Dear Dr. Seckel, I am considering breast enlargement or breast augmentation with silicon gel breast implants but am concerned about the safety of breast augmentation with silicone gel implants. I live in Boston, and my doctor says silicone gel breast implants are safe but I would like your opinion. I am told that the saline breast implants do not feel as natural as the silicone breast implants. I am very fit and healthy, but my breasts have become much smaller after having my three children. I do not have sagging breasts so I don’t think I need a breast lift. I would appreciate your opinion. I don’t want to have breast augmentation with silicone gel breast implants now and wish I had saline breast implants later. Thank you, Renee, Boston, MA.
Dear Renee,
There are many factors to think about when deciding whether to have breast enlargement or breast augmentation with silicone gel breast augmentation or saline breast 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 silicone gel implants for breast augmentation.
My first comment is that breast augmentation or enlargement with silicone gel breast implants or saline breast implants, if done on an appropriate candidate by an experienced board certified plastic surgeon should produce an equally pleasing and successful aesthetic or cosmetic result.
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 breast implant will create a more natural breast implant feel, more natural than a saline implant-the silicone gel implant often feels more like breast tissue than does a saline implant. Some refer to silicone gel breast augmentation as a natural feel breast augmentation or natural breast augmentation.
However, this difference is subtle not dramatic, and there are many people who have saline breast implants in place, and I cannot tell the difference from a silicone gel 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 a more palpable breast implant. If the surgeon does not over fill the saline implant, a palpable breast implant fold can develop.
Placing the saline breast implant beneath the chest muscle helps prevent palpability 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. Saline implants also tend to form fewer capsules or hardness, about 5% of cases as compared to 13-15% of silicone gel breast implants form breast implant capsules or breast implant hardening, called capsular contraction.
A silicone gel breast implant which has been placed under the breast or muscle, with meticulous technique and which does not form a capsular contraction of breast implant or breast implant 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 breast 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 breast enlargement. The new FDA guidelines require that you have frequent MRI exams to check for breast implant rupture-this is expensive. In addition the additional risk of capsular contraction of the breast implant-13-15% compared to 5% with saline breast implants is significant. 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 breast implants, and are unhappy with folds or the feel of the implant and want a more natural feeling breast implant and choose to have replacement with silicone gel implants. The other large group of patients selecting silicone gel breast implants are younger women, single with no children, who have read a lot about breast augmentation and want the most natural feeling breast implant and do not want a palpable breast implant fold.
It comes down to your priorities and your situation. Silicone gel breast implants are safe and if there are no complications, silicone gel breast implants produce a beautiful natural feeling result. The complication rate-firmness or capsular contraction of the breast implant is greater however with silicone gel breast implants.
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 a palpable breast implant fold 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.
If you would like to see results of breast augmentation check my clinical site drseckel.com.
For further information on how to find and chose a plastic surgeon read Save Your Face or contact me.
Sincerely,
978-369-4499
Concord, Massachusetts