Q: Dr. Eppley, I met with you for a breast augmentation consultation last week. Before I schedule my surgery, I have a few more questions about specific brands of implants. I believe you recommended Sientra, but I’ve been looking into Mentor implants. Specifically, the Mentor MemoryGel Siltex round implants. I’ m interested in the textured surface versus the smooth because the (perhaps dubious) Internet research done suggests textured surfaces lead to a lower rate of capsular contracture. And, Mentor appeals to me because of the enhanced warranty available for purchase. If my logic and/or research are wrong, please do correct me. If I did choose to go with Mentor, would there be a price difference from the original quote I received?
A: Thank you for the additional questions about breast augmentation and specifically about breast implants. Let me preface my comments with the understanding that it does not make any difference to me what brand of breast implants a patient uses. From my perspective, the three major breast implant manufacturers offer comparable devices for surgical implantation. The manufacturers, of course, see it differently and often promote and advertise relatively miniscule purported advantages to their devices.
When it comes to smooth and textured breast implants, it is important to understand what their advantages as well as their disadvantages are …as you will pay more to use them. (they are more expensive because it takes an extra step in their manufacture to add the textured surface onto the implant) Textured breast implants have only been shown to reduce the risk of capsular contracture when the implants are placed above the muscle. There has never been shown any differences in capsular contracture rates when they are placed below the muscle. The greatest reduction in capsular contracture, what was once a common breast augmentation problem, was the change in implant location from above to below the muscle. The type or surface of the implant is irrelevant when placed in the submuscular position. In my breast augmentation experience, which spans over 20 years and over 800 breast augmentations, I had yet to see a capsular contracture from a primary breast augmentation. In that time I have only performed a single above the muscle breast augmentation. All the surgeries have been done using smooth breast implant devices. This is a testament to the value and importance of the submuscular (technically the partial submuscuar or dual plane location.
It is also important to be aware that textured breast implants, besides costing more, require a slightly bigger incision to place and have a slightly higher risk of infection as any textured surfaced implant does. (the rough surface offers greater opportunity for bacterial adhesion than a smooth surface does) Due to their thicker shells they will feel more firm and will move less freely (due to tissue adhesion) than smooth breast implants.
Today, all breast implant manufacturers offer the identical warranty…lifelong implant replacement and a 10 year for surgery warranty of new implants plus $3500 towards the cost of surgery to replace them. (technically Sientra offers $3600 towards the surgery cost on the first ten years and also has a capaulat contarcture warranty so one could argue their warranty is better than Mentor and Allergan)
Again, it does not matter to me what breast implant manufacturer, style or size any patient desires. I will surgically place whatever they want. The only thing I do care about is that patients make an educated choice and that they understand the advantages and disadvantages of those choices.
Dr. Barry Eppley