What type of implant filler should I have – silicone or saline?

All breast implants are surrounded by a firm, elastic (silicone elastomer) shell. Silicone gel implants are filled with a firm or soft silicone substance. It is the most popular implant filler because the consistency is most similar to that of normal breast tissue and is therefore capable of producing a very natural look and feel. Modern silicone implants are made to a very high standard and are very durable although it is hard to say how long the implant will last inside the body.

Saline implants have a silicone shell filled with a salt water solution of similar concentration to that found in body tissue. It may be pre-filled or filled through a valve at the time of surgery. If the implant develops a leak then the saline solution is easily absorbed by the body with no ill effect. Compared with silicone implants the saline ones are more prone to rupture or deflation at an earlier stage. They are also more prone to wrinkling, may feel and look less natural than silicone implants and are generally less satisfactory in women with little breast tissue.

What type of silicone filler – soft silicone or firmer cohesive gel?

Firm or cohesive gel implants contain a more solid, jelly-like gel which will keep its shape if the shell ruptures and are therefore less likely to disperse away from the breast. With improvement in implant technology the newer manufactured cohesive gel implants now have a softer and more natural feel while retaining the jelly-like consistency. In general a slightly larger incision is needed in order to insert the firmer implant. Soft implants, filled with a more fluid-like gel have a very natural feel once inserted underneath the breast tissue. However they may distort more easily with moderate capsular contracture producing wrinkling and if the shell ruptures the gel could disperse more readily and can be more difficult to remove completely.

What type of implant – round or tear drop shaped?

Both cohesive gel and soft fill implants are available in either round or anatomical (breast or tear drop shaped) designs. It is possible to achieve a nice shape to the breast with the use of both types of implants. In general if a woman desires a more natural profile shape to her enhanced breasts the tear drop shaped implants are generally a better choice. On the other hand if more fullness of upper part of the breasts are desired then round implants may be preferred.

Are there any cancer risks with silicone implants?

There is good evidence that there is no increased risk of developing breast cancer for women who have breast implants. Indeed the risk may be less. If a woman who has breast implants develops breast cancer, scientific studies have consistently shown that the risk of cancer recurring is no greater than in women without implants, and that there is no difference in their survival.

Are there other health risks?

The Independent Review Group, set up in 1998 by the government to review claims by some women that they developed joint and muscle pain and other symptoms of ill health following breast augmentation, found no evidence that silicone implants pose a danger to women’s health.

Where will the implants be placed – above or below the muscles?

As a general rule the more breast tissue a woman has the easier it is to hide the implant and it is less disruptive to put the implant above the muscle and directly under the breast tissue. On the other hand if there is very little existing breast tissue then it is recommended that the implant be placed underneath the breast and muscle tissue in order to hide it better. Inserting the implant this way involves detaching some of the muscle fibres from their attachment to the rib cage. This generally causes no discernible loss of upper body strength unless the person is a performance athlete such as a gymnast or a rock climber.

Where will be the scars?

The most common approach for breast augmentation is to place the incision in the crease below the breast. The resulting scar is well hidden. Occasionally an incision around the areola may be used but this approach involves cutting some of the milk ducts which can in future affect breast feeding for women who have not had children yet. It is also difficult to insert the firmer tear drop shaped implants through this incision. I do not use the incision through the armpit to insert breast implants.

Is breast feeding possible?

Implants do not interfere with the ability to breast feed. There is some evidence which suggests that the amount of milk produced by some women with breast implants is reduced. Reduction in milk production may also occur if the implants are inserted into the periareolar area, as this technique tends to cut the milk ducts. There is no evidence of an increase of illness in children of women with silicone gel breast implants.

Would it affect future mammography?

The presence of silicone gel-filled breast implants may interfere with standard mammography used to detect breast cancer. In addition, calcium salt deposits around implants can be seen on mammograms and may interfere with findings. However, studies indicate that breast cancer in women with implants is not diagnosed at a later stage compared with women without implants. Women with breast implants should be sure to tell their radiographer that they have implants so that the most appropriate method of screening can be used.

Is it safe to fly and scuba dive?

Breast implants are not subjected to strain or rupture when travelling in aircraft. They should be robust enough to withstand the stresses and strains of normal sporting activities.