One of my favorite things about breast augmentation is how tailored the procedure can be. More than any other surgery, you can pick and choose different options to get different results which accomplish different goals.
That’s exactly why, as a breast implant educator, I make it a point to never say that one choice is always better than another…
Well, almost never.
“Which Breast implant should I get?”
What I’ve learned is that the question, “Which implant should I get?” really means things like:
“Should I get saline or silicone implants?”
“What profile (or projection) should I choose?”
“Should I get smooth or textured implants?”
Each of these questions are very important—but there’s one question which isn’t on the list above that should be…
Get your pencils out, ladies!
One of the most important questions you should be asking, but you probably aren’t asking, is this:
“Which brand of breast implant should I get?”
Breast Implant Brands
It might surprise you to find out that there are quite a few breast implant manufacturers. As of the time I’m writing this article, there are four primary brands that are approved by both the FDA and the European Union:
Please note: Natrelle is the same company as Allergan.
As we dive into this article, my ultimate goal is to empower you with the data-based evidence that led me to personally hold Sientra breast implants above all the rest.
But First… Promise me you won’t freak out
I started Eden Knows Implants to help women turn the chaos of considering breast implants into a crystal clear process. In my Step By Step Guide to Breast Implants, I cover all of my “Boobie Steps” in depth, but here’s a recap:
As you can see, Boobie Step 4 is “Choose Your Implant.” Why?
Because not all breast implants are created equally.
If that last statement gives you a bit of anxiety, take a deep breath with me…
I want to be clear about this… I do not believe that anything other than Sientra implants are completely terrible or “ticking time bombs.” I just believe—because of the data you are about to see—that Sientra is the best by a very clear margin.
Still breathing, right?
I also believe that Allergan and Mentor make good implants and that Ideal has a good concept. I want to be clear on that.
But I want to be clear that I want the best for your body and my body. And right now, I believe that the Sientra HSC and HSC+ are hands down the very best implants for our bodies.
For clarity: HSC stands for “High-Strength Cohesive.” Sientra’s HSC+ implants are soft, and the HSC implants are softer.
A quick Word About Ideal Implants
If you didn’t know, Ideal has reported multiple manufacturing issues — primarily around the valve in their implants. As of writing this, they’ve completely shutdown production and sales for a full two months due to another valve problem.
Knowing this, I can’t possibly recommend anyone consider the Ideal Implant. However, I’m looking forward to updating this article once I feel they are reliable enough to be considered.
Now… lets dive into the data!
The Cornerstone Research Piece
In Volume 38, Issue 1 of the Aesthetic Surgical Journal, there was an in-depth study called the Long-Term Safety of Textured and Smooth Breast Implants. In large part, the data you will find presented here was compiled within this multi-year, peer-reviewed article.
My hope is to summarize the article in a way to share my personal perspective on the data, help you develop a perspective of your own, and allow you to confidently take a stand on the data in whatever situation you encounter.
The Data-Based Evidence
Many of you know that I was in the medical field of Clinical Research before I was blessed to do Eden Knows Implants full-time. I can’t help but use the data-driven side of my brain, especially on this topic.
When it comes to which breast implant brand you should choose above all the rest, there are three areas I believe deserve the most attention:
I’ve never met a woman who didn’t have breast implant safety on her mind, so let’s start there…
Breast Implant Safety: Volume of Research
If you’re considering breast implants, you will be happy to know that they are the most rigorously studied medical devices, ever. Said differently, there is no other medical device that is placed inside the human body that has more data backing it.
If you didn’t know, breast implant manufacturers must report back to the FDA multiple times on the data of their implant patients over many, many years.
Unfortunately, the number of patients who are being included in these studies are not equally represented between the different implant brands. But why does that matter?
Because more patients equals more data.
In the Aesthetic Surgery Journal research piece mentioned earlier, Sientra brought over HALF the patients to the end of the study. That really shows me their commitment to reporting the most accurate data possible.
Breast Implant Safety: BIA-ALCL Cases
Next, let’s talk about risk. As with everything else you do in life, there is risk to breast implants. Anyone who says there isn’t is lying.
And since risk can be emotional, let’s talk about the most emotionally scary (but extremely unlikely) risk to getting breast implants: developing a form of Non-Hodgkin's Lymphoma called “Breast Implant Associated Anaplastic Large-Cell Lymphoma.” Or BIA-ALCL, for short.
Now don’t freak out… hang with me for a minute…
BIA-ALCL is very treatable, and more people will die via the quintessential example of getting struck by lightning than anywhere close to BIA-ALCL.
Again, while BIA-ALCL is the most emotional risk to breast implants—it’s the rarest by far. To help put that in perspective, here’s the risk:
That’s 1 in 2.5 million women with breast implants, or .4 micromorts. Said differently, you are 1,525% more likely to die via getting struck by lightening.
Moreover, if getting into a car doesn’t terrify you 3,749 TIMES MORE than dying from BIA-ALCL, then your fear is out of proportion.
To take this data one step further, according the data, here are the likelihoods of developing BIA-ALCL with Sientra implants compared with other breast implant brands:
As you can see, only 2% of the reported cases of BIA-ALCL have been women with Sientra implants. That makes the likelihood of BIA-ALCL even lower than the numbers previously mentioned.
Now, let’s shift gears and talk about breast implant reliability…
Breast Implant Reliability: Overview
Since we’ve covered the very emotional side of breast implant safety, let’s spend some time on the two most common reliability issues — ruptures and capsular contracture.
Fortunately, there are mounds of data on both of these issues, so let’s start with breast implant ruptures…
Breast Implant Reliability: Rupture Rates
In short, a breast implant rupture occurs when the shell of an implant develops a small tear.
But what causes the tear to develop?
A lot of people think breast implants rupture because the implant gets squeezed too hard. In the vast majority of cases, that’s not actually true. Breast implants are WAY more durable than you’d think.
Case in point, this video…
In fact, the thing that causes most breast implants to rupture is when the silicone gel separates from the implant shell, causing two parts of the shell to continuously rub against each other.
Over time, this creates a tear in the implant shell, causing a rupture.
That’s why a measurement called “Gel-Shell Integration” is so important.
Gel-Shell Integration measures the strength of the bond between the shell of a breast implant and the cohesive gel inside the implant.
Not only does the data suggest that Gel-Shell Integration may be the most critical factor in maintaining breast implant shape in the upper-pole of your breast; but also, the stronger the bond between the gel and the shell, the less likely a rupture will be to occur.
In a complete runaway against the two other brands, the Gel-Shell Integration of Sientra’s implants is as much as 130% stronger than the competition.
Now, hold all that in your mind while we go over capsular contracture, then we’ll look at more data together.
what is capsular contracture?
Whether it’s a breast implant, pacemaker or an artificial joint, the human body always forms a capsule around any foreign object. This capsule is made up of tightly-woven collagen fibers.
Sometimes these capsules begin to shrink and tighten around the foreign object, which we call “Capsular Contracture.” In the case of breast implants, when capsular contracture occurs, the capsule may be removed so that a new one may form.
Breast Implant Reliability: Ruptures + Capsular Contracture
As mentioned, breast implant rupture and capsular contracture are the two most likely complications that can develop from a breast augmentation.
That’s why I really like to look at the data of both these two complications combined. When we visualize the data presented in the Aesthetic Surgery Journal, here’s what we find:
It’s also interesting to note that the rupture data included in the chart above is from the MRI Cohort group. Said differently, even “silent ruptures” were included in the data!
Breast Implant Reliability: Warranties
As we’ve seen, breast augmentation isn’t always perfect — it is surgery, after all. And that’s why it’s so important for us to look at warranty information between the different companies!
You can think of a breast implant warranty in the exact same way you think of the standard warranty you get when buying a car. They are free, but they cover different aspects. The same is true in the world of breast implants.
Let’s take a look at six specific areas of coverage in these brand’s free, silicone implant warranty programs:
Rupture Financial Assistance
The out-of-pocket surgery expense that will be covered for a ruptured breast implant.
Rupture Assistance Length
How long after getting implants that financial assistance be paid.
Capsular Contracture Warranty Length
How long the implant itself will be replaced for free due to capsular contracture.
Capsular Contracture Financial Assistance
How much out-of-pocket surgery expense will be covered for capsular contracture.
Capsular Contracture Assistance Length
How long after getting implants can you get financial assistance for capsular contracture.
Replace with Any Style or Size?
If you can select any replacement size or style implant due to rupture or capsular contracture.
Mentor and Allergan/Natrelle have some major catching up to do with Sientra in the area of their free warranties. With the other data we’ve seen from Sientra, it actually starts to make sense why they can be so confident in their guarantees.
Please Note: All three brands cover implant replacement due to rupture for your lifetime, and allow you to change both implants if just one of them ruptures or has a capsular contracture. All information in the chart above was pulled from the Mentor, Allergan/Natrelle, and Sientra warranty pages.
Now… on to our third and final area of data.. Look & Feel!
Breast Implant Look and Feel: Overview
The final area of data we’ll review together will help answer the question, “How well is the breast implant shape maintained, and how soft (or firm) does it feel?”
The two primary data points we’re going to review are:
Softness / Cohesivity
Breast Implant Look and Feel: Shape Retention
“Shape retention” is one of the often overlooked, but most important factors of whether or not women are happy with their implants.
Think of shape retention like this… when you go from laying down to standing up, how much of the silicone inside the implant slumps into the bottom of the implant? (Also called upper pole displacement.)
The more gel that gets displaced from the upper pole, the more the implant loses its shape.
Please note: I couldn’t find numbers for Mentor on this one, but here are the Allergan and Sientra numbers from this study.
Even against Allergan/Natrelle’s most firm implant, Sientra’s upper-pole displacement was 260% lower. What’s even cooler is that Allergan/Natrelle reports their Cohesive implant as nearly 25% stiffer than Sientra’s HSC+ (also called “Style 107”). Well played, Sientra.
That covers “look.” Let’s talk about “feel…”
Breast Implant Look and Feel: Softness + Strength
In the world of implants, there is always a tug of war between making an implant soft and making an implant strong.
Unfortunately, the softest breast implants have traditionally had the weakest “gel strength,” and implants with low gel strength more easily have gel fractures (which is not good.)
In the past, I considered Allegan/Natrelle’s “SoftTouch” implants as the best feeling option.
But all of that changed when I first held the Sientra HSC+ (also called the 107’s). The HSC+ implants felt very similar to me as the SoftTouch implants.
(That makes sense actually, because the SoftTouch implants were measured by an independent lab to have nearly the same “gel elasticity” as Sientra’s HSC+ implants.)
I honestly didn’t think much of that until I saw how much stronger that Sientra’s HSC+ implants were than the SoftTouch implants. Check it out:
One of the nerdy-coolest things about Sientra HSC+ implants is that the data shows them to be more than 35% stronger than Allergan/Natrelle’s SoftTouch implants.
Additionally, Sientra’s HSC implants (often compared to the softness of Mentor’s MemoryGel implants) are more than 50% stronger. Just wow.
The Bottom Line
Ok… we’ve looked at a TON of data together. And at the end of the day, my job is to empower YOU with crystal clear information.
So here’s my bottom line…
It is my personal opinion that the Sientra HSC and Sientra HSC+ are the safest, most reliable, best looking, and amazing feeling silicone breast implants on the market today.
They are the only implants I would choose for myself, and I wouldn’t personally consider a plastic surgeon who didn’t use Sientra implants.