Thank you for your question. No, the IDEAL implant is filled at the time of surgery, usually after it is placed in the proper space behind the breast and usually under the muscle. I use the trans-axillary approach, so there is no scar on the breast after surgery. I would definitely recommend the IDEAL implant. The new IDEAL implant has 2 chambers of saline and internal baffles that allow it to maintain its contour very well, with good projection, and has less chance off rippling. In the original clinical trail of over 500 patients, with a followup of over 5 years, the patient satisfaction rate is near 95% with deflation and capsular contracture rates lower than that of other implant makers. It was FDA approved in 2014 and became commercially available in September of 2015. I have an extensive clinical experience with saline implants and believe the new IDEAL Implant to be the first major advancement in implants during my career. The patients I have treated with the IDEAL implants have all been very satisfied. I hope this was helpful, good luck.