Palpable folds beneath the breast skin are the most common complaint I hear among women who have had saline breast implant breast augmenatation.

Breast augmentation or breast enlargement with breast implants is one of the most common plastic surgery procedures. Results are usually excellent and patient satisfaction is very high.

Above: Before and after breast augmentation

Breast augmentation is also frequently done in combination with a breast lift for patients who have had sagging or breast ptosis after having children:

Above: Before and after breast lift and breast augmentation

Unfortunately a very high per cent age of Saline breast Implants do develop palpable, and occasionally visible folds after a number of years. The problem is intrinsic to the saline implant and is the most common complaint I receive. The breasts usually look excellent but patients just don’t like the feel of the saline implant especially if they feel the fold. Most commonly the fold occurs, as it has in you, at the bottom of the breast and towards the side.

Most plastic surgeons over fill the saline implants to avoid this problem but folds still do occur.

The new silicone gel breast implants are much less likely to cause folds and generally feel more natural than saline breast implants. Safety data for the new silicone gel breast implants for breast augmentation and breast enlargement is excellent and complication results are very similar for saline implants and the new generation of silicone gel implants.

Breast implant folds are felt to be more common with low profile breast implants. The low profile implants have a wider base and less projection and do have a greater tendency in my experience to cause folds.

Today I more frequently choose a moderate or medium profile implant which projects the breast more forward and has fewer tendencies to fold.

In patients who complain of folds in their saline breast implants my recommendation would be to replace the saline breast implant with a moderate profile silicone gel breast implant, possibly a bit larger to fill the space and compensate for any stretching of the skin from your previous breast implants.

My experience with the new silicone gel breast implants has been very positive. Patient satisfaction with the silicone gel breast implants has been very high and patients who have replaced their saline breast implants with the new silicone gel moderate profile breast implants have been very happy with the results.

The safety data are very similar for both the saline and new silicone gel breast implants. The one downside is that the FDA recommends follow up MRI scans to check the implant at 2 years. This is a safety feature but can be an inconvenience to you.

Typically the procedure to remove your old saline breast implants and replace them with new silicone gel breast implants is a very simple procedure with less discomfort and recovery than was experienced with the initial breast implantation or breast augmentation surgery.

Thank you for your excellent question.

If you would like to learn more about plastic surgery or breast implants please visit DrSeckel.com or contact me at 978-369-4499.

Be sure to sign up for my newsletter to learn about new developments in breast augmentation and plastic surgery.

Thank you,

Dr Seckel

978-369-4499

Concord, Massachusetts

Boston, Massachusetts

There are many factors to think about when deciding whether to have breast enlargement or breast augmentation with silicone gel breast implants or saline breast implants.

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 feel more natural than a saline implant-the silicone gel implant often feels more like breast tissue than does a saline implant.

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 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 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 capsules or hardening.

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 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 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 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 is younger women, single with no children, who have read a lot about breast augmentation and want the most natural feeling breast implant.

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 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.

For further information on how to find and chose a plastic surgeon read Save Your Face or contact me.

Sincerely,

Dr Seckel

978-369-4499

Concord, Massachusetts

Boston, Massachusetts