What to Expect from Silicone Breast Implants?

Is Silicone implant surgery above the muscle safe? What should I expect?

Doctor Answers 12

Saline or silicone?

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Much of the final “look” achieved after breast augmentation surgery  depends on several factors:

1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.

2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.

3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.

4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.

I hope this helps.

Safety is same as below the muscle

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The issue is not about safety-- it's safe to use silicone breast implants below or above the muscle. However, placement above the muscle really should only be used in very specific situations, and it's important to discuss with your surgeon why he would prefer placing the implant there versus behind the muscle. He should review with you carefully the pros and cons of each option so that you can make an informed decision and pick the procedure that is best for you.

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

Absolutely safe

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The FDA approved the currently used silicone gel implants after 14 years of study involving thousands of women who had their silicone implants placed either above or below the chest muscle. If you look hard enough on the internet you will find sites claiming silicone is unsafe and made the author of the site ill. Our FDA is essentially the most conservative in the world and if there was evidence of systemic problems with silicone, it would have most likely not been given approval.

Dr Edwards

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Very safe

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The surgery experience of placing silicone implants above the muscle is very safe and well tolerated by patients, usually involving recovery periods of only obne - two days of mild discomfort. With appropriately selected patients, excellent outcomes should be expected. I perform both saline and silicone, above and below the muscle depending on patient's anatomy, preferences and expectations.

Have realistic expectations

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Dear W,

All of the different aspects of breast augmentation cannot be imparted to you in this forum. There is just too much information to discuss. A face to face discussion with a board certified plastic surgeon can greatly enhance your knowledge. In general, silicone implants above the muscle are safe and you should expect a good result if your tissues are amenable to placement in this plane. Good luck!

Should be safe

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You should expect larger breasts, improvement in symmetry, fuller and firmer breasts.  Science has proven no link to silicone implants and diseases.

My professional preference is under the muscle for many reasons, but it is acceptable above the muscle too.



Safety is relative

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What do you mean by safe? Relative to below the muscle, saline implants, or no implants? Silicone gel implants do not cause systemic disease or cancer. When they work as intended, they feel natural. However, all prostheses and all surgeries carry inherent risks. The most common with silicone gel implants above the muscle is capsular contracture or hardening. There is also a risk of leakage that is true whether placed above or below the muscle. Long term risks are need for repeat surgeries for various non-life-threatening problems like displacement, leakage, hardening, calcifications. Remember that breast augmentation is an imperfect procedure and your choice of technique is often governed by what risks or side effects you are able to tolerate.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

There are many options in breast augmentation

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There have been many published medical reports on the safety of silicone gel implants. The use of this material is safe. The choice to place the implant either above or below the muscle is an individual. There are many factors that must be considered including the size of the existing breast, the quality of the tissue, the degree of breast sagging, if present. Both saline and gel implants will look good if there is sufficient overlying soft tissue. In the absence of overlying soft tissue a gel implant will be a better choice. During your examination a plastic surgeon can examine your breasts and be in the best position to determine which options are best for you. As you research breast augmentation you will see that there are many choices to be made. There is no one right way to do the operation. All factors must be considered. There is an increased risk of capsular contracture with an implant placed above the muscle. For a smooth walled implant this risk is in the 20% range, however a textured gel implant above the muscle has a more reasonable 4 - 7 % risk. It is at this point all factors must be weighed against each other and the method best suited to your needs can be selected.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

The very most natural and softest breast are with Silicone gel under the breast.

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While 80% of my patients select saline implants under the muscle through and arm pit incision, I feel I get the best and most natural results with textured silicone gel implants placed through a peri areolar incision under the breast tissue. The patients usually choose the saline implants because of the cost difference and are very happy with their results but then again they have never experienced the silicone gel under the breast. Both saline and gel are now very safe and you can expect a great result either way.

Carl W. "Rick" Lentz III, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 17 reviews

Why even go in front of the muscle?

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I'm not sure if your question is about the safety of silicone, silicone in front of the muscle, or the issue of in front vs. behind the muscle.

The safety of silicone has been demonstrated and the controvery over that topic has been laid to rest.

The real issue is whether to be in front or behind the muscle. There are substantial reasons to go behind the muscle. In fact, the number one factor determining how natural your result will be and how it will hold up over time is the thickness of tissue covering over the implants.

When tissue is thin, the implant is always more visible than when the tissue is thick. Going behind the muscle is an important step in gaining tissue coverage.

With today's advanced Dual Plane Techniques, one can go partially behind the muscle while other parts of the implant are directly in apposition to breast tissue. The advantages of both can be attained while minimizing the trade-offs of each. There are in fact very limited indications today for going in front of the muscle.

Focus your research on why you want to go in front of the muscle and why those benefits cannot be realized by having a Dual Plane pocket.

Steven Teitelbaum, MD
Los Angeles Plastic Surgeon
4.6 out of 5 stars 49 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.