1. “Is a saline implant safer than a silicone implant?”

No. There is no evidence suggesting that saline (salt water) implants are any “safer” than the current version of silicone implants. In fact, there have been a multitude of studies designed to look at whether or not silicone implants increase the chance of complications or side effects after surgery. All of the studies have proven that silicone implants are safe. Therefore, think of saline and silicone implants as being equally safe.

2. “Why have I been told that saline implants are safer than silicone implants?”

This is a misconception that was created approximately 15-20 years ago and has been promoted in the media. Back then, the older versions of silicone implants had weaker outer coverings which made them more likely to open, or “rupture.” Also, the inside of the older versions of silicone implants were filled with a liquid form of silicone. Thus, when the outer covering would open, the liquid silicone would spill into the breast tissue. Although this was never proven to cause any health problems, it did make it difficult to remove the liquid silicone from the breasts. This was frustrating for patients and for surgeons alike. The current version of silicone implants DO NOT have this problem. First of all, the outer covering of the new silicone implants is much stronger. Thus, it is very unlikely that the new version of silicone implants will ever open or rupture. Secondly, the current version of silicone implants is filled with a very thick “jello” like form of silicone. So, even if the implant were to rupture, which is extremely rare, the silicone would not go anywhere. The silicone would not spill into the breast. It would stay right in place inside the implant.

3. “Do I have to get an MRI every 2 years if I get silicone implants?”

The older style of silicone implants had a weak outer covering and a liquid form of silicone inside. This made it more likely for them to break, open or rupture as a result. In the past, if a silicone implant did break open, the liquid silicone would spill out of the implant and the breast would deflate. As a result, it was relatively easy to tell if an old silicone implant had ruptured, since the breast would change in shape. As I explained above, the new and current version of silicone implants have a stronger outer covering and a very thick silicone jelly inside. It is extremely rare for the implant to rupture, but if it does, the silicone stays inside the implant. Thus, if the current version of silicone implants was to rupture, it would be very difficult to know, since the breast would not change in shape and you would likely not feel any difference.Thus, the only way to reliably know if a silicone implant ruptured would be to obtain an MRI of the breasts. This is the reason why the FDA and implant companies recommend getting an MRI every 2 years. The purpose is to diagnosis a rupture if it is present. However, this is only a recommendation and it is not mandatory. Several studies have shown that rupture with the current form of silicone implants is very rare. Thus, the vast majority of women who get an MRI will not have evidence of rupture. Furthermore, even if the MRI did show a rupture, it is very unlikely that the rupture would be associated with any changes in the shape or feel of the breast. Therefore, even if the implant was found to be ruptured, there would be no reason to have any kind of treatment for it. In summary, both the FDA and the implant manufacturers recommend you get an MRI of the breasts every two years. However, this is not mandatory.

4. “What happens if a saline implant ruptures?”

First of all, it is important to know that it is very rare for the current versions of saline or silicone implants to break or rupture. So, although it is important to discuss what happens if an implant were to rupture, it is also important to remind yourself that it is rare. If a saline implant were to rupture, the salt water inside the implant would leak out and become absorbed by the body. The breast would eventually appear deflated. Thus, if a saline implant ruptured, you would almost certainly need to undergo another surgery to replace it.

5. “What happens if a silicone implant ruptures?”

As I explained above, it is very rare for the current versions of a saline or silicone implant to rupture. However, if a silicone implant did rupture, the thick silicone jelly inside the implant would stay inside the implant. It would not leak out or spill into the breast. The breast would probably not change in size or shape. You should not feel any difference or see any change in the appearance of the breasts. Therefore, you would probably not need surgery to replace the implant, if you discovered a rupture.

6. “What are the advantages and disadvantages of saline implants?”

One of the main advantages of a saline implant is its cost. Saline implants cost significantly less than a silicone implant because it is much less expensive to manufacture. Another advantage, for some people who are opposed to having silicone implants, is that a saline implant contains only salt water. On the other hand, there are a few disadvantages to saline implants you should be aware of. The main disadvantage of having saline implants is the risk of something called “rippling.” Rippling is the presence of folds and wrinkles on the surface of the implant which can become visible or can be felt. This does not happen in everyone with saline implants, and this can also occur with silicone implants, but it is much more common with saline implants than with silicone implants. When rippling occurs, it can become unsightly and bothersome. Many women who develop rippling eventually replace the implants with silicone implants in the future. Another disadvantage is that if a saline implant were to rupture, the breast would likely become deflated and you would need to undergo another surgery to replace the implant. If a silicone implant ruptures, the silicone would stay inside the shell of the implant and you would probably not need another surgery to replace it.

7. What are the advantages and disadvantages of silicone implants?

Silicone implants have several advantages. One advantage is the fact that silicone implants have much less rippling than saline implants. Another advantage of silicone implants is the “feel” of the implants. The thick silicone jelly inside the implants resembles the feel of a natural breast more than saline implants. Another advantage is the fact that you would probably not need to replace the implant if it were to rupture. The reason is that the thick silicone jelly stays inside the implant even if the implant ruptures. Therefore, you should not be able to feel any difference and there should not be a change in size or shape. One of the few disadvantages of silicone implants is the cost. Silicone implants are more expensive products and thus your surgery cost will likely be higher with silicone implants than with saline implants.

8. “Which implant do you recommend?”

The decision of which implant to use is ultimately up to you. My advice is to choose the silicone implant, if it fits within your budget. If it does not, then a saline implant is a perfectly fine option.

9. “Where is the best place to have the scar?”

Implants can be inserted through the belly button, the armpit, the nipple/ areola and through the inframammary crease (the fold below the breast). The location of the scar should be based on several factors. The first consideration is the safety of the technique. The belly button approach is known to have a high risk of complications. Because of this, the American Society of Plastic Surgeons does not even recognize it as a valid approach for breast augmentation. Another consideration is whether the approach can yield consistently good results. The armpit approach makes it very difficult to control the shape of the breast consistently. The reason is that working through the armpit prevents the surgeon from properly visualizing all aspects of the inside of the breast. Thus, a lot of the shaping of the breast has to be done blindly. Therefore, the results can be unpredictable. The surgeon may have a great result one time, and a poor result the next time. One must also consider the potential side effects and complications from each approach. There have been many studies which show that inserting implants through the nipple/ areola can increase the risk of capsular contracture. Capsular contracture is a condition in which the scar tissue around the implant becomes very tight and hard. This causes the implant to be squeezed and the breast appearance to become deformed. The theory is that making the incision around the nipple and areola cuts into milk ducts which have bacteria in it. The bacteria then get transferred to the implant as it is inserted. Although only a few bacteria get on the implant, it is enough to cause inflammation around the implant which then leads to capsular contracture. Another possible side effect/ complication of inserting implants through a nipple/areola approach is the risk of numbness and/or inability to breast feed. Although these risks exist with any surgery on the breast, it may be slightly higher with the nipple/areolar approach. The last consideration should be the cosmetic appearance of the scar. The nipple/areola scar heals very well. The scar is made in the border between the dark color of the areola and the lighter color of the breast skin. This camouflages the scar very well. However, it is important to understand that all scars, no matter how perfectly they are designed and heal, are always visible. Therefore, the scar on the nipple/ areola will always be slightly visible when the breasts are not covered. The scar in the inframammary fold is designed to fall in the crease that will be formed once the implants are inserted and have time to “drop” to their final position. Even women who do not have a fold or crease to begin with will have a fold or crease after augmentation. Therefore, this scar heals in a location that is never visible, even when nude, unless the woman lifts her breasts. Furthermore, the scar heals very well in this location and eventually becomes a very fine line. For all of these reasons, the inframammary fold is the preferred method of inserting implants for top surgeons. Using the inframammary fold allows for more control over the breast shape, which leads to better and more predictably consistent results, with the least amount of risk and the best chance for a barely noticeable scar.

10. “Do I have to replace my implants after 10 years?”

No, you do not necessarily have to replace your implants after 10 years. The idea that you have to replace your implants after 10 years is a misconception that has been spread in the media and on the internet. It started after a misunderstanding of a study done on women undergoing breast augmentation. In that study, a group consisting of hundreds of women was followed for over 10 years after their augmentation. The study showed that the vast majority of women who received breast implants did, indeed, have them changed within 10 years. However, closer analysis of the study reveals the true reasons why. The majority of the woman who were included in the study were in their early 20’s. Over the course of 10 years, many of these women went on to become pregnant, have children, breast feed, etc. In the ten years that followed their augmentation, their breasts underwent the normal changes that any woman’s breasts would have. Many of them then had surgery for the same reasons that women who have children undergo breast surgery. Some wanted larger implants. Others wanted new implants and a breast lift. Some of the women wanted to change their saline implants to silicone implants. In many of the cases, the women changed their implants because they wanted to, not because they had to. Some of the women in the study did have to change their implants because of complications such as capsular contracture or dissatisfaction with the result. The majority of the women, however, changed their implants voluntarily. The media and internet focused on the fact that many women change their implants within 10 years, but they failed to mention the real reasons why. The fact is that the current form of implants are very safe and you will only need to change the implants if you develop a complication or wish to change the implant for another reason.