time).  Silimed's cohesive implant clinical trial includes 4 round implants, Since these implants are anatomical, they only come in textured surfaces.  In the event of a rupture, cohesive silicone breast implants would not lose their contents, except for small amounts of lower molecular silicone oils within the gel which were not crosslinked.  This gel bleed should be very nominal and may only be detected in mammograms, or if the gel bleed causes a hardening of the natural capsule due to increased inflammation. The three clinical trials of cohesive silicone-filled implants are with the aforementioned manufactures and all patient enrollment is now complete.
• Soya Oil:  This implant-filler is no longer available and is not recommended.  The oil was known to turn rancid and cause injections in the event there was a rupture.  If you still have Soya-filled breast implants you should speak to a board certified plastic surgeon about possible removal.
• Hydrogel:  Although Hydrogel simply implies a gel which is made primarily of water.  It may be used to describe hyaluronic acid (below) or a substance made from polyacrylamide.  The safety and efficacy of large amounts pf polyacrylamide have not been proven definitively.
• Hyaluronic Acid: You may have heard of the namebrand, Restylane or Perlane (Allergan) injectable fillers. These products are made from a non-animal hyaluronic acid.  However, this substance is currently not cost-effective to fill breast implant shells with for augmentation purposes.

Breast Implant Surfaces
There are two types of surfaces available on either fill type implant.  Textured and Smooth.  Each has its advantages and disadvantages.  The original reason behind experimenting with implant surface textures, or lack thereof, is the prevention is Capsular Contracture.  All breast implants will normally be enveloped by a soft capsule of collagen which is your body's natural way of walling off a foreign material from the rest of the body.  Under normal circumstances, this capsule remains soft and pliable.  When your body finds the foreign material too much of an inflammation, or when there was blood introduced to the pocket during the surgery, or bacteria is introduced either during the surgery or afterwards (anaerobic bacteria), for instance after major dental work or another type of infection, this capsule may thicken and harden.

• Smooth Implants: Smooth surface breast implants are more commonly used than textured surface implants.  Doctors feel that since there is no conclusive evidence pointing to textured implants hindering the formation of Capsular Contracture, smooth implants have become a preference.  Many surgeons believe that implanting the prosthesis under the pectoral muscle is more effective in preventing CC than using a textured breast implant.
• Textured Implants:  Surface texture is thought to dissuade collagen from adhering to the surface of the breast implant in a uniform matter, thereby creating weaker areas in the capsule which may hinder it from hardening completely.  Although the intention was to hinder Capsular Contracture, studies have shown no real reduction in the amount of cases of CC.  Another reason for the textured surface may be to keep breast implants in place and prevent them from flipping in the pocket.  This was more geared towards anatomical (or teardrop) shaped breast implants.  Textured implants have thicker shells than smooth implants to compensate for the irregularities in the implant shell.  For this reason, textured implants may be more palpable, or more easily felt and seen. 

Breast Implant Shapes
There are two general shapes of a breast implant, round, or anatomical (also called teardrop, or contoured).  Although many surgeons feel that when a breast implant is placed under the pectoralis muscle, the end aesthetic result is essentially the same.  However, the introduction of Cohesive Silicone Breast Implants has changed this general thinking do to the cohesiveness of the breast implant filler retaining its shape no matter the pressure of the pectoralis.

• Round: Round shaped breast implants are the most common chosen by patients and their surgeons.  Although in theory, anatomical breast implants are meant to look more natural, round breast implants tend to settle in a sloped shape when standing, and settle towards the armpits as a natural breast does, when a woman lies down.
• Anatomical (teardrop, contoured): Anatomical breast implants were designed to maintain a natural slope of an unaugmented breast.  Anatomical breast implants have a textured surface to keep the implant from flipping in the pocket.  As mentioned before, when placed under the pectoralis, the aesthetic result is usually the same.

Breast Implant Profiles
Implant profile defines the projection of the breast implant from the chest wall.  Originally there was really only one profile, moderate, which was the middle of the road.  Today there are low, moderate, Moderate Plus (Mentor only), and high profile implants available.   When there was only one profile available, when a petite woman chose a larger breast implant, it was often too wide for her ribcage.  This also required more dissection of the tissues which could create its only problems such as Symmastia (or Breadloafing) and even Bottoming Out..  The opposite was also true for women who wanted small breast implants but had a wider ribcagse.  A small breast implant would result in what looked like tennis balls for breasts.  The same woman can get a higher volume implant in a low profile and be matched perfectly with her frame and the amount of projection s she wishes.  These profiles allow whatever implant width a woman needs to match or complement her own ribcage size.

• Low Profile: The low profile provides a wider base, without s much anterior (forward) projection as the below profiles.
• Moderate Profile: The moderate profile allows for a full, round breast appearance. But may not be suitable for petite women.
• Moderate Plus (Only by Mentor): Mentor provides patients with an option that is right in the middle of Moderate and High Profile choices.  More options, means more customization to better suit your personal needs.
• High Profile: High Profile Implants produce more anterior (forward) projection and also have less wrinkling than the other profiles. This is a good choice for women who have narrower ribcages.  A smaller woman can get a larger volume without the implant being too wide at the base. 

Breast Implant Sizes
One of the more common complaints of breast augmentation patients post-operatively is size.  Many patients wish they had gone either smaller or larger, most wishing they had gone larger. Volume ranges anywhere (with the average smooth, round breast implant) from 120cc to 850 cc with room for overfilling.  Although remember, overfilling can crate more firmness.

Although size may be the most difficult chose involving your breast augmentation procedure, your surgeon can best help you decide what is best for your body and desires.  Although you may have heard of using the rice test (1 cc of raw rice equals 1 cc (or ml) of filler) in helping you decide on a volume, the way your breast implant lies under your tissues will look smaller than bags of rice or sizers placed in a bra.  However, in the end, the experience of your plastic surgeon is your best bet for satisfaction.

For your convenience, we have provided you with the manufacturers' available breast implant sizes.

• Manufacturer Dimensions & Specifications

Alternative or New Breast Implant Types

• IDEAL Implant: The ideal implant is made from the same elastomer as other breast implant shells, and filled with the same saline as other saline-filled breast implants. However it is the inner structure that makes it unique.  The IDEAL implant has a standard elastomer shell which contains several additional elastomer shells with varying perforations.  This structure allows gradual movement of the saline which is said to create a more natural shape, movement and little to no palpable implant edges.  The IDEAL implant was available through clinical trials only to 500 women, 400 for primary breast augmentation surgery, and 100 for revision breast augmentation to replace a patent's saline or silicone-filled breast implants.  Patient enrollment is now complete.

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