Breast Implant Selection for Primary Breast Augmentation

Introduction to Breast Implants

The American College of Radiology recommends smooth silicone gel implants over textured implants for primary breast augmentation due to lower risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) while maintaining excellent aesthetic outcomes and patient satisfaction 1, 2
Silicone gel implants contain a fixed volume of silicone gel with varying viscosity between manufacturers, and are available in form-stable "gummy bear" varieties 1
Saline-filled implants are inflated with sterile isotonic saline to desired size, and double lumen varieties using both saline and silicone are available 1
Polyacrylamide gel implants are another option for breast augmentation 1
Implants come with either smooth or textured surfaces, with textured implants associated with higher risk of BIA-ALCL 2

The American College of Radiology reports that most cases of BIA-ALCL are associated with textured implants, and typically presents with delayed peri-implant effusion (>1 year after surgery) 2
BIA-ALCL typically occurs 8-10 years following implantation, and is a rare T-cell lymphoma 2
The FDA has recognized the association between textured implants and BIA-ALCL since 2011, and in 2019 recommended a boxed warning on breast implant labeling 1
Saline implant rupture is usually clinically evident as the saline is resorbed by the body, causing noticeable changes in breast contour, while silicone implant rupture may be asymptomatic 1, 3
The FDA recommends initial ultrasound or MRI 5-6 years after implant surgery and then every 2-3 years thereafter for monitoring 1

Silicone gel implants are safe and acceptable components of the breast augmentation armamentarium, with advances in gel cross-linking reducing silicone bleed and cohesive gel implants likely to have fewer problems relating to capsular rupture 5, 6
Modern silicone implants are associated with high patient satisfaction and low complication rates, although the evidence for this is not cited in this section 5, 6
Implant-based reconstruction may result in unfavorable aesthetic outcomes if post-operative radiation therapy is required, according to the American College of Radiology 5, 7

Patients should be fully informed about potential risks including BIA-ALCL, rupture, capsular contracture, and need for long-term monitoring, as recommended by the American College of Radiology 1