The most sophisticated approach to breast augmentation is through the armpit with a surgical camera (transaxillary endoscopic). Using this modern approach the space can be crafted under direct vision, with virtually no bleeding and no postoperative bruising. Most importantly, the shape of the breast is meticulously created. The other, older methods of insertion are technologically less advanced. Both silicone and saline implants can be placed through the armpit by a surgeon with skill and experience using this approach. The incision in the crease is the oldest method of placing the implants and puts a scar directly on the breast.
A round implant would be a better choice because they move more like breasts. The anatomic implants have a textured surface which makes them feel very unnatural. In addition, there is no benefit to anatomical. There is an X-Ray study that shows the implants from the side at 6 months. Standing, the round and the antomical implants have the same profile. When you lie down however, the anatomical implants do not change, which is unnatural. A round implant will change when you lie down, like a natural breast would.
HP implants, which are a more modern shape than moderate profile implants, fit most women better. They have a more appropriate base diameter and can be made to look very natural or very augmented, depending on where in the range the implants are filled to achieve a particular volume. High profile implants are the first choice in my opinion. I rarely find an indication to use moderate or moderate plus implants. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of volume, and where in the range the implant is filled.
There are many advantages to sub muscular dual plane placement and very many disadvantages to sub glandular placement. I would see no indication to do anything but sub muscular dual plane. Subglandular silicone implant placement is the historical approach to this surgery, and was widely used in the 1960's. The implant edges are more visible, the risk of rippling is higher, the implant is in contact with the non-sterile breast tissue so the risk of infection and capsular contracture is higher. The interface between the breast tissue and the muscle is blurred so the implant interferes with mammography more than sub muscular placement. The blood supply surrounding the implant is worse so the risk of capsular contracture is higher. The support for the implant is less so there is more long term shape abnormalities and sagging. The look of a sub glandular implant is much less appealing than a sub muscular implant. The placement of sub glandular implants makes any subsequent revision surgeries more complicated and less successful. There are no advantages to sub glandular implant placement.
The choice between saline and silicone is one that requires a complex discussion of all of the advantages and disadvantages of both implants. The issues to be considered are safety, density, mobility, rippling, rupture rate, consequences of rupture, detection of rupture, need for follow-up care, cost of follow-up, appearance, feel, sensation of heaviness, radio-density, mammograms, and costs, among other things. There are advantages and disadvantages of both products. The decision will ultimately be up to you based on what is appropriate for your particular situation. Beautiful results can be obtained with either implant.
The best way to determine the size that fits your personal perception of the perfect breast is to try on sizers. This way you can see how they fit on you, how they add to your current volume, and whether they fit your frame. Although the surgeon can guide you, only you will be able to tell what is the right size. Try on sizers. Measuring a diameter and then telling the patient what volume they can have (in high, moderate or moderate plus implants) in my mind is backwards. The patients should be allowed to choose the volume. Then the surgeon carefully considers the base diameter, projection, profile, manufacturer, and fill material that will achieve the patients goals of size as well as qualitative look (natural, intermediate, or bold upper pole fullness or projection), all the while taking into consideration the patient's anatomic features that will affect the outcome. The experience of the surgeon and the degree to which they explain the options to you is of utmost importance. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of implant. Don't let the doctor tell you what would look good on you. They cannot tell what you perceive to be the best size. There is no maximum. That is up to you.
You will get the best answer to your question by scheduling an in person consultation with a plastic surgeon certified by the American Board of Plastic Surgery and discuss your unique situation and concerns. The surgeon would meet with you, examine you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of the operative procedure in person and what to realistically expect. Then you can make an informed decision on size and shape. Your surgeon should be able to explain to you why they are recommending the type of implant and the size they are according to your current breast measurements including your chest width and your desired outcome.
You will be able t feel the different types of implants in person (silicone/Saline) and go over the pros and cons of both. We have all our Breast Augmentation patients not only utilize our 3D imaging so they can get a real visual on what the implants will look like on them but also to actually try on the different size implants with a tight bra and t-shirt to see what they might expect. That way they have a good visual of what a 450cc implant will do as opposed to a 350cc implant for example. You want to make sure that you see a surgeon that will listen to you and your goals for the procedure and discuss in detail their recommendation for size and shape not only taking into consideration your desired outcome but also your breast measurements before the procedure including your chest dimensions. And then let you try the implants that they feel will give you the desired result so you are in agreement with the size.The cost of Breast Augmentation varies from practice but the cost of the implants should not go up or down depending on the size of the implant alone. A 350cc gel implant costs the same as a 650cc gel implant. The cost of the implants vary depending on the type of implant- saline vs silicone but not volume. Discuss your needs, wishes, recovery time constraints, and budget limits with an honest and experienced surgeon, and receive bias-free personal advice. ALWAYS consult a surgeon who is certified by the American Board of plastic surgery, to ensure the highest standards of ethical practice and safe surgery.
Mark Schoemann, MD FACS
American Board of Plastic Surgery
American Society of Plastic Surgeons
American Society of Aesthetic Plastic Surgery
* The above commentary is not personal medical advice, and is intended for general education on the internet.
I appreciate your question.
The size of implant best for you is dictated by your chest wall measurements. Once we determine that we can choose the profile based on what you want or need to achieve. If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.
Silicone will give you a fullness at the top (upper pole fullness).
Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion.
Anatomic gummy bear implants might be a good choice to give you volume.
These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.
During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers.
The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.
Best of luck!
Board Certified Plastic Surgeon
Both are FDA approved for safety. In my practice, my patients are usually choosing silicone. Each has their pros and cons. Please visit our plastic society websites (ASPS or ASAPS) to learn more. I have information on my site as well. We are here to guide you and make sure you are well informed of the procedure. Overall, this procedure has a very high satisfaction and is one of the most commonly performed procedures in the US. Please make an in-person consultation with a ABPS board certified PS to evaluate you and discuss your options.
Hope that helps and best wishes!
ABPS Board Certified
Thank you for your question. Both saline and silicone are FDA approved in US and are safe. It is personal choice which clients wants. Now in the country about 70% use silicone and rest use saline. Please consult with a board certified PS for evaluation.
Both the saline and silicone implants have the same
type of outer rubbery silicone shell. The inner fill is different: sterile
saline solution in the saline Implant and silicone gel in the silicone Implant.
There are advantages and disadvantages of each type of implant. Both are
utilized by surgeons across the country with satisfactory results. They are
both safe and approved for usage by the FDA. Currently there are more silicone
gel implants used in the U.S.
While either implant can produce excellent cosmetic results in the appropriate
patient, most patients prefer the feel of the silicone gel implant.
The best cosmetic result in any particular breast augmentation patient depends
on a variety of factors, including: your individual anatomy, desired outcome,
realistic expectations, a thorough discussion with the plastic surgeon about
the options, and an understanding of the pros and cons of any particular
implant choice. Proper sizing is not just about the number of cc’s. The
thickness of your tissue, breast dimensions which include the width, height,
and projection, as well as chest wall width all need to be considered when
choosing an implant. Trying on implant “sizers” of various shapes and volumes
while wearing a tight t-shirt, bra, or bathing sit at a preoperative visit will
help you and your surgeon choose the optimal implant.
Keep in mind that following the advice from a surgeon on this or any other
website who proposes to tell you exactly what to do without examining you, physically feeling the tissue,
assessing your desired outcome, taking a full medical history, and discussing
the pros and cons of each operative procedure would not be in your best
interest. I would suggest that you discuss the options with your plastic
surgeon who should be certified by the American Board of Plastic Surgery and
ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS)
that you trust and are comfortable with. You should discuss your concerns with
that surgeon in person.
Robert Singer, MD FACS
La Jolla, California
Both saline and silicone implants are FDA approved for cosmetic breast augmentation in the United States. Clinical trials demonstrate similar infection, failure and re-operation rates. Neither type of implant causes breast cancer. Despite lawsuits, and internet horror stories, medical studies do not link silicone implants to autoimmune disease like lupus, scleroderma or rheumatoid arthritis.The major difference between saline and silicone implants is how the implants look and feel. In general silicone implants are softer, lighter and will feel more "natural." Saline implants are firmer, rounder and gives a more augmented or fake look. These can be positives or negatives depending upon your goals. The main downside to saline is increased scalloping and rippling, meaning a higher likelihood of seeing (visibility) or feeling (palpability) the implant in thin patients. The only two things that control implant visibility and palpability are the device itself and the amount, and quality, of tissue above the implant hiding it. Therefore, the type of implant selected plays a large role in your result in terms of both look and feel. The vast majority of my patients select silicone implants.Interestingly, when we refer to silicone or saline, we are talking about the inner fill material. Both saline and silicone implants have the same silicone shell, so the body is exposed to the exact same material for the majority of woman who never experience a failure. Only if the shell was to fail would the breast pocket and capsule be exposed to the fill material. Saline is absorbed and urinated out, silicone gel remains inert, and except in extraordinary cases, stays within the breast pocket.One factor that should not be considered when considering the difference between saline and silicone breast implants is price. A few hundred dollars is a small difference upfront, for a device you may have for decades. Additionally, both implants carry a lifetime warranty against device failure, but the silicone implant includes a 10-year warranty to help pay some of the surgery fees (up to $3500) should the device fail. To put it simply, both have a lifetime “parts” warranty and silicone includes a 10 year “labor” warranty while that “labor” portion of the warranty is an additional $200 for saline, thereby negating most of the price savings.
Silicone vs. Saline is a personal choice. They are both safe and can both be used to make the breasts larger. Some people feel that silicone has a more "natural" look and feel inside the breast.