Once you’ve made the decision to have breast implants, you need to start thinking about what type of implant you prefer. You and your surgeon will talk about the pros and cons of the various types and shapes of implants, and together you can figure out which one is right for you. Here is a rundown of the various categories of implants and decisions you’ll need to make.

Saline or Silicone?

Saline implants are filled with a safe salt water solution that’s not toxic to the body (it’s what you would be given through an I.V. if you were dehydrated, for example). Saline implants are perceived as safer, with less chance of capsular contracture (when scar tissue forms around the implant and causes painful stiffness in the breast, and possible fluid leakage inside the implant). If a saline implant ruptures, it simply deflates within a few hours. However, the feel of a saline implant is not as nice as silicone gel, and some women feel they don’t look as natural.

Silicone implants have been surrounded by controversy. They were off the market in the United States from 1992 to 2006. Women like the look and feel of silicone implants, but they do come with greater risks (such as rupture and capsular contracture). However, newer silicone implants are filled with gel (versus liquid), which doesn’t leak if punctured. It’s called “cohesive” gel. There’s a newer highly-cohesive implant, referred to as the “gummy bear implant,” which is currently under review by the FDA. It has the texture of — you guessed it — a gummy bear.

Smooth or Textured?

Implants always come in a shell, and that shell can either be smooth or have a texture. Both saline and silicone implants can be either smooth or textured. Smooth implants (which are always round) come in a thinner shell, and wrinkle less than textured implants. If you’re having the implant placed above the muscle, smooth implants might be the better call. Smooth implants also feel softer than textured implants unless they are overfilled. They have a “teardrop” profile when in the upright position, and they may also move a bit with activity, the way a natural breast does.

Smooth silicone implants have historically had a higher rate of capsular contracture than textured silicone implants (approximately 34 percent vs. 15 percent respectively, according to some earlier studies), but the trade-off is that textured implants (where the shell feels more like sandpaper) are usually more firm than smooth implants, because the texturing requires a thicker shell. If you have thin skin, or fairly small breasts, you may be more likely to feel your implants if they are in the textured shell. In terms of saline implants, earlier studies have shown the rate of capsular contracture to be about the same (approximately 8 to 14 percent) regardless if the saline implant is smooth or textured.

Round or Teardrop?

Round implants consistently provide the most natural look and feel with the least potential complications, but some surgeons feel that round implants offer less control over long-term superior pole (the upper portion of the breast) fullness. That’s why anatomical or teardrop (sometimes also just called “shaped”) implants were developed — to provide a contour more like the natural shape of the breast itself. In long-chested women the implant may provide greater control of superior pole fullness.

However, a teardrop implant must be textured (which comes with greater risks, as discussed above) so that it adheres to the breast tissue and has less chance of rotating in the body. Because of its shape, the teardrop implant can only be oriented one way. If it rotates at all, the top part could wind up pointing outward or inward, and it wouldn’t look right. Rotation isn’t a concern with round implants, because all sides are the same. Some surgeons feel comfortable with the shaped implants, and have a considerable amount of skill with them (and a good track record), especially when it comes to reconstructive surgery.

Standard, Low-Profile or High-Profile?

The “profile” of the implant refers to how far it sticks out from your chest wall. A standard profile is exactly that, standard, and it can work for many women. A low-profile implant is flatter and wider, whereas a high-profile implant has a narrow base and is more cone-shaped. We have these various profiles