Breast Implants

There are many different types of breast implants available in Denver, Colorado, and throughout the U.S., and they all come in various sizes and shapes. With all the variations, the choice can seem daunting, yet choosing the right implant is one of the most important predictors of a successful outcome after augmentation surgery. After all, a poorly chosen implant, even if expertly placed, will result in a disappointed patient. All implants have advantages and disadvantages, and no one implant is right for every patient.  

That’s why a personalized consultation with one of our board-certified plastic surgeons is essential. During this process, your surgeon will consider your body type, aesthetic goals, and lifestyle to recommend an implant that best suits your needs. Factors like implant material, surface texture, profile, and placement will be carefully evaluated to ensure the result not only meets but exceeds your expectations. 

For many breast augmentation patients, the key to achieving a natural look and feel lies in selecting an implant that harmonizes with their natural proportions. This is where expertise and attention to detail truly make a difference. By discussing your preferences and concerns openly with your surgeon, you can make an informed decision and embark on your transformation journey with confidence. 

Breast Implant History

To understand where we are now, it is worth briefly reviewing the history of breast implants in the United States. 

The first breast implants were invented in the early 1960s by Drs. Cronin and Gerow, who worked with Dow Corning to create the devices. They were broadly adopted through the 70s and 80s, and improvements in shell and gel technology were seen during that time. In the late 80s, questions started to surface regarding potential health risks regarding these implants, in particular a potential association between silicone and autoimmune disorders. These concerns culminated in a partial U.S. moratorium on silicone breast implants in 1992, restricting their use to reconstructive applications. The manufacturers were forced to prove the safety of their implants with new FDA studies. In 2006, after extensive research documenting their safety (and showing a lack of connection between silicone and any systemic illness), silicone implants were released back into the U.S. market for all cosmetic and reconstructive purposes.  

In the years since their reintroduction, silicone implants have evolved significantly. One of the more significant changes has been in gel technology. Early implants had a minimally cohesive gel that was more liquid than solid. Although they behaved better than saline, they were more prone to rippling and upper pole collapse. Manufacturers responded to these challenges by creating more cohesive “gummy” implants. Initially, these modern gel devices were only produced as anatomically shaped, textured implants. They had some advantages but could be challenging to use. In 2011, the first connection between textured breast implants and a rare disease called breast implant-related anaplastic large cell lymphoma was reported. As awareness of this so-called BIA-ALCL became more widespread, its reported incidence increased. In 2016, the WHO recognized it as a distinct disease, and the use of textured implants decreased dramatically. Around this time, the more modern “gummy” silicone was made available in round, smooth devices, which is where we are today. In the U.S. in 2024, there are virtually no textured or shaped devices being used, and more cohesive implants have a dominant share of the market. 

A Reputation Built on Results

All the staff and Dr Wolfe are amazing - attentive, caring, thorough and made my personal experience...
The Center for Cosmestic Surgery is by far the best in Colorado. Dr Freeman is beyond exceptional in...
Almost one month post-surgery and so happy with the results. I had upper blepharoplasty and only wish...
Minimal pain requiring only one prescription medication otherwise Tylenol relieved the discomfort. I...

IMPLANT TYPES

Implants can either be filled with saline (a salt-water solution) or silicone gel. The shells of both types of implants are made from a silicone elastomer, although the shell of silicone-filled implants is a bit more pliable.  

Saline implants are often praised for their safety profile; in the unlikely event of a rupture, the body simply absorbs the saline solution. They also require a smaller incision during surgery, as they are filled after being placed in the breast pocket. However, they may feel firmer and are more prone to visible rippling, particularly in patients with less natural breast tissue.

Silicone gel implants, on the other hand, are known for their more natural feel and appearance. The cohesive nature of the silicone gel helps the implant maintain its shape. Advances in silicone technology, such as highly cohesive “gummy bear” implants, have further improved safety and aesthetic outcomes. However, these implants may require a slightly larger incision and regular monitoring to ensure their integrity over time.

Ultimately, the choice between saline and silicone implants comes down to personal preference and individual anatomy, so a detailed consultation with your surgeon is critical to finding the best fit for your unique needs. Explore the details below for an in-depth look at each type of implant.

Saline Implants

There are two types of saline implants in the U.S.: the standard single-lumen implants that have been around in their current form for more than 30 years and a newer, more complex device called the Serene Implant (formerly the Ideal Implant). 

Standard saline implants come in a variety of shapes and sizes. (All saline implants currently available in the U.S. are round and not shaped/anatomic.) They are made by Allergan and Mentor. These devices are structurally simple, with a single lumen, and are essentially a medical water balloon. The shells are fabricated at the manufacturing plant and shipped empty, except for air, to keep the shell shape intact. Prior to insertion into the body, the implants are irrigated with solution, a fill tube is inserted into a valve in the implant shell, and the air is evacuated. The implants are then rolled up and placed into the breast. Once implanted, they are filled to the appropriate volume with sterile saline, the same solution that is used for IV therapy during surgery. Any particular implant has a narrow range of flexibility for implant volume, allowing the devices to be fine-tuned. After adding the saline, the fill tube is removed, and the valve self-seals. There is a small nub that overlies the valve, and this is seated on the outside of the valve to keep scar tissue from growing into the valve and causing a leak.  

These standard saline implants have some advantages. They are less expensive than other devices. When they leak, they tend to go completely flat and are easily noticed by patients, who can then simply have them replaced. (In some cases, a valve malfunction can result in partial deflation, and this can be more subtle.) The saline is completely biocompatible and doesn’t cause any untoward effects on the breast or the rest of the body if it leaks out. Given the ease of detection and safety of a rupture, saline implants are a “get-it-and-forget-it” situation. As long as the breast is behaving normally, no additional screening or preventative surgery is indicated.  

Despite these advantages, saline implants make up a small percentage of the market due to the disadvantages that plague them. First and foremost, saline is not a particularly lifelike imitation of breast tissue, and saline implants can be both palpable and visible in thinner, smaller-breasted women. The more breast tissue and fat a patient has, the less noticeable her implants will be. Standard saline implants also have higher rupture rates than other devices.  

To improve upon these limitations, the Serene (Ideal) Implant was developed. This is a more complex device. Instead of a single chamber, the Serene has two chambers, one of which has a series of baffles that partitions the saline and decreases the sloshing and rippling that can impact patient satisfaction. The rupture rate is much lower than standard saline implants and is, in fact, lower than some of the silicone implants on the market. When the implants leak, there is only a partial deflation due to the two chambers, creating less noticeable deformity. The implant has its limitations, however. They are relatively expensive, with a price point similar to many silicone implants. They also have only one profile in different sizes, limiting their applicability to certain body types and volume preferences. Although an excellent implant for someone who wants saline, the drawbacks have prevented widespread adoption by patients and plastic surgeons. Indeed, the name change from Ideal to Serene happened due to the bankruptcy of the original company and a purchase by another investor. Time will tell whether the new company can improve its position in the market.  

What kind of patient does best with saline implants? They work best in a patient with adequate soft tissue coverage, meaning fuller native breasts and thicker subcutaneous fat. Pregnancy and breastfeeding can compromise the quality of the overlying tissue, making the implants more noticeable. Patients focused on safety, especially if they have an aversion to silicone, may prefer saline due to the ease of detection and relative safety of deflation. A good candidate must understand and accept that the implants will likely be seen or felt by them or their partner in some situations. Saline implants are FDA-approved for patients over the age of 18.  

Breast Augmentation With Saline Implants Before and After Photos

WARNING:

This feature contains nudity. Please click OK to confirm you are at least 18 years of age and are not offended by such material.

Before & After Mommy Makeover Case 270 View #6 in Denver and Colorado Springs, CO
Breast Augmentation With Saline Implants Before & After Photos
Before & After Mommy Makeover Case 270 View #7 in Denver and Colorado Springs, CO
Breast Augmentation With Saline Implants Before & After Photos
Before & After Breast Augmentation Case 86 View #1 in Denver and Colorado Springs, CO
Breast Augmentation With Saline Implants Before & After Photos
Before & After Breast Augmentation Case 86 View #2 in Denver and Colorado Springs, CO
Breast Augmentation With Saline Implants Before & After Photos
Before & After Breast Augmentation Case 273 View #1 in Denver and Colorado Springs, CO
Breast Augmentation With Saline Implants Before & After Photos
Before & After Breast Augmentation Case 273 View #2 in Denver and Colorado Springs, CO
Breast Augmentation With Saline Implants Before & After Photos
Our Reviews

Reviews & Testimonials

Read Now

Silicone Implants

Silicone implants have a silicone elastomer shell and are filled at the factory with silicone gel. At the time of surgery, they are simply removed from their sterile packaging, irrigated with a solution, and inserted into the breast, sometimes with an insertion device or funnel. These implants can either be shaped/anatomic or round, although virtually all augmentations use round, smooth devices due to concerns over BIA-ALCL. There are four manufacturers making breast implants for the U.S. market: Allergan, Mentor, Sientra, and Motiva. The portfolios of each company differ, with a variety of shell designs, gel types, sizes, and profiles. Given this broad range of characteristics, there is an implant well-suited to virtually any potential patient. Silicone breast implants are FDA-approved for women (both cis and trans) over the age of 22 for cosmetic purposes and for patients of any age for reconstruction. Any other use is considered off-label, the most common scenario being the use of silicone implants for a patient under the age of 22. This is allowed at the discretion of the treating physician and is fairly common. There are potential implications regarding the manufacturer warranties and legal responsibilities, however, so a thorough discussion with the surgeon is warranted. 

Shell Type 

Three of the U.S. manufacturers use very similar shell technology. Mentor, Allergan, and Sientra all make smooth devices with virtually no surface texture. They tend to be well tolerated by the body but do have an increased risk of capsular contracture (a thickening of scar tissue formed by the body in response to the implant) when placed above the muscle. In contrast, Motiva® breast implants have a proprietary 4-micron SilkSurface that, while technically a smooth device, elicits less inflammation and has a significantly lower capsular contracture rate than other smooth implants. Importantly, Motiva implants have a similarly low rate of contracture both above and below the muscle, broadening our choices when designing surgical plans for the wide variety of women seeking augmentation. Allergan’s textured implants were removed from the market due to a higher risk of BIA-ALCL than other devices. Mentor and Sientra both continue to offer textured implants in both round and smooth configurations. They may be appropriate implants for some patients but are rarely used due to the low but still present risk of BIA-ALCL.  

Gel Type 

Silicone implants from the four manufacturers are filled with gels that vary based on cohesivity, firmness, flow characteristics, and a variety of more esoteric properties. In the past, implants could simply be considered cohesive or not. As the manufacturers have increased their offerings, it is perhaps more informative to view silicone implants as a continuum of “gumminess.” On the less cohesive side, both Allergan and Mentor continue to offer 4th generation gels that are quite soft and fairly liquid – they would not be considered “gummy.” The technology is older than that of other devices on the market, but they are time-tested and still chosen by many patients and surgeons. In the middle of the “gumminess” spectrum would be Mentor Boost implants, Allergan’s Soft Touch, Sientra’s HSC, and Motiva’s Ergonomix. On the firmer side are Allergan’s Cohesive implants, Sientra’s HSC+, and Motiva’s Round devices. This is an oversimplification but may be a useful way to view the implants.  

The degree to which the properties of the implants affect the look, feel, and behavior of the breast will be dictated by the anatomy and soft tissue characteristics of the patient. A patient with more soft tissue coverage will simply notice her implants less than a woman with thinner, more relaxed tissue. Put another way, a woman who presents preoperative with fuller breasts and thicker subcutaneous fat, especially if she’s never had children, can get a natural feeling and looking breast almost independent of her implant choice, even if she chooses saline. A thinner, smaller-breasted patient with a breast-feeding history would notice a much more significant difference in her results based on her implant choice. Similarly, a woman with tight soft tissues and a larger volume implant can expect to look rounder and more augmented look, regardless of the softness of her implants, while a softer-breasted woman might need a firmer device to achieve a similar degree of roundness.   

Implant Shape 

There are variations in implant shapes, most dramatically between round implants and shaped/anatomic devices. As previously stated, shaped implants require a surface texture to maintain their position and this texture has fallen out of favor due to ALCL risk, the potential for rotation resulting in deformity of the breast, and complications like late seroma. It is important to understand that shaped implants do not necessarily look more natural and round implants don’t need to look obvious (although they certainly can). A number of studies have shown that neither surgeons nor the lay public can reliably differentiate between round and shaped implants based on postoperative results. Size of the implant, degree of projection, and the patient’s soft tissue properties will affect the shape of the breast much more than the shape of the implant will.  

With round implants, the base of the implant is circular. Rotation is a non-issue, and the smooth shell surface is well tolerated, making the implants a bit more forgiving. We can choose from among a wide variety of profiles when helping our patients select implants. The profile of an implant refers to the degree of projection it has relative to its base diameter. A lower-profile implant will look flatter than a higher-profile one. Neither is better, and one does not choose the profile of the implant, per se. A surgeon should measure the base diameter of the breast of the patient and limit implants to an appropriately wide implant. A patient wanting a smaller volume of augmentation will tend to need a lower profile, less projected implant, while a woman wanting more volume in the same base diameter will require more projection to keep the implant from getting too wide. This is a frequently misunderstood nuance of implant selection, and patients often present asking for high-profile implants because they want more upper pole fullness. On the contrary, a wider implant will fill out the top of the breast more significantly. A high-profile implant may be appropriate, but only when the base diameter constraints and desired implant volumes dictate it.  

Implant Selection 

There are many factors that must be considered when choosing an implant, and a skilled augmentation surgeon must take them all into account during the consultation process. At the Center for Cosmetic Surgery, we have a variety of techniques for helping patients visualize possible outcomes with different implants. Most importantly, we have state-of-the-art Vectra 3D imaging, which captures a high-resolution image of the patient’s chest and can enhance it to accurately simulate a postoperative result with any implant on the market. The Vectra can also illustrate a breast lift in conjunction with the implant, if appropriate. We also utilize a system of in-bra sizers to give a different sense of what various implants look and feel like. Our patients find that the combination of Vectra 3D simulation and the sizers is very effective at helping them make an educated decision, and we rarely have patients returning with dissatisfaction regarding implant choice.  

Silicone Implant Monitoring for Rupture 

Despite the technological advancement of silicone implants, they are not lifetime devices and can rupture. When a silicone implant ruptures, the gel stays within the breast scar pocket, and the breast typically exhibits no outward symptoms. (This contrasts with saline implants, which tend to go flat over a period of days). Over time, the leaking silicone can be irritating to the surrounding tissues and can result in a capsular contracture if left untreated. However, there do not appear to be any systemic health risks from ruptured silicone. To diagnose ruptures, the FDA and the various manufacturers recommend periodic surveillance of the implants with either MRI or ultrasound, beginning 5 or 6 years postoperatively and continuing every two or three years thereafter. Ultrasound, in particular, is a very accurate, cost-effective, and convenient screening modality. At the Center for Cosmetic Surgery, we have embraced this technology and offer in-office ultrasound screening for our past patients and current consultations. In addition to diagnosing implant ruptures, ultrasound is a useful tool for visualizing fluid collections around implants, one of the most common presenting symptoms for BIA-ALCL. 

Virtually all patients want to know how often they should change their implants, but there is no clear-cut answer. Much of the public has the misconception that implants should be changed every 10 years, despite any data showing this to be a reasonable course. Given the long life span of modern implants, elective replacement can often be spread out to 15- or 20-year intervals, especially if appropriate monitoring with MRI or ultrasound is being performed. If a rupture is detected on an MRI or ultrasound, the FDA recommends that those implants be exchanged.  

Implant Warranties 

All breast implants come with manufacturer’s warranties that cover some of the complications that can arise. The details of these warranties vary based on manufacturer and type of implant. At the very least, implants are guaranteed against rupture for the life of the patient, and a patient with a ruptured implant can expect to receive two implants from the manufacturer at no charge at any time after surgery. The implants may be free, but there will likely be additional costs for surgical and facility fees, and manufacturers will often provide some sort of financial compensation to help defray these additional costs if the implant ruptures within a specific time after surgery. Other complications, such as capsular contracture, late seroma, and suspected ALCL, may be covered to some degree under the various warranties. A thorough discussion regarding the details of applicable warranties is an essential component of the consultation process. Links to the manufacturers’ websites are provided below and will detail the current implant warranties. Patients who already have breast implants can call the manufacturers with their serial numbers to find out exactly what warranty coverage was provided at the time of their surgery, as current coverage may be different from what they are entitled to. Our team members are experts at helping patients navigate warranty issues and can contact the manufacturers on patients’ behalf to clarify any uncertainties. 

Below is a summary of some of the manufacturers’ warranty information:

MENTOR™ Breast Implants Warranty

Natrelle® ConfidencePlus® Warranty

Motiva® Implants Always Confident Warranty®

Sientra Platinum20 Product Replacement and Limited Warranty Program 

Dr. Steven Vath, Dr. Matthew Freeman, Dr. Teresa Cunningham, Dr. Andrew Wolfe, Dr. Paul Steinwald

OUR EXCEPTIONAL PLASTIC SURGEONS

Board-certified plastic surgeons Dr. Steven Vath, Dr. Andrew Wolfe, Dr. Paul Steinwald, Dr. Matthew Freeman, and Dr. Teresa Cunningham lead our patient-centered practice with warmth, honesty, and respect.

BREAST IMPLANT ALTERNATIVES

Breast implants remain the most predictable means of enlarging the breast. They have limitations, however, so the search for alternative means of breast augmentation continues. After years of research and improvements in technique, fat grafting is a viable alternative for breast enlargement in some women. With this process, live fat cells are harvested from areas of relative abundance with liposuction, washed and filtered, and then grafted into the breast, where some portion of those cells will survive, providing long-term fullness. For some patients, fat grafting can be used in combination with a breast implant to achieve the desired result, while other women may do well with fat grafting alone. Good candidates for fat grafting will have extra fat in some areas of their body, with the inner thighs and lower abdomen being excellent donor areas due to an abundance of stem cells in these fat deposits.  

Making your cosmetic goals a reality is easier than ever with our flexible financing options:

LEARN MORE ABOUT FINANCING OPTIONS
Financing Logos including Prosper Healthcare Lending, PatientFi, and CareCredit

The Center for Cosmetic Surgery has two plastic surgery offices conveniently located in the Denver metropolitan area. One is located just outside of Denver in lovely Golden, Colorado, immediately off 6th Ave West, and the other is located downtown in Cherry Creek, Denver. Please schedule a personal consultation to learn what plastic surgery can do for you. Simply call (303) 278-2600 or request your consultation online.