Silicone or saline implants? (photos)

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!