Breast Implant Selection — Dr. Meyzin Explains

Implant Selection Is Not a Single Decision

When you consider breast augmentation, the first question is usually misleading: "Which brand of implant should I choose?" Implant selection is not one decision — it is a chain of eight interconnected technical decisions. Gel type, surface, shape, profile, volume (cc), pocket placement, incision, and brand: each affects the outcome from a different angle.

This article explains each of the eight decisions. Our aim is not to tell you which implant to choose; it is to help you understand what your surgeon is asking during your consultation and what your answers mean for your outcome. An informed patient asks better questions.

Breast augmentation at Nis Clinic is individually planned through measurement and tissue assessment. The content below makes the technical framework of that planning transparent.

1. Gel Type — Silicone Gel or Saline?

The standard in modern breast aesthetics is cohesive silicone gel. Saline (salt water) implants were common in the 1990s; they are rarely used today.

Silicone gel implant:

• Feels similar to natural breast tissue ("memory gel")
• Maintains its structure if the shell ruptures — the gel does not disperse
• Softer transition in the upper pole, less rippling
• FDA- and CE-approved; over 60 years of clinical data

Saline implant:

• Filled with sterile salt water; shell is silicone
• If it ruptures, the contents are absorbed by the body
• Disadvantage: feel is more artificial; higher rippling risk in patients with thin tissue cover
• Still an option for the rare patient with concerns about silicone

Practical decision: More than 95% of patients today choose cohesive silicone gel. Unless you have a specific medical indication for saline, silicone gel is the standard. Like all implants, silicone implants require lifelong medical monitoring.

2. Surface — Smooth or Textured?

This topic became the most controversial subject in breast aesthetics between 2018 and 2019. The short story: certain macro-textured implants were linked to BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma), a rare immune system condition. The FDA initiated a voluntary recall of Allergan's Biocell textured implants in 2019.

Today, the industry has largely returned to smooth surfaces.

Smooth: Moves freely within the capsule — natural feel. Not linked to BIA-ALCL. Standard for round implants.

Macro-textured: Adheres to the capsule to prevent rotation — particularly important with anatomical implants. Use has declined significantly following the BIA-ALCL link.

Micro-textured / nano-surface: Modern technologies such as Motiva's SmoothSilk® offer a surface that is smooth at the micron level. Data suggest lower rates of capsular contracture and bacterial adhesion. This surface is standard in the Ergonomix2 Diamond implant within the Mia FemTech system.

Practical decision: Most surgeons today avoid macro-textured implants. The choice between smooth or nano-surface is determined automatically by the brand and implant shape selected.

3. Shape and Profile — Round/Anatomical and Projection

Shape and profile are two separate decisions, though in practice they are evaluated together.

Round or Anatomical (Teardrop)?

Round implant:

• Symmetrical upper and lower halves — appearance does not change if it rotates
• Provides more prominent fullness in the upper pole (décolletage)
• Shows a more natural movement when you move
• The most commonly chosen type worldwide today

Anatomical (teardrop) implant:

• Less volume in the upper portion, more in the lower — resembles the natural breast curve
• Preferred in patients with thin tissue cover who do not want round projection in the upper pole
• Rotation risk is the most significant disadvantage: if the implant rotates, the tip of the teardrop shifts laterally, causing asymmetry
• Typically uses a textured surface, so anatomical implants were more affected by the BIA-ALCL discussion

Profile (Projection Height)

Profile refers to how far the implant projects forward from the chest wall. Different profile options exist at the same cc volume because the base diameter changes.

Practical decision: The surgeon measures your chest base in centimetres; the implant with the closest matching base diameter is selected. "Higher profile = more prominent breast" is true but incomplete — a profile that does not match your base increases the risk of tissue pressure and rippling over the years.

4. Volume (cc) — The Real Answer to the "What Cup Size?" Question

The most frequently heard phrase in a breast augmentation consultation is: "I want a C cup." However, cup size is not a unit of measurement in the implant world — cc (cubic centimetre) is the unit used.

How much volume is one cc?

• 100 cc is roughly equivalent to half a small glass of liquid in volume
• Typical range: 250–500 cc (the large majority of patients)
• Athletes or very small frames: 200–300 cc
• Seeking a significant increase: 400–550 cc
• 550+ cc is generally not recommended — the risk of tissue fatigue, ptosis, and rippling increases noticeably over the long term

Why is "cup size" unreliable? What one woman calls a C cup can equal the same volume as what another calls a B — bra sizing varies by manufacturer. An 80C in one brand differs in volume from a 34D in another. Serious clinics therefore discuss the look you want, not the cup size you want.

Criteria for volume decision:

• Chest base width (base diameter)
• Existing breast tissue volume
• Skin elasticity and tissue cover thickness
• Shoulder and hip proportions
• Lifestyle (active sport combined with very large volume = loss of comfort)
• Long-term effects of gravity

At consultation: The surgeon uses sizer implants (trial implants) in different cc volumes or 3D simulation for visual assessment. The Vectra XT 3D system shows the effect of different volumes on your body before the procedure.

5. Pocket Placement — Submuscular, Subglandular, Dual Plane

The "pocket" in which the implant is placed in the body can be positioned at three different levels. This decision directly affects the outcome.

Subglandular (prepectoral / above the muscle):

• The implant is placed directly beneath the breast tissue, above the pectoral muscle
• Shorter operating time, less postoperative discomfort
• No implant distortion from muscle movement in patients who train their upper body
• Disadvantage: higher rippling risk in patients with thin tissue cover; capsular contracture rate is somewhat higher

Submuscular (below the muscle):

• The implant is placed beneath the pectoralis major
• More natural transition in the upper pole — a clear advantage in patients with thin tissue
• Minimal rippling risk
• Capsular contracture rates are reported as lower in the literature
• Disadvantage: longer recovery, more initial discomfort, "animation deformity" when the muscle contracts (implant shape changes with muscle contraction)

Dual plane:

• The upper portion of the implant is below the muscle; the lower portion is above
• Combines the upper-pole advantage of submuscular placement with the lower-pole naturalness of subglandular placement
• Currently the most widely used technique
• Technically demands more surgical work

Practical decision: The surgeon performs a pinch test — measuring the tissue thickness of the upper breast pole between their fingers. If it is less than 2 cm, submuscular or dual plane is preferred; if it exceeds 2 cm, subglandular placement remains on the table.

6. Incision Site — Inframammary, Periareolar, Transaxillary

An implant can be inserted through three different incision sites. Each has a different scar profile, complication profile, and range of application.

Inframammary (inframammary fold):

• A 4–5 cm incision placed within the natural fold beneath the breast
• The scar remains within the fold — not visible when standing
• The most direct surgical access to the implant — advantageous for haemostasis and symmetry
• Currently the most commonly used incision type worldwide
• Disadvantage: in patients with very small breasts or an indistinct fold, the scar may be more visible

Periareolar (around the nipple):

• An incision at the colour border of the areola
• The scar is naturally concealed at the pigmentation transition
• Not suitable for patients with a small areola (insufficient access)
• Theoretical effect on breastfeeding: the incision passes close to the milk ducts; this may represent a relative risk for long-term breastfeeding function (clinically significant loss has not been observed in the majority of patients, but it is a point of consideration)
• Capsular contracture rates have been reported as somewhat higher than inframammary in some studies

Transaxillary (axillary):

• A 4–5 cm incision within the natural axillary fold
• No scar on the breast — an advantage for swimwear and low-cut clothing
• The surgeon works from a greater distance; endoscopic assistance may be required
• Limited in cases involving large implants, revision surgery, or inferior positioning
• The Mia FemTech system performs the transaxillary approach through a very small incision (1–2 cm)

Transumbilical (navel):

• Applicable only with saline implants; rarely chosen
• A marginal option in current practice

Practical decision: For most patients, inframammary is the standard choice. If areola anatomy is suitable, periareolar is considered. If you wish to avoid a visible scar, transaxillary or the minimally invasive Mia FemTech option is evaluated.

7. Brand — Allergan, Motiva, Sebbin, Mia FemTech

There are dozens of implant manufacturers on the market. Let us compare the main brands used in serious clinics honestly.

Allergan Natrelle:

• Based in Ireland/USA; an established name in breast aesthetics
• Brand image was affected by the 2019 Biocell textured implant recall; the smooth line has since been strengthened
• The Natrelle INSPIRA® series is the current core product
• Lifetime rupture warranty, ConfidencePlus programme
• Price: mid-to-upper segment

Motiva (Establishment Labs):

• Based in Switzerland/Costa Rica; premium line
• SmoothSilk® nano-surface technology
• Ergonomix® (teardrop form, rotation-neutral) and Round product lines
• MotivaImagine patient tracking system — implant identity card, lifetime registration
• Motiva Protection Plan: coverage for rupture and Baker III/IV capsular contracture
• Price: upper segment
• The Mia FemTech system we use at Nis Clinic is manufactured under this brand

Sebbin (GC Aesthetics):

• Based in France; widely used in Europe
• CE-approved; no FDA approval (not used in the US market)
• Known for a reliable quality-to-price balance
• Price: mid segment

Polytech:

• Based in Germany
• Known for Microthane® polyurethane-coated implants (data suggest reduced capsular contracture rates)
• CE-approved; limited FDA approval
• Price: mid-to-upper segment

What to consider when choosing a brand?

Key criteria:

1. Regulatory approvals: Must be CE- or FDA-approved for the country of use
2. Clinical data: Choose a brand backed by long-term published follow-up
3. Warranty programme: Manufacturer coverage for rupture and capsular contracture
4. Traceability: Is the implant lot number recorded and an identity card issued to the patient?
5. Surgeon experience: However good the brand, the number of cases the surgeon has performed with that specific brand is a determining factor in clinical outcomes

An honest point: There is no single "best brand" answer. Both Allergan and Motiva are reliable and have accepted clinical data in the literature. The price difference reflects surface technology, warranty scope, and manufacturer support systems. "More expensive brand = better outcome" is not an automatic equation; the right patient–implant match and surgical skill are more decisive.

Our approach at Nis Clinic: We use Allergan Natrelle and Motiva/Mia FemTech. At consultation, we review the options that suit your anatomy, expectations, and budget together.

8. Implant Lifespan and Safety Profile

The most frequently asked question from patients considering breast augmentation: "When will I need to have this implant replaced?"

Implant Lifespan

The FDA's official position is clear: Breast implants are not lifetime devices. Average service life is accepted as 10–20 years, varying from person to person. Modern implants typically include a lifetime rupture warranty from the manufacturer — free replacement if the implant ruptures. This does not mean "you will definitely need to replace it after 20 years"; if follow-up reveals no problems, the implant can remain in place.

Recommendation: The FDA recommends the first MRI or high-resolution ultrasound scan 5–6 years after silicone implant placement, then at intervals of 2–3 years thereafter. At Nis Clinic, this monitoring is part of our standard protocol.

Safety Profile

Capsular contracture: Hardening of the tissue capsule surrounding the implant. The rate with modern implants is 5–15%. Mild grades cause no problems; Baker III–IV may require revision. Risk-reduction measures include submuscular placement, atraumatic surgery, correct sizing, antibiotic irrigation, and nano-surface technology.

BIA-ALCL (Implant-Associated Lymphoma): A rare immune system condition; linked primarily to macro-textured implants. According to FDA data, the risk ranges from 1:3,000 to 1:30,000 (depending on implant type). No cases have been linked to smooth implants. Late-onset seroma should raise suspicion.

Breast Implant Illness (BII): Some patients report systemic symptoms — fatigue, joint pain, brain fog — that they associate with their implants. The FDA and major surgical societies do not recognise BII as an official diagnosis, but they acknowledge that patients' reported symptoms are real. The scientific position remains uncertain; both "it does not exist" and "it is definitively established" are incorrect positions.

Rupture: The annual rate with modern cohesive gel implants is 0.5–1%. Thanks to cohesive gel, the contents do not disperse; most ruptures are silent and detected by MRI or ultrasound.

Shared Decision-Making at Consultation — How We Work

We do not expect you to make any of the eight technical decisions alone. Being informed makes you a better partner during the consultation; final decisions are made by combining your preferences with the surgeon's examination findings.

Op. Dr. İbrahim Meyzin is a specialist in Plastic, Reconstructive and Aesthetic Surgery (Cyprus Turkish Medical Association (CTMA), Registration No. 969). He is personally present for your procedure and leads the consultation and measurement stages himself.

Steps followed at consultation:

1. Expectations and lifestyle — target appearance, sport, breastfeeding plans, occupation
2. Chest measurement — breast base width, IMF distance, intermammary distance
3. Tissue analysis — pinch test, skin elasticity, asymmetry
4. Medical history — chronic conditions, medications, family cancer history, previous procedures
5. Visual assessment — sizers or 3D simulation
6. Joint review of the eight decisions
7. Clear preliminary plan — suitability, technical combination, price, timeline

The consultation concludes with a recommendation tailored to you. We do not push a plan that does not suit your anatomy; if you are not a suitable candidate, we say so plainly. If you are travelling from abroad, the first assessment can be carried out via Zoom or WhatsApp; the face-to-face examination takes place at our clinic before the procedure. Our medical tourism packages include airport transfer, accommodation, and 12 months of follow-up.

For full procedure details, see the breast augmentation service page; to get in touch, visit the appointments page.