Implant choices for breast reconstruction

Which is the best implant for me?

If you are considering breast reconstruction with implants, you are probably asking yourself this question. Today, there are many different types of breast implants on the market. The one thing that is common to all types of breast implants is that the shells are always made of a silicone elastomer, while shape, surface and filling are available in a wide variety:

The breast implant shape

While it is common to refer to breast implants as merely round or anatomical, it is more accurate to define the shape of breast implants by the following features:

  • Base, which is the side with which the implant rests on the rib cage and can be round, short or oblong
  • Profile, which can be round or dome-shaped or anatomical or teardrop-shaped
  • Projection means how much the breast implant extends forward in front of your chest. It generally can be low, moderate, high or extra high

Implants with a round profile are generally considered suitable for the reconstruction of a more youthful breast, whereas the anatomical or teardrop shaped implants have the natural curved shape of an adult woman’s breast.

In addition to the different bases, profiles and projections, implants are available in different volumes, or sizes.  This diversity is required in order to accommodate different body types and breast shapes. In a detailed consultation, your doctor will take the time to discuss your options and find the implant that is most suitable for you.

The filling of breast implants

Silicone gel-filled implants are the most widely used implant type all over the world, both for augmentation and reconstruction. Saline-filled implants are used far less often because they tend to feel less natural and come in a limited range of shapes.

State of the art implant technology, also offered by POLYTECH, has allowed the production of silicone implants filled with a highly cross-linked, cohesive silicone gel. In these, the cross-linking of the gel preserves its form. These types of implants also revert to their original shape when touched or moderately pressed.

Today’s implants are much safer than the implants of earlier generations due to the significantly improved manufacturing standards. All implants have a diffusion barrier that minimizes the risk of small silicone molecules migrating into the surrounding tissue. In addition, the low molecular weight components in the highly crosslinked and cohesive gel filling have been drastically reduced. If these implants are damaged, they will not leak in case of rupture.

The surface of breast implants

Breast implants are available with a smooth, textured or micro-polyurethane foam-coated surface. Why is that?

The first breast implants were manufactured in the 1960s and had a smooth surface. A polyurethane foam covering was introduced in the 1970s to minimize the event of capsular contracture as well as implant dislocation and rotation. Textured implants were introduced in the late 1980s, to mimic the effect of the polyurethane layer.

What is capsular contracture?

As part of the body's natural reaction, a capsule of connective tissue is formed around any foreign body inserted into the tissue, including around breast implants. The undesired tightening of this capsule (capsular contracture or capsular fibrosis) can result in changes to the shape as well as to the position of the implant, and so to the shape of the breast. Additionally, the capsule can become very hard and cause pain. Capsular contracture is the most common complication of breast implant surgery and is classified using the Baker scale (see the section Risks and complications with breast implants).


Baker scale for capsular contracture

  • Grade I - The breast is normally soft and appears natural
  • Grade II - The breast is a little firm and appears natural
  • Grade III - The breast is firm and appears abnormal
  • Grade IV - The breast is hard, painful to the touch, and appears abnormal

A capsular contracture may never occur, or it may occur after weeks, months or years. It cannot be predicted if or when a capsular contracture will occur and, if it does, how pronounced it may be. 

Capsular contracture rates, as well as rates of other complications such as rotation and dislocation, vary in relation to the implant surface.1

Capsular contracture rate

  • Smooth implants: 30-50%
  • Textured implants: 15-30%
  • Polyurethane-covered implants: 0-9%

In most of the large studies, the capsular contracture rate for polyurethane-foam-covered implants is as low as 0-3 %.1

Recent studies have shown that POLYTECH Microthane® implants are a safe choice for breast reconstruction, and have lower complications even in cases of radiation treatment, which is known to dramatically increase the risk of capsular contracture.2 


1. Handel, N., Cordray, T., Gutierrez, J., Jensen, J.A. (2006) A long-term study of outcomes, complications, and patient satisfaction with breast implants. PRS 117, 757 et seq.; Kjoller, K., Holmich, L.R., Jacobsen, P.H., Friis, S., Fryzek, J., McLaughlin, J.K., Lipworth, L., Henriksen, T.F., Jorgensen, S., Bittmann, S., Olsen, J.H. (2002) Epidemiological investigation of local complications after cosmetic breast implant surgery in Demark. Annals of Plastic Surgery 48(3), 229-237; Malata, C.M., Feldberg, L., Coleman, D.J., Foo, I.T., Scarpe, D.T. (1997) Textured or smooth implants for breast augmentation? Three-year follow-up of a prospective randomised controlled trial. British Journal of Plastic Surgery 50(2), 99-105; Tebbetts, J.B. (2001) A surgical perspective from two decades of breast augmentation. Clinics in Plastic Surgery 28(3), 425-434; Young, V.L., Nemecek, J.R., Nemecek, D.A. (1994) The efficacy of breast augmentation: breast size increase, patient satisfaction, and psychological effects. Plast. Reconstr. Surg. 94, 958-969; Hohlweg-Majert (1991) AWO-Jahrestagung, Baden-Baden; Spear, S.L., Mesbahi, A.N. (2007) Implant-based reconstruction. Clinics in Plastic Surgery.

2. Pompei, S., et al., “Polyurethane Implants in 2-Stage Breast Reconstruction: 9-Year Clinical Experience”, Aesthetic Surgery Journal, Volume 37, Issue 2, 1 February 2017, Pages 171-176,; Pompei S, Evangelidou D, Arelli F, Ferrante G. 2016. “The Modern Polyurethane-Coated Implant in Breast Augmentation: Long-Term Clinical Experience”. Aesthetic Surgery Journal 36(10):1124-1129