The FDA has approved Silicone Breast Implants after years of intense studies.  Silicone breast implants have been approved, but with certain restrictions. They are only available to patients over 22 years of age.  Furthermore, only the cohesive gel (memory gel – gummy bear) implants are available.  If you have had or are considering Breast Augmentation, here are some facts you need to know. 

Due to the firmer nature of the cohesive gel, a larger than normal incision is necessary; therefore, the inframammary (under the breast) incision is preferable for the insertion of these implants.  The gel implant may also be inserted through a breast lift incision or an abdominoplasty (tummy tuck) incision.

Saline-filled implants, on the other hand, are placed through a smaller incision, as they are not filled until they are placed in the pocket.

• More natural position, appearance and feel
• Less painful, quicker recovery

• Less tapered upper pole (less noticable with sub fascial placement)
• Possible increase in capsular contraction

• Gives more coverage and support to the implant, particularly in thin patients with small breasts
• More natural upper pole fullness
• Possible less interference with mammography
• Slightly less risk of capsular contracture

• More painful
• Longer recovery
• More movement with muscle contracture
• Possibility of visible step-off at muscle edge

• Very low leakage rate (cohesive)
• Lighter than saline therefore less tendency to cause sagging if placed above the muscle
• More natural feel
• Less chance of rippling

• Larger incision necessary

• Smaller incision
• Lower cost
• Slightly less incidence of capsular contracture

• Higher leakage rate
• Higher incidence of rippling
• Heavier than gel, therefore preferable placement is behind the muscle to avoid sagging

• Volume can be changed after surgery
• Patient has input into final size
• Better able to correct asymmetry
• Better able to treat complications following previous breast surgery i.e., irregularities in shape, capsular contracture, symmastia  (disruption of midline)

• Injection dome has to be removed (can be buried or externalized)
• If the injection dome is buried, a second minor procedure, performed under local anesthetic, is necessary to remove the infection dome.

• More natural feel
• Less incidence of seroma (fluid) formation after surgery

• May decrease capsular contracture (This has not been proven with the new cohesive gel implants)

• Smooth, round, moderate profile- plus cohesive gel implants, preferably placed above the muscle, under the fascia (sub-fascial).

• Adjustable saline implants with external injection ports
• If the patient wishes to ultimately have silicone gel implants, adjustable saline implants are used to expand and adjust the pocket above the muscle.  These can subsequently be replaced with silicone gel implants, usually with local anesthetics.

• Submuscular saline implants are removed, the muscle is returned to its original position and new silicone gel implants are placed above the muscle (it is usually not necessary to remove the capsule unless it is calcified)

The most common breast problem seen after a woman has had one or more children is sagging of the breasts, combined with a loss of volume.  This condition is best treated by combining a breast lift procedure with a breast implant.  However, by combing the two procedures, the risk of complications are increased since the breast lift procedure results in tightening of the breast skin, while the implant enlarges the breast, resulting in increased tension on the scar.  It is for this reason that the sub-areola technique and the adjustable implant is beneficial when combining mastopexy with augmentation. Dr. Hilton Becker uses the adjustable implant, known as the Mentor-Becker implant, which he developed and pioneered in 1984.  Use of this implant, either saline or a combination of gel-saline, reduces the risk of scarring and complications associated with the mastopexy augmentation procedure.

If the adjustable saline implant is used it is placed under the muscle, the silicone gel implant is placed above the muscle.

A minimal amount of saline is placed in the implant at the time of the surgery.   Saline is added slowly over a period of 5-10 days to allow for healing of the incision.   When swelling has subsided and the implants are filled to the desired volume, the fill tubes and domes are then removed.  The implant seals itself with a self-sealing valve.

If a vertical scar is warranted, due to excessive ptosis (sagging), use of the adjustable implants greatly improves the shape and symmetry of the breast, while reducing the amount of scarring.

The new Silicone Cohesive Gel (MemoryGel –Gummy Bear) implants have been used with excellent results in combination with a sub areola mastopexy procedure.

Dr. Becker has lectured and performed live surgery at several national and international plastic surgery meetings on these techniques.  He has written two chapters in plastic surgery text books and has published three articles on this topic, including:

1. The Adjustable Breast Implant – Plastic Surgery Journal 1992
2. Augmentation Mastopexy using Adjustable Implants with External Injection Domes Aesthetic Surgery Journal – November 2006

Now that silicone gel implants have been approved for use by the FDA, women have the option of having the most natural form of breast enlargement available.

When Silicone gel implants were not available in the United States, woman had only two options available to them:

1.      Use saline implants placed above the muscle - Due to the weight of the saline implant they would tend to sag excessively, resulting in an abnormal shape, commonly known as Rock-In-The-Sock.   Rippling was also problematic.

2.      Place the saline implant under the muscle.  Although this technique reduced sagging, muscle contracture resulted in abnormal distortion of the implant.

It is of my opinion that the most beautiful and natural results in breast augmentation are seen with Silicone Gel implants, placed above the muscle.  Our patients who have received these implants are happier than ever.

Patients, who have previously had saline implants and are dissatisfied with their results, can now have their saline implants replaced with the New Cohesive Gel (MemoryGel – Gummy bear) implants.

Now you can change the size of your breasts without additional surgery.

The adjustable breast implant which was developed in 1985 by Dr. Becker is used in this procedure. The implant consists of a membrane that is filled with saline via detachable domes.  Saline (salt water solution) is added or removed from the implant post operatively by inserting a thin needle through the skin into the injection dome. Once the patient is satisfied with the size and shape of her breasts, the dome is removed usually three to six months post-operatively. The implant seals at the self-sealing valve.  Alternatively the injection dome may be exteriorized and removed one week later.

It is the ability of the adjustable breast implant to correct or improve difficult breast problems such as ptosis (sagging), symmastia (loss of cleavage), tubular breast deformity, and Polands syndrome (unilateral non-development) that makes this implant so unique. The adjustable-fill breast implant is useful in expanding underlying tissue and generating more breast tissue to create a more natural and symmetrical breast shape. Because these implants can be filled gradually over a period of several months, discomfort is minimized while the skin slowly stretches. In order to avoid the unnatural, hard-looking appearance of some augmentation, especially the upper fullness, adjustable breast implants can be overfilled, and then the volume reduced, allowing the breast to relax, producing a more natural appearance.

"My patients love the adjustable implant because it allows them to ‘try the size on' before the augmentation is finalized"  In the past, augmentation patients would immediately think their breasts were too big, due to the normal swelling that always follows surgery. Of course, over time in the weeks following the procedure, the swelling would decrease and patients would then complain that they looked smaller than they expected.  It can also be that they get used to the size and wish they had gone bigger.

"Now, the adjustable breast implant allows the volume to be corrected after surgery."