Breast Implants/Reconstruction

Breast Implant Illness

Breast implant illness (BII) refers to a group of symptoms experienced by some patients who have breast implants, which may or may not be relieved after implant removal. Since very little research has been done regarding BII, it is poorly understood by doctors and patients alike. Without independently funded, rigorous scientific studies to guide clinical decision-making, we are left with a range of opinions on how to approach and treat breast implant illness. 
The fact remains that women are having real symptoms that may be related to their implants. They want to be heard and they want treatment. I would like to share my opinions and experience with BII, as well as the approach to treatment we offer at Halvorson Plastic Surgery



Some colleagues attended the Atlanta Breast Symposium, one of the most highly regarded conferences on plastic surgery of the breast, and told me an interesting story.  During one of the sessions, the crowd was shown photographs of women who had breast augmentation using a round or shaped (aka “teardrop” or “anatomic”) implant.  Surgeons were asked to submit their guess as to which type of implant was used.  The result was a great surprise.  Plastic surgeons, who take pride in their ability to assess augmented breasts, could not tell the difference!  Since that time, at least two studies using far more rigorous methodology have been published in major plastic surgery journals confirming the fact that experienced observers cannot tell the difference between shaped and round implants in most breast augmentations. 


Should we assume that anatomic implants have no role in breast augmentation?  If you’ve spent some time looking through my website, I hope you’ll see that I don’t believe in blanket statements regarding patient care in plastic surgery.   Just because a study finds that an intervention makes no difference in 100 patients does not mean that it won’t make a difference for an individual patient.  Although I generally do not use anatomic implants for breast augmentation surgery, there are certain patients in which they may offer an advantage.  The important thing is to realize that there are advantages and disadvantages to each type of implant, so being happy with the implants you choose is more about making an informed decision that is right for you than it is about the specific implant.  


Shaped implants must be textured.  The rough surface allows the implant to stick to the surrounding tissues like Velcro, so it does not rotate.  If a shaped implant had a smooth surface, it would rotate and the breast could look upside down one day, sideways the other, etc.  In the last few years we have learned that textured implants can, in very rare instances, lead to a form of lymphoma around the implant (breast implant associated anaplastic large cell lymphoma, or BIA-ALCL).  The more aggressive the texturing, the lower the risk of rotation but the higher the risk of BIA-ALCL.  This is another reason I generally do not use textured implants.  My patients don’t like worrying about BIA-ALCL, even if it is rare. 


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So – when is a textured shaped implant appropriate for augmentation?  For a woman with very small breasts who wants a fairly large augmentation but wants to look as natural as possible, I do think an anatomic implant makes a difference.  Most patients have a fair amount of breast tissue on top of the implants, and this is why it’s hard to tell the difference between a shaped and round implant.  However, if the implant comprises 80-90% of your overall breast volume, then I do believe the shaped implant will result in a more natural appearance.  These patients have to accept the risk of implant rotation (1-2%) and the remote risk of BIA-ALCL (1 in ~30,000 for Mentor implants), but it is something to consider. If a patient wants to pursue this (which is rare), I recommend using a Mentor implant, which has the least aggressive texturing.  The risk of implant rotation may be a little higher, but the risk of BIA-ALCL is much lower. 

Is the Ideal® Breast Implant the ideal breast implant?

Silicone breast implants have improved tremendously over the years due to improvements in both shell design and silicone gel structure, but saline implants have seen very little change and are avoided by most plastic surgeons I know.

I have always offered saline implants to my patients, especially those seeking a small or modest breast augmentation, as I think they are very good products that have certain advantages and feel similar to silicone implants when covered by a modest amount of breast tissue.

The most significant advantage of saline implants is that you, the patient, are the first one to know if the implant ruptures. It simply deflates as your body absorbs the saline. Unfortunately, saline implants have a higher rupture rate than silicone implants, so while you can detect rupture much more easily, rupture nevertheless happens more often with saline implants.

Still, most patients prefer the more natural feel of silicone implants. Until now…

Dr. Robert Hamas, a retired plastic surgeon in Texas, has developed a saline implant that feels very similar to a silicone implant and has several advantages over all current implants available. This novel implant is essentially a saline implant within a saline implant.

Saline implants have a silicone shell, so this implant has a shell within a shell, with several additional layers between the two implants that have slits in them called “baffles”. These slow down the flow of saline as the implant is manipulated, effectively turning a substance that is not form-stable (saline) into one that feels like it is.

If you feel this implant under a 1cm sheet of padding, it is nearly indistinguishable from a silicone implant. There are other aspects of the implant design that are intended to improve projection and reduce rippling. You can learn more at

I am really excited to offer this implant, as it combines the advantages of both silicone and saline implants. It certainly may be the ideal implant. Studies have shown that rupture and contracture rates are similar, if not better, than current implant offerings. It is currently FDA-approved for use in primary or revision breast augmentation, and I am open to using it “off-label” for patients undergoing breast reconstruction.

Although a limited number of implant sizes are available (compared to the major manufacturer’s offerings), it is likely one is available that will suit your needs and there are sure to be more available in the future. If you are interested in exploring the Ideal® implant, please call us to schedule a consultation!