The Body Bible

Breast augmentation is the most commonly performed cosmetic surgical procedure in the UK. The demand for breast augmentation has increased exponentially since the introduction of silicone implants in the 1960s by Cronin and Gerow. In response to this demand, there are several competing implant manufacturers, each producing breast implants with slightly different qualities in an attempt to corner the market. For patients and surgeons alike there can often be a bewildering array of implants, with seemingly little to choose between them. So where do you start? Body Bible decided to research the best breast implants and bring you the findings, assessing the most commonly used breast implants to a set criteria.

Method

We decided to poll a selection of plastic surgeons to find out how they would rank the commonly used manufacturers. The respondants were provided with a summary sheet from the manufacturers covering selected points about their product. They were then asked to score the company for several key features, using a scale of 0 to 10 (0= not at all satisfactory, 10 = most satisfactory). The results were analysed and placed in rank order.

The key areas covered in the questionnaire were:

1. Range of implants – each company offers a set range of implants. This specifically covers volumes, implant dimensions (height, width and profile), shape (anatomical or round) and the consistency of the gel fill. It is desirable to have as wide a range of implants as possible to ensure that the implant best suited to the patient is available.
2. Types of testing performed and quality certification- it is essential that implants are thoroughly tested and certified, for wear of the outer shell, gel bleed, rupture and capsular contracture
3. Whether the company are manufacturer or distributor and which country the implants are made in – most companies allow surgeons to have a range of implants in their hospital. The surgeon is only charged for the implants that they use. Occasionally, if the appropriate implant is not in stock, then it may have to be ordered last minute to avoid postponing the operation. This is much easier if the manufacturer distributes their own implants and if they are made in the UK.
4. Length of time manufacturing or distributing implants – the longer the company has been involved with implant production, then their wealth of experience is likely to reflect in the quality of service and/or implants.
5. Other countries implants distributed to and number of implants sold – it follows that the more popular the product then the wider the distribution and the higher the number of implants sold.
6. Rate of return for implant rupture – with the advances in fourth generation implants, it is unlikely that implants will rupture. If a company has a high rupture rate, then one would suspect that there might be a design flaw.
7. Capsular contracture rate – capsular contracture (where the breast tissue hardens around the implant) is an unfortunate but not uncommon complication of breast augmentation. The incidence is often quoted as being up to 30% in the literature. However with the current generation of implants, this troublesome complication seems to be greatly reduced to around 3-5%.
8. Ability to retain shape. High viscosity means implant are able to retain their shape no matter what position they are in. Gel implants are liquid, which makes them soft and feel like breast tissue. However they deform when lying flat.
9. Gel bleed rates - Gel bleed is the process by which silicone gel particles penetrate and pass through the silicone envelope, which was designed to contain the gel. In contrast to implant rupture, there is no definite break in the implant envelope. Once outside of the elastomer it is free to migrate through-out the body, although the implications of this remain controversial.
10. Patient warranty (does it cover capsular contracture, rupture, implant on the other side and small changes in implant volume? Does the patient have to pre-register the implant?) – not all companies offer patient warranties and those that do have very specific policies on what they will cover.
11. Training and support to physicians.

Results

The questionnaire was sent to a number of NHS plastic surgeons. The results are shown in the table below. The scores ranged from 4 to 7, with a mode of 6.

Table 1. Comparison of mean score for each company

Company	Mean Score (0-10)
Allergan	6
Eurosilicone	4
Mentor	6
Nagor	7
Sebbin	5
Silimed	5

The results highlight that most companies have similar implants, with very little to choose between them. Nagor ranked the highest in our survey, by virtue of their extensive warranty policy. This gives a lifetime guarantee on all Nagor implants against capsular contracture or rupture, and will cover a size change above and below the implant as well as the contralateral breast.

Read More in: The Body Bible's guide to Breast Enlargement Surgery