Silicone or saline implants? (photos)

Hello,You are putting yourself at risk for a multitude of problems by choosing a circumareolar mastopexy. Although it is a good lift in the right person, someone like you with larger, saggier, and asymmetric breasts will not have a good outcome: thick scars, pleating of skin, enlarged and irregularly shaped areola, persistent low positioning of the nipple-areola complex on the breast mound, persistent sagging of the breast mound, and flattening of the breast mound. Your breasts' appearance afterwards will be much less aesthetically pleasing than if a properly executed formal breast lift was performed. Go visit a few ABPS certified/ASAPS member surgeons who specialize in breast surgery. Its 2018, get silicone gel implants.  Best of luck! 

Yes it’s possible to get Saline implants however the silicone implants are very safe and feel more natural than Saline. Saline implants are a safe alternative however they do have the downside of possible deflation and do not look and feel as natural as silicone. You are right in that the more natural breast tissue you have the less you will be able to feel the implant either Saline or silicone. 

Hello and thank you for your question.  I prefer silicone for my patients. The best advice you can receive is from an in-person consultation. 
With that being said, based on your photographs, the best shape and contour
could be achieved with an implant and a vertical or wise pattern breast
lift.  I rarely recommend a Bennelli or circumareaolar (donut) lift. 
Over time, the areola tends to enlarge with a thickened scar.  The other
even worse problem with a circumareaolar lift is that it flattens out the
shape of the anterior breast over time.  A vertical or wise pattern lift
with an implant can result in a very nice shape if good technique is
used.   The size, profile, and shape of the
implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.  Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D. FACS
Harvard-trained plastic surgeon

Dear Riley77bear,Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.The pros of silicone implants are that they look and feel more natural and ripple less. 
The pros of saline implants are that they do not require as large of an incision as silicone, less expensive, they have less incidence of capsular contracture (scarring around the implant), one can tell immediately if there is a rupture, the size can be slightly adjusted, and they can be used for women less than 22 years of age.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Silicone implants certainly have a more natural feel than saline and is one of the reasons that 95% of my patients choose silicone. However it is true that if you have a lot of breast tissue to "hide" the  unnatural feel of the saline, then it does not matter. Your choice since you do have a fair amount of tissue. You did not ask, but if I were you I would reconsider your donut mastopexy since I think it will flatten your breasts and not get your new nipple position high enough. I think a vertical lift will give you a much better shape, scar quality, and nipple position even with the extra scar. At least rediscuss with your surgeon. Good luck with your surgery!

Thanks for posting your question.  The question of which type of implant to choose is a topic that you and your surgeon should spend some considerable amount of time discussing.  In general silicone implants feel more natural than saline implants, but as you rightly point out, since you have a reasonable amount of breast tissue, it will be able to 'pad' the implants.  Your surgeon may not be familiar with the most recently introduced "Ideal" implants which are saline filled but feel much more like silicone implants, and like silicone, are much les prone to rippling than traditional saline implants.  Since you are two months away from surgery you have time to discuss this option with your surgeon as well.