Which would you recommend; Silicone OR Saline for the "pornstar" very round "perky" look ? (photos)

The look you show would be achieved with a high profile saline implant placed under the muscle through the transaxillary incision by a surgeon who has experience in breast augmentation.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. What you are looking for is going to come from saline!!!!!!



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.

Thank you for your question.In my opinion in order to achieve the very
round, very augmented look, you are looking at needing an over-filled saline
implant.Using the overfilled saline
implant is going to give you a very “fake” look if that is your goal.Also, by overfilling the implant you will
hopefully have less rippling which is one of the risks in using the saline
implants in someone very thin with thin skin like in the picture you
posted.The silicone implants decrease
the rippling and are more soft and natural, so to get you what it sounds like
you are looking for, the saline implant is probably your best option.Good luck to you.

Those implants look fake for a couple reasons.  First, they're very large for her frame and secondly they are very round with a clear edge that's visible, particularly in the upper breast.  Implants placed above the muscle will have this more clearly defined upper edge.  When using implants above the muscle, there is less natural tissue to camouflage the implant and a silicone implant will feel and usually look better (less likely to see or feel wrinkles).  The other consideration is the profile of the implant.  For a given volume (number of cc's), there are several different profiles of implants available.  The higher the profile, the narrower and perkier the implant.  Silicone implants come in an ultra high profile, which is likely to be the best choice to achieve your fake, very round, large breasts.  Saline implants don't come in an ultra high profile but an overfilled high profile saline implant can have a similar shape but would feel like a rock and may have visible wrinkles.  Talk to your doctor about your concerns and have them explain why they think the silicone is the best choice for you.

A disadvantage of saline implants, especially with a large implant, is the potential for ripples. In women with minimal skin who desire large implants, the gel implant may look better, especially if the implant is placed just behind the breast. Placing the implant just behind the breast will help accent the edge of the implant, especially in women with minimal breast tissue.

Good question. 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. For example, if a patient has minimal soft tissue/breast tissue present, use of a higher profile silicone or saline implant can achieve the "faker" round look. On the other hand, if the patient has a significant amount of breast tissue present naturally, the use of a saline breast implant ( possibly overfilled) may be necessary to achieve the desired aesthetic outcome.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.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 or D cup” or "upper pole fulness" or "fake look" etc. 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. I hope this, and the attached link (dedicate to larger breast augmentation concerns), helps. Best wishes.