Which is better: saline or silicone? There is no right or simple answer. A saline breast implant is placed completely empty inside the sculpted, customized pocket surgically created for it – then filled directly from an IV bag (i.e. IV saline) – sort of like building a ship in a bottle. This allows for a very small insertion incision and for fine adjustments in the fill volume to get better symmetry when one breast is larger than the other. Silicone implants are pre-filled with a specific volume of sterile silicone – the access incisions to place them must be larger (often at least double the incision size needed for saline implants) and they cannot be volume adjusted after insertion. IV saline is used in millions of patients, all over the world, every day in IV’s where it goes directly into the bloodstream; the body recognizes it as identical to its own fluid composition. No one questions its safety. Silicone is a foreign material to the body but after years of research has been approved as safe by the FDA – but data is still being collected and research is still ongoing. Confirmation or denial of that FDA approval is actually still pending further data review. Many still question the safety of silicone. If there is ever a leak, saline is harmlessly absorbed by the body. Silicone is not absorbed by the body so a leak might go undetected until an MRI is performed. Saline implants commonly cause “rippling”, a small series of indentations that can sometimes be felt or (rarely) even seen through the skin. Rippling usually occurs at the bottom or at the outer side of the breast where the covering tissues are thinner. Rippling is more of a risk factor for thinner women with low body fat and thin skin. Most women with saline implants cannot detect any rippling – those who do usually do not find it overly objectionable. Silicone implants are extremely unlikely to cause any rippling and this is probably their single biggest advantage. Both silicone and saline implants have the potential for looking very beautiful and feeling very soft and nice for years as well as the more uncommon potential to be hard and stiff (due to thick scar tissue formation – the capsule). They weigh about the same but Silicone implants cost more. Don’t believe anything you’ve heard – talk with your board certified plastic surgeon and get the real story.
A breast implant augmentation procedure hurts. Sorry. Are you younger, thinner, and more athletically built than some of your friends…and proud of it? Don’t be so smug – you will probably hurt a lot more after your breast augmentation than will the average patient. Tighter, firmer tissues are more resistant to the expansion and tissue relaxation part of the recovery, and that means more pain. And the bigger the jump you need or want in cup size means more pain, too. The pain is actually more of a pressure-like feeling, very similar to the breast milk pressure pain seen with pregnancy. Some surgeons will use pain pumps, but everybody gets pain pills, and everybody uses up all their pain pills. It usually takes about a week before the swelling begins to subside, the tissues begin to relax a bit, and you stop cursing with every little movement. Most women will feel comfortable enough after a week to return to almost all of their typical daily activities. Until then, it can be a little rough so be prepared. Having someone around for good emotional support is just as important as is their physical ability to lend you a helping hand.
Picking the right size can be tricky. There are good ways and there are bad ways to do this. Every patient knows someone who got “350’s” and went from a 34B to a 34 full C, so you want “350’s”, right? Not necessarily. Every woman’s body is different, the breasts are different, the stretchability, contours, skin/breast tissue density – all different. A review of the photos of 100 women who each received “350 cc” size implants would likely reveal 100 noticeably different variations in size and shape. You can test this by looking at sample before and after photos available all over the internet and make yourself very confused. Adding to this confusion is the fact that bra sizes are not equivalent among different bra brands and styles so what does a cup size really mean? And within a C cup, a woman could be a full C, a middle C, a small C, between a mid and a full C, etc. etc. Which one do you mean when you say “C”? Which one does your plastic surgeon mean when he says “C”? Whew. There are a few good ways to get a better handle on your ideal target range. Look at some of the men’s magazines, bikini catalogs, etc. and start picking out photos of some sizes and shapes. Too big, too small, too fake, too high, too low, just right. You should have your loved one do this too and compare notes. You will find this process very enlightening and probably even a little fun. Bring these photos with you to your consultation. Everyone looking at a photo or two and saying “that’s about where we want to go” means everyone visually and artistically is on the same page. In the end it is all about your plastic surgeon’s best understanding of what you’ve expressed…and his ability to get you in that range – there is never a guarantee of an exact result size. Most women and plastic surgeons will also advise you to go a bit fuller than perhaps you originally thought. In the rather small world of those who are dissatisfied with their augmentations are a very small number of “I think I’m too big” post-op patients and a much larger number of “I should have gone bigger”.
Sometimes a Breast Lift procedure may be needed. If your breasts have any degree of droopiness, a condition plastic surgeons call “ptosis”, a breast lift may be very important to consider. Breast implants fill out and restore volume to the breasts which does help to create a fuller and more lifted “look” but the breasts are not actually lifted. The breasts will still end up positioned fairly low on the chest wall if that’s where they began. And although the nipple/areola areas will be a bit higher and more centered on the breasts, if they started out very low and pointing down, no breast augmentation will make them look right. Significant skin/breast laxity and overall droopiness might require a lift. Only a breast lift truly “lifts” the breasts and reshapes them: tighter, firmer, more round and higher up on the chest where they belong. Only a breast lift can remake the nipple/areola area to be perfectly centered, symmetrically sized and repositioned. Some women make the unfortunate mistake of trying to accomplish these goals via the use of an over-sized breast implant. It simply doesn’t work. The overly enlarged breast will quickly sag once again and then just be a bigger version of its original droopy form. A breast lift is definitely a more involved procedure and typically requires bigger incisions and scars. But cheer up – most women thinking that they might need a lift actually don’t and an augmentation with implants alone will accomplish everything that they seek!
There is no such thing as a routine maintenance “Ten Year Implant Replacement” surgery. There is actually no reliable or conclusive data on how long breast implants really “last”. However, a very practical and realistic way to think about a breast augmentation is that it is quite likely that at some point in your life you will want or need at least one or more additional surgeries for your breasts. This won’t necessarily be because of an actual implant problem – and it usually isn’t. Perhaps the breasts have gotten droopier over the years and a lift may now be needed, or perhaps a larger or even a smaller size has become more desirable. But if you are happy, your regular check-ups are going well, and there is no problem in particular with your breasts or your implants, then nothing need be done – whether it’s 10, 20 or 30 years down the line!
Dr. Lyle Back is originally from New York City, receiving his medical and surgical training at Rutgers Medical School, Cooper Hospital – University Medical Center, and Ohio State. He is Board Certified in General Surgery (ABS) and Plastic Surgery (ABPS). He is a Fellow of the American College of Surgeons (ACS), the American Academy of Cosmetic Surgery (AACS), and a longstanding member of the premier American Society of Plastic Surgeons (ASPS). He served as a Professor of Plastic Surgery at Temple University and St. Christopher’s Hospital for Children and performed reconstructive surgery with “Operation Smile” in Vietnam. He specializes in the full range of the most modern and state of the art cosmetic surgery procedures for the breasts and non-surgical cosmetic enhancement techniques available today.
