Many people have written me about the safety of silicone gel breast implants and how to decide which type of implant to choose. I am reprinting here one response which I think presents helpful guidelines for women considering breast augmentation or enlargement, or Breast Lift, and trying to decide which breast implant to choose, saline or silicone gel.
There are many factors to think about when deciding whether to have breast enlargement or augmentation. The newer silicone gel breast implants have been approved by the FDA and have been available since January 2007. Many women share your concern about the safety of these new implants for breast augmentation.
My first comment is that breast augmentation or enlargement, if done on an appropriate candidate by an experienced board certified plastic surgeon should produce an equally pleasing and successful aesthetic or cosmetic result with either type of implant.
The main difference in the result of breast augmentation with saline breast implants from that with silicone gel breast implants is the feel of the implant. If there are no complications such as hardening of the implant, and the result of the surgery is satisfactory, then a silicone gel implant will feel more natural than a saline implant.
There are many factors which contribute to the different feel of the Saline implant and most of them can be predicted or managed. In very thin women with very little breast tissue to cover the implant, the saline will be more palpable. If a capsule forms around the saline implant, it will be more palpable. If the surgeon does not over fill the saline implant, palpable folds can develop.
Placing the saline breast implant beneath the chest muscle helps to prevent palpable folds in the implant and over filling the implant helps prevent folds. Meticulous surgical technique and avoidance of bleeding during surgery also helps avoid the capsule which is scar tissue which makes the implant hard.
A silicone gel breast implant which has been placed under the breast or muscle, with meticulous technique and which does not form a capsule or hardening does result in the most natural feeling breast. A "perfect result" with a silicone gel implant does feel better than a "perfect result" with a saline implant, but visually, the way they look, is about the same, in my opinion.
There are however disadvantages to silicone gel implant breast augmentation or enlargement. The new FDA guidelines require that you have frequent MRI exams to check for rupture-this is expensive. The risk of capsular contraction of the breast implant is about the same with the newer gel implants as with the saline implant-13-15%. In addition if the implant does rupture and need to be replaced, the surgery to replace a silicone gel breast implant is more complex than that for a ruptured saline breast implant.
Most women in my practice find the decision an easy one. Many patients are very health conscious and only concerned with safety, want the least risk, don't want to bother with MRI's, and are most concerned with how the breast looks and don't care about a subtle difference in feel and want the least risk of firmness or capsular contraction of the breast implant. These patients are usually married, have children, and are in their late 20's to early 40's. They typically choose saline breast augmentation.
By far the largest group who select silicone gel breast augmentation are patients who have had a previous breast augmentation, usually with saline implants, and want a more natural feeling breast implant and choose to have replacement with silicone gel implants. The other large group of patients selecting sgel breast implants is younger women, single with no children, who have read a lot about breast augmentation and want the most natural feeling implant.
It comes down to your priorities and your situation. Silicone gel breast implants are safe and if there are no complications, they produce a beautiful natural feeling result.
If you want the peace of mind of not worrying about firmness and having to have MRI's and worrying about the possibility of rupture and you are willing to accept the fact that the implant will be subtly palpable and MAY (many do not form folds) form palpable folds that likely only you will notice, the saline breast implants are a better choice for you.
If you want the best feeling or most natural feeling implant then silicone gel breast implant is the best choice.
The most important thing is for you to find an experienced board certified plastic surgeon who has done many breast augmentation operations and can give you an honest opinion.
In my opinion the most important factor in achieving a good result with either type of breast implant is the skill and experience of the surgeon. This operation needs to be done meticulously and carefully, and not all surgeons take this approach.
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