New Clinical Study Uses Arbrea Breast 3D to Reveal How Implant Type Shapes Long-Term Breast Augmentation Outcomes

The research team enrolled 106 patients (212 breasts) undergoing primary breast augmentation at a single private practice. Recruitment took place over two years, from June 2022 to June 2024. Each patient was then followed individually for 12 months postoperatively. All procedures were performed by the same surgeon using a dual-plane technique through the under the breast fold incision. This deliberate design choice minimized variability and isolated implant characteristics as the primary variable.

Five implant types were included in the study:

• Progressive Gel ULTIMA (PgU), smooth round
• HSC+ gel, smooth round
• Round, microtextured (HSC+ gel)
• Anatomical, microtextured (HSC+ gel)
• Anatomical, polyurethane (PU) coated

Surgeons assessed patients preoperatively, at 6 months, and again at 12 months. At each visit, the team used Arbrea software to perform 3D measurement-based analysis from standardized 2D photographs. Two key indicators of implant behavior were measured at every follow-up:

• Nipple-to-under the breast fold distance (N-IMF): a direct measure of lower pole stretching, recorded in centimeters
• Lower pole ratio (LPR): the percentage of lower pole volume relative to total breast volume

Why These Measurements Matter

Lower pole stretching is one of the most clinically significant changes that can occur after breast augmentation. Too little stretching in the early postoperative period can indicate a tight and unnatural result. On the other hand, too much stretching, particularly in patients with tissue looseness, can lead to bottoming out, implant displacement, and revision surgery. Tracking N-IMF and LPR over time therefore gives surgeons an objective view of how the implant is interacting with surrounding tissue. Before tools like Arbrea, surgeons had to rely on visual assessment alone.

Key Findings: Not All Implants Behave the Same

The study found a clear ranking of implant stability across all five groups. Overall, surface texture and gel firmness were the two factors that made the biggest difference.

Smooth Implants: The Most Change Over Time

First, smooth PgU round implants changed the most. Between 6 and 12 months, the nipple-to-under the breast fold distance increased by nearly 1 cm on average, and the lower pole volume share grew by almost 7 percentage points. This happens because the softer PgU gel shifts downward when the patient is upright, gradually stretching the lower pole over time. As a result, the outcome can look natural and full. However, it also means these implants carry more risk in patients with soft or loose tissue. Similarly, smooth HSC+ round implants showed moderate stretching, roughly half that of PgU implants, with better upper pole fullness preserved. Nevertheless, measurable change still occurred between 6 and 12 months.

Textured Implants: Better Control, More Predictability

In contrast, microtextured implants, both round and anatomical, sat comfortably in the middle. Adding surface texture and increasing gel firmness slowed down tissue adaptation without stopping it entirely. Therefore, these implants offer a strong middle ground for patients who need positional control but still want a natural feel.

Polyurethane-Coated Implants: Virtually No Movement

Most remarkably, polyurethane-coated anatomical implants barely moved at all. Over the full 12-month period, the average change in lower pole distance was just 0.04 cm, which is statistically zero. This is because the polyurethane coating encourages surrounding tissue to grow into the implant surface early on, effectively locking it in place. Consequently, PU-coated implants proved to be the most stable option, particularly for active patients or those with tissue looseness.