Once you have made the decision that you would like to pursue breast augmentation, it is important to learn about your implant options. The amount of information available can be overwhelming, so I will try to condense it here for quick reference. I will include an explanation of the preferences I have and why I have them. You should be an implant expert by the end of this article!

Saline and silicone implants have been around since the 1960s. Both types have an outer shell made of silicone. Saline implants are filled with salt water and silicone implants are filled with a different type of silicone than the shell. The silicone on the inside of a silicone implant is now very thick, compared to earlier-generation implants. This prevents the gel from oozing out if the shell tears. Saline implants feel firmer than silicone, which is one of the reasons I prefer silicone. Saline implants exhibit more rippling, which can show through the skin. Silicone implants rarely ripple.

Patients commonly ask when their implants will need to be replaced. There is really no such thing as a lifetime breast implant. Like most things in life, some maintenance is required. Saline implants only need to be exchanged if they leak. Leaking from a saline implant is easy to diagnose because the breast will decrease in size as the fluid leaks out of the implant, where the body absorbs it. The ability to easily determine when a saline implant needs to be replaced is one of the rare benefits of saline implants over silicone implants. It is not a medical emergency to replace the implant the instant it starts to leak, but the longer a breast is left with an under-inflated implant, the more difficult it is to obtain symmetry. Many saline implants remain intact even twenty to thirty years following implantation. Rarely, I have seen them deflate as early as six months following implantation. They come with a ten-year replacement warranty, so if they fail within the first ten years, the manufacturer assists with replacement costs.

Newer silicone implants don’t “leak” because the gel inside is too thick to ooze out of the shell. If the shell tears, the implants should be replaced, as they are no longer in their original form at that point. Current data shows that approximately one in ten women will need a replacement of their silicone implants at ten years following augmentation. We don’t have data yet at longer than ten years after implantation because these implants have only been manufactured for the last ten years. An MRI has been used to evaluate for shell tears, but ultrasound is being used in studies and may replace the MRI in the future. Even though it is more labor-intensive to diagnose when a silicone implant should be replaced, I think the softer look and feel of silicone far outweighs the challenge in determining their longevity.

Developing scar tissue around a breast implant can make the breast feel firm or look overly round in shape. This is called a capsular contracture. It is more common when implants are placed on top of the pectoral muscle. It is less common with current-day silicone implants than with previous generations of either saline or silicone implants. Currently, less than 15% of women who undergo silicone breast augmentation develop scar tissue. Avoiding contracture is a huge benefit as contracture can lead to additional surgeries, another vote for silicone in my book.

Injecting fat into the breast is a newly developing technique for breast augmentation that may allow woman who want to avoid implants an opportunity to increase their breast size. While the technique shows some promise and is being used widely in Europe, there are some significant drawbacks. The biggest one is that US radiologists are just now starting to be trained in how to read mammograms after fat injections. On some occasions, the injected fat can look like calcium deposits associated with cancer and result in the need for a biopsy. Patients must wear a large vacuum device on their breasts twelve hours a day for three months to prepare the breasts for fat injection. A significant amount of the fat shrinks, and a significant amount needs to be harvested to allow for even a modest increase in size. If you are thin and want more than a cup size increase, this is not a good option for you. The cost is five to ten times greater than breast augmentation with implants. This is still an investigative technique. For the less than one percent of patients I see that would be candidates, I encourage them to seek out a university setting where this procedure is being performed as part of ongoing study protocols.

Deciding which type of breast implant is right for you should be done with the assistance of a board certified plastic surgeon. Hopefully, this information will help you ask good questions at your consultation so that you can make an informed decision and thoroughly enjoy your result.

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