Q. I read about a new saline implant in your Q&A article in this magazine a few years ago called the Ideal Implant. I am interested in a breast augmentation and it sounds like a good alternative to silicone implants. However, at the time I read the article they were very new to the market and I was worried that they had not been in use long enough to know for sure that they are safe. Are you still using these new saline implants and if so, do you think they are good implants?

A. The implant that you are referring to is called the structured saline implant and is manufactured in Wisconsin by a company called the Ideal Implant Company. The implant design is unique to breast implants and reduces one of the major issues of saline implants, implant rippling, which can be palpable on the surface of the breast. I am still using this implant and now have more than three years’ experience with the Ideal Implant and have over one hundred patients who have chosen it. The more that I use it, the more I believe it is an excellent alternative to the silicone gel implant and the standard saline implant. However, not everyone needs to use this implant. About 25% of my patients are still very good candidates for the standard saline filled implant, which has the advantage of being less expensive than the Ideal implant. The remaining 75% of breast augmentation patients are better candidates for either the Ideal implant or silicone gel implants. The best candidate for the Ideal implant is someone who has small breasts (B cup or smaller) and does not want to use a silicone gel implant. There are some advantages of the Ideal implant over the silicone implant, including less likelihood of hardness (capsular contracture), ease of diagnose of a leaking implant, and less risk of visible or palpable rippling on the skin surface of the breast when compared to standard saline implants. It is important to know that a leaking implant is not really a complication but more of an expectation after a certain amount of time that the implant has been inside your body. All implants, saline and silicone gel, given enough time will eventually fail. With any saline containing implant, it is much easier to know when the implant has leaked because the saline (salt water) will be absorbed and then excreted from the body and the breast will get smaller. With a silicone gel implant, the leaked silicone will not leave the breast so there will not be any change in the size of the breast. The only accurate way to determine that the silicone implant has leaked is to perform an MRI. The other advantage of the Ideal implant is less frequency of hardness of the breasts that occurs as a result of scar tissue that forms around the implant. So as you can see, there are some advantages to using the Ideal implant which, in my opinion, is an improvement over the standard implant and the silicone gel implant.