“I am 5′0 tall and weigh 105 pounds. I wear a 32 A cup bra. I would like to use a 650 cc breast implant. Is there any problem with doing this?”

I received an email from a woman yesterday looking to use a very large implant on a very small frame.  She inquired if there would be problems in doing this.  In a word, “Yes.”  There will be problems to using a very large implant in a patient like herself.    Let me go into this further. 

 Appropriate implant selection is one of the most important decisions that a woman will make when choosing breast implants.  There are long term ramifications to using an implant that is larger than the soft tissues can handle.  An implant has weight and over time will thin the breast tissues and cause descent of the breast on the chest wall.   Furthermore, it is possible that breast tissues can thin enough to cause significant problems with rippling or even implant extrusion.   Large implants are very heavy and cause significant stretching and thinning and put patients at greater risk for these problems.  The fact that heavy breasts fall sooner may be obvious to women who were well developed in their teens who later in life have breasts that are much lower following pregnancy or breast feeding.  However, young women who are seeking breast augmentation usually don’t have issues with breast positioning and are unlikely to recognize this potential problem.    

During your consultation with me,  I analyze your breast using a technique outlined by Dr. Tebbetts.  The approach is called the “High Five Process” and is designed to systematically assess five critical aspects of breast augmentation planning to come up with an “ideal” procedure for an individual patient.  I use the process because I believe that there is probably an “ideal” implant volume for a given patient that can be derived from her soft tissues.  Implants that are signficantly larger than this “ideal” will be at greater risk for complications.  Furthermore, I believe that if an “ideal” procedure is used  that there will be a reduction in the rate of reoperations following breast augmentation.

Here is an example of a patient that underwent a breast augmentation in my practice using the “High Five Process.”  She is a 27 y/o that presented wanting a saline breast augmentation.  She was internally motivated and wanted a proportional augmentation that would not have an increased risk of breast thinning and descent with time.  On examination she has some mild asymmetries and modest soft tissue coverage.  Here is the preoperative photograph:

During our consultation I used the “High Five Process” to derive an implant volume based on her soft tissue characteristics.  The implant volume was 425 cc’s.  Due to the thinness of her soft tissues at the upper pole of her breasts the implant was positioned into the dual plane.  Here is the postoperative result at 4 months:

The operation achieved her goal of a proportional breast augmentation using an implant that was individualized and idealized for her soft tissue needs.  This implant should reduce her risk of tissue thinning and other complications in comparison to a larger implant.

Our websites, www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of breast augmentation for review.  I invite you to schedule a consultation with me if you would like to learn more about breast augmentation or the “High Five Process.”  Please feel free to contact our office at (713) 661-5255 if you have any questions.

-Brice W. McKane, M.D.

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“I think that I’d like to use saline breast implants instead of silicone. Is this a good choice?”

I wrote the other day about silicone implants.  Following this, I received an email from a woman in Clear Lake asking if saline implants were a good choice.  Implant selection is a very important decision to make, and as such I feel that I should also spend some time addressing saline implants.   

Again, let me begin by saying that both types of implants have benefits and trade-offs associated with them.  Since the recent FDA approval for their use, it has become fashionable to use silicone implants.  Certainly in some patients there are benefits to using a silicone implant, but let’s not forget that saline implants have a large amount of long term data collected on them that support that they are not only effective devices, but that they are safe devices.  The current generation of silicone implants does not have long term data collected on them at this point.  Definitive conclusions about their safety and efficacy can’t be made yet.  In fact, the post approval study to address these very issues is being conducted as we speak. 

In the plus column for saline implants:  Saline implants are approximately half as expensive as silicone implants at the time of surgery.  They are also less costly in the long run.  To monitor for silicone implant rupture, the FDA has recommended that patients undergo a breast MRI at year 3 following their surgery, and every 2 years thereafter.  This is a very expensive study, and is not necessary for saline implants.  When saline rupture occurs, the patient or her surgeon are usually able to make the diagnosis.  Saline implants can be placed through a much smaller incision since they are not prefilled and can be rolled to a small size during insertion.  Revision surgeries are often necessary after breast augmentation and these procedures may be easier if saline implants were used during the initial procedure.  The rupture rate for saline implants is probably lower than silicone implants.  This is being evaluated currently in the post approval study.  Between 93 and 98% of saline implants remain intact at 10 years, contrasted to 60-85% seen in the historical data for silicone implants.  The capsular contracture rate for saline implants is also probably lower than silicone implants.  This question is also being evaluated currently.  The capsular contracture rate after saline implants is 16.6% at 10 years in comparison to 38.5-90% seen in the historical data for silicone implants.  Lastly, patient satisfaction with saline implants is also very high and is on the order of 87-95%. 

In the negative column for saline implants:  Feel.  Some patients prefer the texture of a silicone implant and believe it to feel more like breast tissue.  Wrinkling and rippling is also a greater problem for saline implants as saline is not a cohesive substance.  Silicone implants have less problem with wrinkling and rippling, and may be a very good choice for a woman who is thin and who has little soft tissue coverage for this reason.

So to answer the question ”Are saline implants a good choice?”  The answer is yes.  We have a large amount of data in the literature that supports their use.  Are they better than silicone?  It depends.   The individual needs of the patient will make this determination.  Again, I truly believe that a patient that is fully informed about her options will make the best decision for herself, be it saline or silicone.

Here is an example of a patient that underwent a saline breast augmentation in my practice.  She is a 25 y/o that presented desiring saline implants.  She was concerned about needing repeated MRI’s to monitor for implant rupture.  She was uncomfortable with the fact that she might not know that her implant had ruptured and could be leaking silicone gel.  On examination she has some mild asymmetries, and fair soft tissue coverage.  Here is the preoperative photograph:

The operation achieved her goal of a proportional, natural appearing breast augmentation using implants that have demonstrated both safety and efficacy in many patients without the need for an expensive followup study. 

Our websites, www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of breast augmentation.   I invite you to schedule a consultation with me if you would like to learn more about breast augmentation or saline implants.  Please feel free to contact our office at (713) 661-5255 if you have any questions. 

-Brice W. McKane, M.D.

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“Are silicone implants better than saline implants?”

Since the 2006 FDA approval for silicone implants to be used in breast augmentation, I have received several emails a week inquiring whether silicone implants are better than saline implants.  Lately, my patients have been asking this question almost every day.   I feel part of this is due to recent marketing campaigns being conducted by the major breast implant manufacturers in the United States.  Silicone is all the rage.  Right? 

First, I’d like to respond to this question by saying that both types of implants have benefits and trade-offs.  As a board certified Plastic Surgeon, I feel that I am obligated to educate and inform my patients about their options. 

In the plus column for silicone implants:  There is little doubt that the texture of the gel more closely mimics breast tissue than saline does.  Also for patients who are extremely thin or who have little breast tissue, rippling and wrinkling can be less of an issue with gel implants than with saline implants.   Lastly, the satisfaction rates for silicone implants are very high and approach 97% in some studies. 

In the negative column:  Silicone implants are more costly in both the short and long term to patients.  At the time of surgery, the devices are approximately twice the cost of saline implants and this cost is translated into a patient’s quote for surgery.  Over the subsequent years, breast MRIs are currently recommended to monitor for silicone implant rupture.  Under the current guidelines, this study is to be performed at 3 years after surgery and then every 2 years thereafter.  Patients should understand that this study is very costly and not likely to be covered by insurers.  Very quickly, the cost of repeated MRIs will exceed the cost of the initial surgery.   Also silicone implants come prefilled and due to this require incisions that are twice as large to place them.  This impacts recovery times and scarring.  Furthermore, patients need to understand that breast implants don’t last forever and very often they will need to be replaced in the future due to rupture.  Silicone implants can complicate these future surgeries.  Lastly, the capsular contracture rate associated with silicone implants should be considered.  A capsule is a scar that develops around an implant on the inside of the breast.  This scar can shorten or contract over time causing firmness in the breast, change of breast shape, or pain.  The historical rates for capsular contracture at 10 years is on the order of 38.5-90% for silicone implants.  Saline implants have a 10 year capsular contracture rate of 16.6%. 

So to answer the question, “Are silicone implants better than saline implants?”  It depends.  Blanket statements by the public, surgeons, or manufacturers can not be made.  The individual needs of a patient will make this determination.  One woman may decide that the feel of the silicone implant in comparison to a saline implant makes it better for her, and with this, she is willing to accept certain tradeoffs.   Another woman may decide that the benefits of saline implants in terms of capsular contracture outweigh the feel of her implant.  I truly believe that a patient who is fully informed about her options will choose the best implant for herself, be it silicone or saline. 

Here is an example of a patient that underwent a silicone breast augmentation in my practice.  She is a 26 y/o woman that presented desiring silicone breast implants.  She was very concerned about the feel of her breasts after surgery and wished to have an augmentation that would closely mimic the natural feel of her breasts.  On examination, she has some mild asymmetries and only fair soft tissue coverage.  Here is the preoperative photograph:

During our consultation, she expressed that she would like to have a large augmentation.  She decided that she would like to use 500 cc silicone implants.  Due to her soft tissue characteristics and due to her desire for a silicone implant, I recommended that she undergo a dual plane breast augmentation through an inframammary (breast fold) approach.  Here is the postoperative result:

The operation achieved her goal of a large breast augmentation with implants that feel very natural. 

Our websites www.beauty-surgeon.com and www.drmckane.com have additional information about breast augmentation and before and after photographs for review.  I invite you to schedule a consultation with me if you would like to learn more about silicone implants or breast augmentation.  Please feel free to contact our office at (713) 661-5255 if you have any questions.

-Brice W. McKane, M.D.

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