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1.      Which is a better breast implant, saline or silicone?


Neither of them is better than the other. Both are FDA-approved and millions of women have both types of breast implants. But they do have some property differences between them that patients should know. Understanding their differences can help one decide which is best for themselves.


Saline breast implants have the advantages of being able to be placed through the armpit (leaving no scar on the breast) and are lower in cost. Its disadvantages are that one may be able to feel, and sometimes see, implant rippling and a deflation can occur (flat breast) should a hole or small tear develop in the containment bag.


Silicone gel breast implants have the advantages of a more natural feel with less rippling and will not spontaneously deflate if a hole develops in it. Its disadvantages are that they are more expensive and need a larger incision in the lower breast crease in which to be inserted. 


2.      Should breast implants be placed above or below the chest muscle?


The history of breast augmentation has seen implants placed both above and below the pectoralis muscles. Successful results have been obtained both ways. Each location has certain advantages and disadvantages.

Placing a breast implant above the muscle (subglandular) causes less pain after surgery and fills out a breast better that has some amount of skin sag. It is associated with a higher long-term risk of hardening (capsular contracture)and the outline of the implant may be more noticeable. With the commercial return of silicone implants in 2006, subglandular techniques are becoming more commonly used again.


Implant placement under the muscle (subpectoral) causes more immediate discomfort but creates a more natural look in the upper part of the breast. This approach significantly reduces the long-term risk of capsular contracture and is the preferred location for saline implants due to their rippling concerns.


3.      Can implants help lift up sagging breasts?


As a general rule, no. This is a common misconception. Implants will not lift up significantly  a breast mound that is drooping nor will it make the nipple move up higher on the chest wall. If the nipple is even slightly pointing downward or sits at or below the lower breast crease, one needs to consider a lifting procedure with their augmentation.


Breast sagging, or ptosis, is a frequent issue in the post-pregnancy breast which exhibits a deflated and downward appearance. Careful consideration in this common breast condition of the trade-off between breast shape and scars is essential to avoid an unhappy breast augmentation result.


4.      Will my breast implants last my entire lifetime?


While this is possible, one should not expect it. The filler material in a breast implant is encased in a plastic (silicone) bag. This bag will eventually develop a crack or tear due to fatigue from motion and intermittent deformation from outside pressures. Given the relatively young age (under 40) of many breast augmentation patients, it is not realistic to expect an implant to hold up for several decades.


There does not appear to be differences in failure for saline vs silicone breast implants. The differences is in the awareness of failure between the two. Saline implant deflations will result in an obvious change in breast size. Silicone implants may not be detected for some time after failure as an obvious change in breast size does not occur.


Fortunately, all breast implant manufacturers have lifetime implant replacement warranties and monetary compensation should it occur in the first ten years after surgery.


5.      Will I have normal nipple sensation after surgery?


Most women maintain nipple sensation after breast implant surgery but there is a risk that it may be diminished or lost altogether. One of the major nerves to the nipple comes from the side of the chest wall at roughly the level of the nipple. This nerve’s path is very close to where the pocket must be developed for the implant. The nerve may be stretched or injured during the course of this dissection.


Fortunately, the likelihood of a completely numb nipple after surgery is low. More commonly, there may be some temporary changes in feeling which could be extra feeling (sensitivity) or some mild decrease. Recovery of complete feeling occurs within weeks to a month or two.


6.      Can I breastfeed after surgery?


Yes. A breast implant is well removed from the location of the ducts under the nipple. This is particularly true when the incisions are in the armpit or lower breast crease and the implant is placed under the muscle. If the nipple incision is used and the implant is placed above the muscle, some disruption of the ducts are possible but unlikely.


7.      How do I choose the right breast implant size?


Breast implant size is a personal choice and is  different for every patient. Show some pictures to your plastic surgeon and discuss what you think is appropriate for your body. There are, however, several anatomic considerations that can help one decide about the volume of the implant.


The size of the implant should not be more than your breast tissues can support over time. If it is too big, the implant will bottom out and drop down too low eventually. The thickness of your breast tissue and the tautness of your skin factors into this consideration.


The width (base diameter) of the implant should not be greater than the width of your own breast. This is a good simple measurement that can keep the implant’s size body proportionate. When the implant is wider than your breast width, it is not only likely too big but will also end up being too far to the side and may interfere with the swing of your arm.   

Dr. Barry Eppley

Indianapolis, Indiana

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