Breast Augmentation FAQ

Which type of implant to choose is a very personal decision. Both types of implants are FDA approved and are very safe. There is no difference in how the implants look once in the body. I use both types in my practice, and currently the distribution is about 50% silicone and 50% saline. The main differences are:

• 1.  Cost
  

  a.	Saline implants are $900 per pair
  b.	Silicone implants are $1800 a pair – the increased cost is due to the cost of the studies done over the last 15 years to determine their safety.

• 2.  Incision Size
  

  a.	Saline implant incision size is 2 centimeters. The implant comes empty so it can be placed through a very small incision and then filled once it is in place.
  b.	Silicone implant incision size is 4-5 centimeters. Since silicone implants are pre-filled, they require a larger incision size to place the implant without damaging it.

• 3.  Palpability
  

  a.	Saline implants do not feel quite as natural as silicone implants. This is not an issue when there is adequate tissue to cover the implant. In very thin patients with minimal breast tissue, silicone may be a better choice.
  b.	Silicone implants feel more like breast tissue. If you have adequate breast tissue to cover the implant, you are a candidate for either saline or silicone. If you are very thin with minimal breast tissue, silicone may be a better choice for you.
  c.	Regardless of what type you choose, you will always be able to feel your implant. This is normal. Your partner will not likely feel the implant.

• 4.  Knowledge of Rupture
  

  a.

  Saline – If a saline implant ruptures, you will know because you will lose volume in that breast. The saline is absorbed by the body and will cause you no harm.

  b.

  Silicone – If a silicone implant ruptures, a great majority of patients will not know. This is because the silicone cannot pass through the capsule created by the body around the implant. The only way to tell will be through an imaging study such as a mammogram or an MRI. Although silicone implants have been studied extensively and are known to be safe, some patients have residual concerns about the silent rupture of a silicone implant. If this is your concern, saline may be a better choice for you.

Implants can be placed below the pectoralis muscle or above the muscle. This is a decision that I will discuss with you and we will decide together what the best position is given your anatomy and goals. My goal is to give you the most natural appearing result that meets your size goals. In thin patients without much breast tissue to cover the implant, placing the implant under the muscle gives an additional layer of soft tissue coverage resulting in a natural appearance. Patients that have more droop or constricted lower breasts may be better candidates for placing the implants on top of the muscle. There is a slightly lower risk of capsular contracture (hardening of the breasts) if the implants are placed below the muscle. Implants below the muscle will also have more motion with muscular contraction of the pectoralis (chest muscle).

The incision to place the implant can be placed in the crease below the breast, in the armpit (axilla), in the areola (pigmented tissue around the nipple) or even through an incision in the umbilicus.

The incision below the breast is not visible to you or others, and is the most direct approach to the space above or below the muscle. It is my preferred incision. The armpit and areolar incision will be visible to you and others while healing. Usually they fade to a fine line when healed. However, they may have permanent pigmentation following healing resulting in continued visibility to you and others. The umbilical incision is quite a distance from the breast and although it has been used successfully, if a complication such as bleeding should arise, the incision below the breast will be used to treat the complication, since visibility will be better.

This is a very personal decision. It is difficult to look at breast pictures on the Internet and find the person that “looks just like you”. The best thing to do is try on implants in the office and see what you feel comfortable with. When trying on implants, it is important to bring several items of clothing so you can see what you look like in different styles, necklines, suit jackets and even swim suits. Most patients are concerned about going too big, and then say after surgery “I wish I had gone bigger”. I will help guide you in choosing your implant size based on your chest measurements and goals. While bra size cannot be guaranteed due to manufacturing inconsistencies between brands, I will help you determine what size you will most likely be following surgery. This is important, because you want to be able to buy pretty bras after surgery! If you choose a size that is not common, it may be difficult to find a bra that fits you well following surgery – that is a frustration you don’t need after you have treated yourself to this procedure. During the office visit, it is best to try on several sizes, even ones that you feel are too large, to determine your upper limit. Then you will not second guess yourself after the surgery about size! Ultimately, it is your decision and it is critical that you feel comfortable with your selection.

Capsular contracture is when the breast implants harden. This happens in a small percentage of patients following breast enlargement surgery. The causes are: infection, bleeding, and inflammation. During surgery, every effort will be made to minimize the risk of infection. You will be given antibiotics before and after surgery, the surgical site will be irrigated with triple antibiotic solution and the implant will be soaked in this solution as well. To prevent bleeding, you will be required to stop all aspirin and ibuprofen containing medications 2 weeks prior to surgery. During surgery, all bleeding will be stopped. The key to diminish inflammation is to take it easy following your breast enhancement. Especially avoid any repetitive upper arm activity for the first two weeks after surgery. Additionally, you will be given instructions on breast massage to help diminish the risk of capsular contracture. If you get a capsular contracture and it is painful or distorts the appearance of your breast, then additional surgery will be required to alleviate this problem. There will be additional fees for this surgery.

Implants do not need to be changed unless there is a problem. Every time you have surgery, you are at risk for complications. So, there is no need to subject yourself to unnecessary risk unless you have a problem such as capsular contracture or implant deflation.

A breast augmentation does not lift the breasts, it makes them larger. This often appears to have lifted the breast, because the areolar complex is projecting out further with more visible breast tissue below it. If you are concerned about breast droop, you may need a breast lift instead of a breast enlargement. If you are happy with your breast size in an unpadded bra, but are unhappy with your breast appearance without a bra, then you are a better candidate for a breast lift or mastopexy procedure. If you have droop and would also like to be bigger, then you may be a candidate for a breast lift and augmentation. During your consultation, your breast measurements will be taken and this information, along with your individual concerns about your breast appearance will be used to determine what procedure fits your needs the best. Be wary of recommendations to place a larger implant than you are comfortable with for the “lift” it will give you. You will feel too large following surgery and will not have the lift you wanted.