43 y/o mother of two, 4’11, 107 lbs, saline vs textured silicone?

Question

I am a 43 yo mother of two (4’11”/107 lbs) scheduled for a lift with augmentation up to 450cc. I was set on going saline however, my dr suggested textured silicone for anything over 400cc. i am on the fence as the textured silicone has had an albeit very small percentage of cancer risk, but I am told that going saline at the size risks sagging. I am currently a large C cup and a significant amount of breast tissue will remain after the lift. Would you suggest the same?

Ronald J. Edelson, MD · Answer

Given your build I doubt that implants over 400 ccs would be used. Personally I prefer saline implants. I do t see the logic in using textured implants

J. Timothy Katzen, MD, FACS · Answer

Hi Metal mom30,

Thank you for reaching out with your question about the choice between saline and textured silicone breast implants, especially given your specific situation as a 43-year-old mother. I appreciate the details you've provided about your background.

First and foremost, it's essential to note that textured breast implants are no longer recommended or widely used due to their association with a specific type of cancer risk. As a result, they are not manufactured anymore, and I strongly advise against using them. Consequently, the plastic surgery community, including myself, has shifted away from these implants.

When deciding between saline and silicone implants, it ultimately comes down to a combined decision between you and your plastic surgeon. However, most plastic surgeons, including myself, lean towards silicone implants for several reasons. Silicone implants tend to offer a more natural feel and appearance, and statistically, they are associated with a lower rate of capsular contracture compared to their saline counterparts.

Regarding the risk of sagging, it's important to understand that this risk is more closely related to the quality of your breast tissue and skin laxity rather than the type of implant used. Whether you choose silicone or saline implants, if there's a significant risk of sagging, it should be addressed during the surgery, potentially with a mastopexy (breast lift) procedure.

In summary, while textured breast implants are not a viable option, choosing between saline and silicone should be based on your preferences and the expert guidance of an experienced, board-certified plastic surgeon. They can guide you on the best approach to achieve your desired aesthetic outcome. I hope this provides clarity for your decision-making process, and I wish you the best in your journey.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

Finny George, MD · Answer

Hi, thank you for sharing your question. Implant selection is a personal decision that is guided by your surgeon. My preference is use smooth implants due to the safety profile. Discuss all options with your trusted surgeon.

Daniel Barrett, MD · Answer

Dear Metalmom30,
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.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Ted Eisenberg, DO, FACOS, FAACS · Answer

In my experience (over 7500 augmentations-and many with lift as well), there has not been any increase in sagging with the use of saline implants over 400ccs. Saline is a great option. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Connie Hiers, MD, FACS · Answer

At 4'11" and 107 pounds, I do not recommend going over 400 cc's and you would do much better long term with something smaller. I prefer the smooth implants, both saline and gel, for less long-term problems and excellent results.

Mats Hagstrom, MD (license on probation) · Answer

I think all people should have multiple consultations before scheduling surgery.
The biggest mistake patients can make is having only one consultation, then scheduling surgery. There’s no correct number of consultations needed to find the best provider. The more consultations you have the more likely you are to find the better provider.
 I’ve never been a fan of textured implants, but some providers like them. Considering the recent discoveries I would stay away from them. 
That said, there may be advantages I am unaware of since I’ve never really liked working with them.
We can’t really make a good assessment without seeing pictures. There are generally three variables that determine the quality of breast augmentation surgery. The first is the patient candidacy for the procedure in the first place. The second is the choice of implants in regards to type size and shape. The third is the technical ability of the surgeon to put the implant in the correct position. Having a mastopexy augmentation combination is a moderately complex procedure. Some surgeons even prefer to do these separate procedures. 
Each plastic surgeon will have their own way of guiding patients through the implant selection process.
There isn’t much you can do to change your candidacy. What you do have control over is choosing the best provider. Make sure you’ve at least gone through the vetting process and have something to compare.During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients, who have similar body characteristics to your own. An experience plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. being shown a handful of pre-selected images, representing only the best results of the providers, career or of patients who don’t look like you is insufficient to get a clear understanding of what average results look like in the hands of each provider, what your results are likely to look like or how many of these procedures they’ve actually performed.
Because this operation does have a significant risk of needing revision surgery. You should ask your provider what the most common revision is after mastopexy augmentation, what the revision rate has been in the past, and what the revision policy is regarding payments. 
The time to be critical of plastic surgeons is before you schedule surgery.
Best,
Matt Hagstrom, MD

43 y/o mother of two, 4’11, 107 lbs, saline vs textured silicone?

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