Is Silicone Implant the Right Choice for Patient with Little Breast Tissue?

Due to pregnancy, I have very little breast tissue left and I am considering breast augmentation. My surgeon recommended that I opt for silicone implants. I have read that silicone implants have a higher capsular contracture rate and having little breast tissue. I am concerned with where that will leave me if contracture were to happen? I am also concerned with the higher rate of rupturing with silicone? What are the rates of this happening? I want my implants to look great. Is silicone the way to go with little breast tissue? Is it safe?

Doctor Answers 9

Silicone implants offer a natural feel

The rates for a capsular contracture is about the smae for silicone and saline filled implants. Silicone implants are safe and offer a nice result that create a very natural feel to the breast.

New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Augmentation,an operation with many options

Your physical situation is very common. With preganacies there can be loss of breast volume with a loss of skin elasticity. In general the more soft tissue covering over an implant the better the result. A silicone gel implant can be a better choice for a woman with thin skin and not much overlying breast tissue. Eventhough the palpability of a gel implant is less than a saline one under thin skin it is still possible to get rippling that can be felt and some times seen especially in the lower outer quadrant. There are choices that each woman must make in determining the best operation for themselves. A breast augmenation is a surgery of multiple options, there are no absolutes. Your plastic surgeon should be able to explain the various options. Each choice is designed to give you the best possible result with the least number of problems. There is an increased risk of capsular contracture with the use of silicone gel implants as compared to saline filled implants. Discuss your concerns and educate yourself about the options available.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Silicone implants are best for most women.

Hi! Any implant can leak and any patient can get capsular contracture, but silicone implants do not increase your risks of these problems , and the risks are low.

In general, silicone implants look and feel more natural, specially if you have little breast tissue. I would use round, smooth walled, moderate PLUS profile or high profile silicone gel implants. Do not use "moderate" profile implants, because these are UNDERFILLED and can give you rippling.

Most women are very happy after breast augmentation, but remember, there are no guarantees.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Gel will feel more natural with little breast tissue

One of the best things about the approval of the silicone implants a couple of years ago was the availability of a better option for patients such as yourself. I want to focus on one part of your question, since the advice already posted is good. A practical question has to do with "rupture rates" which is really not the best term to describe what happens when an opening in the shell develops. With saline, it is absorbed quickly into the body and the breast deflates; with silicone, usually nothing. the reason is that the gel is "cohesive" which means that it is a semisolid mass. You can cut a silicone implant in half and the gel doesn't go anywhere, nor is it harmful.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 53 reviews

Neither implant will be absolutely trouble free forever- you should consider your individual goals

Hi there-

Both implants have their own set of advantages and disadvantages, and the relative importance of these pros/cons will depend on your staring anatomy as well.

Silicone implants will generally feel softer and more natural than saline, and this is definitely more of a concern in patients who lack breast tissue of their own for coverage. In patients without this needed coverage, saline implants will have a high rate of visible wrinkling and the ability to feel the implant through the skin. So, if your breasts are small and the tissues thinned by pregnancy, it is likely that silicone implants will make you happier from a cosmetic point of view...

BUT.... Silicone implants are more expensive, they do a have a slightly higher rate of capsular contracture (although I believe technique and good postop management largely mitigates this), and require more follow up (including occasional MRI exams).

If you want to save a bit of money and don't want the increased follow up, saline might make you very happy- but be sure you won't be devastated if you have rippling.

If you want your breasts to look and feel as good as they possibly can, and you don't mind the additional expense and follow up, and the MRIs, gel may make you happier.

It really is an individual decision.

I hope that helps!

Armando Soto, MD, FACS
Orlando Plastic Surgeon
4.8 out of 5 stars 159 reviews

Gel implants are safe

In the thin patient, gel implants do carry an advantage. They tend to demonstrate surface ripples less and may feel somewhat more natural. The contracture rate difference is debatable and should not significantly discourage you from using gel implants. Likewise rupture rate. The gel implants do require surveillance and hence recommendation of MRI evaluation post operatively. This is something you should discuss with your surgeon. The other considerations of gel vs saline is implant cost, with the gels more expensive. Also, scar length for placement with the gel implants requiring a longer scar as they are pre-filled. This may or may not be a consideration for you.

Hope this helps!

Michael A. Marschall, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 9 reviews

Interesting question

Your question is interesting because it is a multifactorial question that raises all the important issues that should be raised when discussing breast implants. It highlights the fact that breast implants, and breast augmentation procedures, are imperfect. Patients and doctors have to look at the many factors and decide which are the more important ones from a benefit and from a risk perspective. For example, the only reason silicone gel implants are on the market is that when they work appropriately, they feel softer than the saline implants. Unfortunately, for all techniques, they also have a higher rate of capsulat contracture. This automatically puts silicone gel impants in competition with itself. However the end result of the feel of your breast relate not only to the implant but to the amount of natural breast tissue so a saline implant in a patient with a large amount of implant may feel just as soft as a silicone implant. Unfortunately this is not the case with your breasts. Ruptures are also good news/bad news. With saline, the good news is that you know they are leaking but the bad news is you bought yourself another surgery to replace it. With silicone implants, the good news is you may not exhibit any changes when they leak (so-called silent ruptures) and the bad news is you may not know your implants are leaking. Fortunately, and the reason they are referred to as silent ruptures, silicone gel implants that leak within the capsule (intra-capsular leaks) generally do not cause any problems if they stay soft and stay with the capsule.

So to answer your question, you have to ask what aspect of the procedure is most important to you and, more importantly, what risk are you willing to accept.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Gel is better if you are thin and have little breast tissue

Silicone implants are better the less tissue you have to cover them, in other words if you are thin and have little breast tissue. Saline implants in this setting can work but will be wrinkled and rippled especially if you lean forward. The capsular contracture rates are higher with gel, maybe at the 5-8% level in my experience recently compared to less than 5% with saline. Always go submuscular.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Silicone implants are safe

I feel that if you have little breast tissue, you are better off with silicone, as it will look the most natural and feel the most natural.

Having said that, some patients are still worried about the gel and just feel better with the saline.

I still do 50 percent gel and 50 percent saline, and my patients are very happy.

Good luck and talk to your surgeon about your concerns.

Andrew T. Cohen, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 44 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.