Breast Augmentation FAQs

woman in floral bra1. What should I expect to pay for Breast Augmentation surgery?

In Central Ohio, the average cost for Breast Augmentation surgery with saline implants is about $5600-5800 and around $6600-6800 for silicone implants. This includes the cost for the implants, surgery, anesthesia and the facility but not your medications. These can usually be purchased using your insurance prescription card. Beware of those charging significantly more or less than this! You get absolutely nothing for paying much more. If anyone is charging much less, there is a reason for it and it's probably not a good one. 

2. Are silicone implants available?

The FDA has recently approved silicone gel breast implants for any woman considering Breast Augmentation who is at least 22 years of age. 

3. What is the implant shell made of with saline implants?

Saline Breast Implant
Saline Breast Implant

The shell of all saline implants is made of silicone. It is a solid silicone rather than a silicone gel so there is very little risk of silicone leaking out into the tissues. It is essentially the same shell as the new silicone gel implants except that they have a fill port which is used to inflate the implant through a tube after it has been inserted.

4. What is saline?

Saline is a sterile salt water solution that is inserted through a fill tube into the implant after the implant has been placed into the breast. It consists of water, sodium and chloride in similar concentrations to what is found naturally in the body. 

5. Is sterile saline safe?

Yes. It is the same solution that is injected directly into the veins of almost every hospitalized patient or those undergoing surgery. It is only unsafe if it is contaminated or in excessive amounts, much more than what is placed in breast implants. 

6. How are saline implants different from silicone implants?

Since silicone gel is much thicker than saline, silicone implants tend to feel more like natural breast tissue. While saline implants come empty so that they can be inserted through smaller incisions and filled after they are placed in the breast pocket, silicone implants are pre-filled, so they require a longer incision to be inserted.

When silicone implants rupture, the over-whelming majority of the silicone stays in the pocket within the breast capsule so the size of the breast doesn't change. For this reason, it can be very difficult sometimes to tell when a silicone implant is ruptured. There are no good tests, such as mammograms, ultrasound, CT-scans or MRI to determine whether a silicone implant is intact or not. MRI is probably the most accurate at detecting a rupture. When a saline implant ruptures, the saline escapes, it is absorbed by the body and is eliminated. This generally results in a loss of breast volume which indicates that the implant has lost its integrity. Therefore, it is typically very obvious when a saline implant has ruptured because the breast becomes much smaller. Silicone implants also usually have somewhat of a higher risk of capsular contracture, which is firm scar tissue forming around the implant, causing the breast to feel harder than normal. However, the new cohesive gel silicone implants not only have a thicker shell, but also are composed of a thicker silicone gel than the old silicone implants. Therefore, the risk of capsular contracture should be much lower for the new implants compared to the old silicone implants.

7. Is there a warranty which covers a ruptured implant?

Both Allergan and Mentor, the two major breast implant companies, provide lifetime warranties for their breast implants. If an implant ever ruptures, they provide you with a free implant. Although there are slight differences between their coverage, both also provide up to $1200 for saline and $2400 for silicone implants to cover the costs of replacement if the rupture occurs within the first ten years after surgery. Believe it or not, they also offer extended warranties which can be purchased after surgery. It's kind of like buying an appliance. 

8. How do I know that my plastic surgeon is qualified?

There is no way to get a guarantee of results. You should, however, at least make sure that your surgeon has had adequate training. There are many physicians, some not even surgeons, masquerading as plastic surgeons with very little or no training at all in plastic surgery. Neither the internet nor the telephone book company care about the truth, honesty, training or credentials. They'll let almost anyone advertise as a plastic surgeon. Make sure that your surgeon is certified by the American Board of Plastic Surgery. It is the ONLY legitimate plastic surgery board. It is the only one that evaluates a surgeon's prerequisite training, plastic surgery training, practice performance and requires passage of rigorous written and oral examinations. One way to find out if your surgeon is truly board certified is to see if he or she is a member of the American Society of Plastic Surgeons, Inc. (ASPS). All members of the ASPS are certified by the American Board of Plastic Surgery. Visit their website at www.plasticsurgery.org. I would also recommend that you go one step further. To make sure that your surgeon specializes in aesthetic surgery and, therefore, is not only well trained, but is also very experienced, make sure that he or she is also a member of the American Society for Aesthetic Plastic Surgery (ASAPS). Surgeons that are members of ASAPS are all certified by the American Board of Plastic Surgery, members of ASPS, and have a practice that is dedicated to aesthetic surgery. You can visit their website at www.surgery.org. Would you let a plumber do the electrical work on your house? Would you have a mechanic do your taxes? How about an orthopedic surgeon operate on your heart? Then why have an untrained physician, maybe not even a surgeon perform cosmetic surgery on you? If you wind up in someone's office that doesn't have the above credentials, don't walk but run out of that office. And forget the consultation fee. They don't deserve to be paid for trying to deceive you. 

9. What is the difference between smooth and textured implants?

Textured implants have an additional shell attached to a smooth implant to create a rough surface. The purpose of texturing is to try and reduce the risk of capsular contracture. There is no good evidence to show that texturing is successful in reducing the risk of capsular contracture, particularly when the implants are placed under the pectoralis muscle. There are a few problems with textured implants. Since the shell is thicker, they are easier to feel through the skin and breast tissue than smooth implants. They also have a higher risk of implant rupture and wrinkling of the skin. Textured implants are somewhat more expensive than smooth implants. 

10. Is it better to put the implants under or over the muscle?

There are very few circumstances where implants should be placed on top of the muscle. Up until the late 1980's, implants were routinely placed on top of the muscle. Since then, multiple advantages of subpectoral (under the muscle) placement have been discovered. These include a lower risk of capsular contracture, less visibility and palpability of the implants, less interference with mammography and, therefore, interference with cancer detection, and better support of the implants to reduce falling or sagging with gravity. Disadvantages include a little more pain with surgery and motion of the implants with contraction of the chest muscle. 

Everyone considering Breast Augmentation surgery should assume that, some day, they may want their implants removed. When that happens, it is likely that many of them will want to have a breast lift (mastopexy) done at that time. Performing a breast lift when implants have been placed on top of the muscle carries a significant risk of necrosis (death, loss of) the nipple and areola. That risk is markedly reduced if the implants have been placed under the muscle. 

11. Are round or shaped implants better?

Round implants are by far the most popular and are less expensive. Shaped implants occasionally turn into the wrong position in the pocket creating an odd shape to the breast. Round implants tend to assume a natural breast shape in a standing position and become more round when laying down, similar to what a normal breast does. Shaped implants tend to keep the same shape in any position, giving them a more 'glued on' appearance.

12. Why do some implanted breasts look more fake than others?

If you put a very small implant into a large breast, you will never see or feel the implant and it will look and feel very natural. Of course, it won't make much of a change in the size of the breast. If you put a very large implant into a very small breast, there is very little natural tissue to cover up the implant, so it will look and feel very unnatural. Therefore, women with larger breasts and smaller implants have a more natural look than women who have smaller breasts and larger implants. In addition, implants placed on top of the muscle also may have more of a 'rock in a sock' appearance because there is less natural tissue to cover up the implant and because there is frequently more capsular contracture. This results in the implant assuming more of a round ball shape as opposed to a more natural disc shape in the breast. 

13. What type of anesthesia is typically used for Breast Augmentation?

Most patients undergo general anesthesia where they are put completely to sleep. This avoids any problem with seeing, hearing or feeling anything during surgery. Some patients have a problem with nausea after general anesthesia so we normally give patients medications to reduce the risk of nausea. The problem with a sore throat after anesthesia can usually be alleviated by using an LMA (laryngeal mask anesthesia). This is a soft, inflatable mask placed over the vocal cords rather than placing a tube between the vocal cords. This reduces the chance of throat irritation. Some patients choose to have an epidural. Epidural anesthesia for Breast Augmentation is a little different from epidural anesthesia for giving birth. The latter provides anesthesia from the waist to the toes while the former anesthetizes from the shoulders to the belly button. Not all anesthesiologists perform epidural anesthesia for beast augmentation, so it generally needs to be requested in advance. Fortunately, I work with several very experienced anesthesiologists from Riverside Methodist Hospital who have considerable expertise in epidural anesthesia. With an epidural, you do not have to be awake. You can still be given be given medications so that you are unaware of what is happening during the surgery. Just local anesthesia with intravenous sedation is not a good option for implants placed under the muscle. 

14. What are my options for where the scar is placed?

Under the breast, hidden in the crease is the most popular and usually the least visible scar. It is usually about 3.5 centimeters in length for saline implants and about one centimeter longer for silicone implants. This is the most direct route to the implant pocket. Around the lower half of the areola is often used as well but it is frequently a more visible scar. Under the arm in the axilla is also possible but this technique has the highest risk of implant malposition. In addition, this can be a very visible scar when wearing a bathing suit or a sleeveless shirt. Theoretically, this incision can interfere with future breast cancer surgery. Through the belly button is not generally recommended. The complication rate is higher and using that approach may void the warranty on the implants. 

15. Is it all right to have another surgery such as liposuction or a tummy tuck at the same time as Breast Augmentation or is it better to do them separately?

In recent years, combination surgeries have become very popular. It is important, of course, to keep safety as the prime consideration. For healthy patients, it is usually safer to undergo one larger surgery that two or three smaller surgeries. There can be a considerable time savings in going through the recovery from surgery once as opposed to several times. In addition, there can be a significant cost savings. The most expensive part of the anesthesia and facility fees is usually the first hour, with additional time adding an incremental increase in cost. Therefore, going through the first hour once as opposed to two or three times can markedly cut down on the costs. Most surgeons will reduce the cost of a second or third procedure done at the same time as well. This can result in savings in the thousands of dollars. Under most circumstances, the procedures are still done as an outpatient. 

16. What is the typical recovery period for Breast Augmentation surgery?

Most patients who perform relatively sedentary jobs or who are going to school return to these activities within about one week. Performing more strenuous jobs or physical activity such as exercising may take two to three weeks. It is important to not perform strenuous activities for the first week while you are recovering from surgery. After that, you can gradually increase your activity depending on how you tolerate it. Let common sense be your guide. If it hurts, don't do it. One thing that I do that really cuts down on the pain and speeds your recovery is to inject both long and short acting local anesthetics into the implant pocket prior to inserting the implant. This is sometimes referred to as tumescent plastic surgery. This means that when you wake up, rather than being in a lot of pain, the area is pretty numb so you don't need much pain medication right after surgery. This also cuts down on the amount of anesthesia that you need which can speed up your recovery and reduce the risk of nausea. The numbness lasts for several hours which allows you to get out of the recovery room faster, go home, get into a comfortable position, put on some ice packs and take your pain medication as needed. Most patients take the /h3er pain medication for the first day or two after surgery and a lighter medication for several days after that. We also give you a muscle relaxant which reduces stress, muscle spasms and anxiety after surgery. 

17. If someday I need to have another surgery on my breasts, such as to replace a ruptured implant or change to a different size or style, do I go through the same recovery?

No. Most of the pain from Breast Augmentation is from creating the pocket under the muscle. Once that has been accomplished, performing a second surgery is much easier. The pain is usually minimal and most patients feel normal within a day or two. 

18. Why do so many women say after surgery that they wish that they had gone larger?

Sometimes, a mistake has been made in selecting the size of implant prior to surgery. In addition, many women get used to the swelling that occurs after surgery. This goes down in a few weeks or months after surgery. At the same time, some of the natural breast tissue shrinks due to compression caused by pressure from the implant. This happens more in some patients than in others and is very difficult to predict. It is important to remember that larger implants, while making the breasts larger, also make them look and feel more fake. It can be a fine line in selecting the size of implant; what's more important to you, smaller and more natural or larger and less natural? 

19. Why is it that some breasts don't look symmetric after augmentation?

No two breasts are identical. There is always a little bit of difference. When you augment the size of the breasts, sometimes their differences are augmented as well. This is particularly true with nipple position. If one nipple is one half of an inch higher than the other before surgery, it may be a full inch higher after surgery. This may not bother some women, but this difference may be obvious when wearing a shirt without a bra. This can be corrected at the same time as the augmentation or later with a minor breast lift. A difference in breast size can often be corrected by placing a larger implant in the smaller side. This means, of course, that the smaller breast with the larger implant will feel less natural than the larger breast with the smaller implant. Still the breasts may not look exactly the same size or shape. Asymmetry is a bigger problem when it is due to asymmetry of the chest wall (rib cage) or to a significant difference in the position of the crease underneath the breasts. These conditions should be recognized prior to surgery and your surgeon can discuss with you what could be done, if anything, to improve symmetry. 

20. What can be done to reduce the risk of bleeding during surgery?

At the time of your consultation, you should receive a long list of medications to avoid for two weeks before surgery. Most importantly, anything that contains aspirin. But even ibuprofen, Vitamin E, gingko biloba, etc. can increase your risk of bleeding and bruising. Pay close attention to this list! After surgery, it is important to avoid strenuous activity for at least a week to prevent delayed bleeding. Many patients find that using ice packs over their breasts for 24-36 hours helps to reduce bruising and also helps with pain relief. 

21. What is the risk of infection for Breast Augmentation?

Fortunately, the risk of infection is less that one percent. The problem is, if an implant gets infected, it usually has to be removed. It can be replaced with a new implant three or four months after the infection has resolved. Occasionally, it can be resolved with antibiotics alone. I place all of my patients on antibiotics before surgery which is continued for about one week after surgery. In my experience, infection is extremely rare. 

22. What is capsular contracture and what can be done to avoid it?

Capsular contracture is an abnormal tightening of the scar tissue around the implant causing it to become hard and painful and possibly to assume an abnormal shape. It was more common with the old, thin-walled silicone gel implants, particularly if they were placed on top of the muscle. The best things to do to prevent capsular contracture are to use saline implants and to put them under the muscle. 

23. Does massaging your breasts after surgery reduce the risk of capsular contracture?

There is no good evidence to show that breast massage reduces the risk of encapsulation. Regretfully, many surgeons use this as an excuse to blame the patient for their firm capsules, claiming that they didn't massage them enough so the capsules got hard. If it makes you feel better, there is no harm in doing massages, but it really doesn't change your risk for capsular contracture. 

24. Is extrusion of the implant a possibility?

Extrusion of a breast implant means exposure of the implant either through the skin or by separation of the incision. This is a rare problem that usually indicates an underlying problem such as an infected implant or an excessively large implant. The risk of extrusion is significantly increased if steroids are place in the implant pocket, which is not recommended. Extrusion of an implant generally means that the implant has to be removed and can be replaced with a new implant in about three or four months. The risk of extrusion is also higher when a full breast lift is done at the same time as Breast Augmentation. 

25. Can any silicone from the shell of a saline implant get into the tissues?

Anything that is inserted into the body will degrade or break down to some degree over time. If a biopsy was performed on the scar tissue around a saline implant, chances are that a microscopic amount of silicone would be found. There is no evidence to show that this causes any significant medical problems. 

26. Do breast implants get in the way of doing mammograms?

Yes. The concern is that this could cause a delay in the detection of breast cancer which may result in it being more advanced at the time of discovery and, therefore, make it less curable. On the average, somewhere around 30% or more of the breast tissue is hidden by the implant on a mammogram. A larger breast with a small implant has less tissue hidden than a small breast with a large implant. In addition, the implant gets in the way more if it's placed on top of the muscle than when it is placed under the muscle. At this time, studies show that women who have breast implants, have the same risk of breast cancer as women who don't have implants and that their cancer is not generally found at a later stage. Women with breast implants and subsequently develop breast cancer have the same prognosis and have similar survival statistics as women who get breast cancer without implants. If you are 40 years of age or are 35 with a family history of breast cancer, you should have a mammogram prior to surgery. 

27. Can a mammogram rupture my breast implant?

Yes, but it is very rare and it does not void your warranty. 

28. What can be done to prevent wrinkling or rippling of the implant?

The reason wrinkling and rippling can occur with breast implants is because, if you think about it, a saline implant is basically just a water bottle. A water bottle wrinkles, ripples and sloshes because water is such a thin liquid. The most important thing to do to reduce these risks, very simply, is don't choose too big of an implant. If there is very little breast tissue to cover up the implant and a large implant is chosen, it will look and feel just lake an implant. The more natural breast tissue that is present and the smaller the implant is, the less chance of wrinkling and rippling. The second most important thing to do is put the implant under the muscle, so there is more natural tissue to cover up the implant, particularly on the upper half of the breast. 

29. Is it possible to breast feed after getting breast implants?

Yes, I have had many patients successfully breast feed after getting breast implants. However, that is not a guarantee that you would be able to do so. Since breast implants put pressure on your natural breast tissue and cause it to shrink over time, I believe that this results in less milk production while trying to breast feed. Hence, breast implants may increase the possibility of needing to supplement with a bottle. 

30. Once breast implants are put into the body, do they stay where they are put or can they move?

Migration or displacement of breast implants can occur over time. Initially after surgery when implants are put under the muscle, there is usually considerable tightness of the lower muscle and skin. This causes the implant to bulge superiorly causing excessive fullness to the upper aspect of the breast. Gradually, as the skin and the muscle stretch, the upper breast fullness goes down and there is more fullness on the lower aspect of the breast, increasing the projection of the breast. At the same time, the implants move down a little, this is referred to as 'settling.' Usually, the implants settle pretty much into the same position, but not always. If one settles more than the other, asymmetry results. Many times this is due to a natural difference in the chest wall from one side to the other causing the implants to sit in a different position. No treatment is necessary if the difference is not very noticeable. If there is a big difference, it may be necessary to reposition one of the implants. Sometimes, when there is a significant chest wall or rib cage asymmetry, it can be difficult to obtain good symmetry of the breasts. Implants can also move off to the side creating a wider space between the breasts. This can occur either because the surgeon failed to adequately release the medial aspect of the pectoralis muscle near the middle of the chest, or because there is a steep slant to the ribs causing the implants to fall off to the side when laying on your back. The former can be treated by releasing the muscle while the latter can be very difficult to overcome. Some women just have a very wide breast bone (sternum) which causes a wide separation between the breasts.

31. I've heard that implants can cause a deformity of the ribs, is that true?

It is true that implants can cause an indentation of the rib cage. It is much more common and more significant with tissue expanders. These are saline filled balloons that are inserted following breast cancer surgery for reconstruction of the breasts. They are gradually inflated on a weekly or biweekly basis and build up a lot of pressure to stretch the overlying muscle and skin. It is not unusual for these to result in 1-2 centimeters of rib cage indentation which may resolve over time after a standard implant is inserted. It is much less common with implants inserted for Breast Augmentation but is possible with larger implants. 

32. I do a lot of strenuous activity like running, weight lifting and kick-boxing. Do these activities increase the risk of implant rupture?

Despite 18 years of performing Breast Augmentation and having inserted thousands of breast implants, I have yet to see a single implant rupture related to strenuous activities. This includes numerous fitness experts, professional body-builders, marathon runners and kick-boxers. These activities do not void your implant warranty. 

33. What are the long-term effects of having breast implants?

Over time, your breasts undergo two changes as a result of getting breast implants. You grow some additional skin to accommodate the increase in breast volume and your own breast tissue shrinks to some degree as a result of pressure from the implant. This means that, if some day you decide to have them removed, you don't return to the same size and shape you were before augmentation. You have two changes: You're smaller and you have more sagging. This means that many women may choose to have a breast lift (mastopexy) if they eventually decide to have their implants removed. 

34. What is Mondor's disease and what can be done about it?

Mondor's disease is a condition where a blood clot develops in a vein underneath the breast, causing a tender ridge or band to form extending down from the breast crease. It only happens after 2-3% of Breast Augmentation surgeries and is noticed 2-3 weeks after surgery. It is easily treated with aspirin and warm compresses. 

35. At this time, is there any known disease caused by silicone breast implants?

Currently, there is no conclusive medical evidence that silicone implants cause or increases the risk of developing any auto-immune diseases such as scleroderma, rheumatoid arthritis, lupus or fibromyalgia. 

36. Do breast implants cause stretch marks?

Breast implants of average to moderate size do not normally cause stretch marks as long as they are placed under the muscle. Large implants and those placed on top of the muscle can contribute to stretch marks. 

37. I've heard that some women hear or sense a sloshing in their breasts soon after surgery, what is that?

The pocket that is created in the breast is slightly larger than the implant. In between the implant and the edge of the pocket, the empty space fills with fluid form the body. If you reach or bend over a few days after surgery, you may sense the motion of that fluid. It is not the fluid in the implant at it does not mean that the implant is leaking. This fluid eventually gets absorbed and disappears. This fluid could also accumulate after strenuous exercise in women who have breast implants but is relatively rare. 

38. I've heard it said that you need to have your implants changed every ten years, is that true?

No. If you are not having any problems with your implants, there is no reason to have another operation. 

39. I know that many women with very large breasts have breast reduction surgery because their breasts cause neck, back and shoulder pain. Is that also true with women who get breast implants?

It is very unusual for women who get breast implants to have these problems. One reason is because most women who get breast implants don't go so large as to cause these symptoms. The other reason is that most implants are placed under the muscle which helps to support the implants unlike natural breast tissue which is on top of the muscle. 

40. Do breasts with implants sag like breasts without implants?

Breasts with implants positioned under the muscle tend to sag less than many unaugmentated breasts and breasts with implants on top of the muscle because the muscle generally helps to support the implants and, therefore, the breast as well. Breasts with implants on top of the muscle don't have that support so they tend to sag more over time. 

41. If I get breast implants, should I just assume that some day I will have a second operation just because of the implants?

Yes. If you assume that some day you will have another surgery just because of the implants, you won't be disappointed when it happens. It may be to go bigger, switch to silicone, shift one, replace a ruptured implant, or maybe a new implant becomes available that is better and more natural. Fortunately, your recovery from a second procedure tends to be very short (See question 17). 

42. I'm afraid that I may be disappointed with my surgery. What should I do?

Figure out what your greatest concerns are and discuss them with your surgeon prior to surgery. If you are not happy with the response, get a second opinion. Most studies show that about 94% of patients are happy with their surgery. This includes patients that have had some problems and require a second surgery. 

43. What should I expect from my consultation about breast implants?

Your surgeon should spend a considerable time with you discussing the procedure, how it is done, what your options are, what the cost is, what your risks are and what can be done to minimize those risks. You should expect a careful examination; you should be shown the implants and allowed to select a size. Your surgeon should help guide you in your decision and not make it for you without your input. You should receive a packet of information which includes a brochure, a consent form, information from the implant company, a list of medications to avoid prior to surgery and a cost estimate. You should have plenty of time to ask questions and you should not feel rushed or pressured. 

44. Is getting breast implants a replacement for getting a breast lift?

No. And don't let anyone tell you otherwise! The larger a breast is, the more it tends to sag with gravity. Making a breast larger with an implant just makes the sagging more appropriate for the size. Don't fall for the 'If I put the implant on top of the muscle, it will correct your sagging and you won't need to have a lift' line. Implants placed on top of the muscle are not supported by the muscle and, therefore, usually create more sagging over time. If you need a lift, get a lift. I have seen many women over the years regret getting breast implants because they were talked into them to avoid getting a lift. They come in saying 'Take these things out and give me the lift I should have had in the first place, I never wanted to be this big.' It is possible, however, to get a slight lift with implants but it will not be a dramatic change. 

45. What is the chance of losing sensation of my nipples with Breast Augmentation surgery?

The national average is about 15% of women lose sensation in one or both nipples with Breast Augmentation surgery. As with most of the risks of Breast Augmentation, the bigger you go, the higher the risk. 

46. How much cleavage can I get with breast implants?

The amount of cleavage you can get with implants has a lot with what you have to start with and how wide your breast bone (sternum) is. Women who have a wide sternum will always have a wide space between their breasts unless the implants are placed abnormally close together. This results in the nipples being positioned wide apart and off to the sides of the breasts which is not very attractive. Trying to put the implants too close together may result in the implants touching one another which creates something called symmastia where it looks like there is only one oblong shaped breast. If the implants are placed over the sternum, visible rippling of the implants may occur in that area because the skin over the bone tends to be very thin. Since the chest is somewhat of a round structure, the breasts naturally should lay slightly off to the sides. Cleavage is created when the breasts are pushed together with a bra or tight shirt. The breasts should be separated when not wearing clothes. 

47. Do breast implants increase the risk of getting breast cancer?

There is no known association between breast implants and breast cancer. Studies have shown that women who get breast implants have a slightly lower risk of developing breast cancer and getting implants does not change that risk. 

48. If I have silicone breast implants, how do I monitor them for rupture?

The FDA has recommended that women who have silicone gel breast implants should have an MRI within three years of their surgery and every two years after that to try and detect implant rupture. 

49. I have very small breasts and I want to be a lot larger with implants, should I go with silicone or saline?

Patients who are very small and want a significant change in size with Breast Augmentation are probably better off with silicone gel implants placed under the pectoralis muscle. This is because the gel implants tend to be more natural feeling and looking, which is particularly important in someone who has very little breast tissue to cover up the implants. Some of the down sides to silicone implants are that they are more expensive, they require a slightly longer incision, they may have a higher risk on capsular contracture and it is more difficult to tell if an implant has ruptured. Patients with silicone implants tend to have less rippling than those with saline implants which is more of a concern in thin patients with less breast tissue. 

50. I have quite a bit of breast tissue and I just want to be a little bit larger, should I get silicone or saline implants?

Individuals in this situation are probably better off with saline implants placed under the muscle. Those who already have a significant amount of breast tissue can go with a less natural feeling implant and still have a natural feel because the implants are covered up with a lot of natural tissue. The advantages of saline implants are that they are less expensive, they require a smaller incision, they probably have a lower risk of capsular contracture and it is easy to tell when they have ruptured. 

51. What is the difference between the new silicone implants and the old silicone implants?

Old silicone implants had a very thin silicone shell and the silicone gel inside was almost like a thick liquid such as honey. This would allow some of the gel to 'bleed' through the shell and into the implant pocket. This would frequently result in a hard capsular contracture as well as calcium deposits in the scar capsule itself. The newest generation of silicone implants have a more substantial shell and the inner gel is also thicker (more viscous), almost like molded gelatin. When an old implant ruptured, all of the silicone would leak out like thick oil. With the newer implants, if the shell loses its integrity, the silicone gel keeps its shape and may not even move out of the shell. 

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