Breast Augmentation FAQs

1)  Which are better, silicone or saline?
Silicone implants are generally better aesthetically. They feel more like breast tissue, especially in someone who is thin or very small-breasted. That said, most people with saline implants are very happy with them, and they do have advantages with regard to cost and incision size.
2) Which last longer?
Both saline and silicone implants have similar longevity, and differences between manufacturers are slight. It is important to realize that no implant lasts forever, so future surgery must be considered when thinking about having breast implants.
3) Which surgical approach is best?
There is no ‘best’ approach. There are pros and cons to the various incisions, and this is best discussed during your consultation. I perform inframammary, periareolar, and axillary (armpit) approaches. The axillary approach I use is NOT the blind technique you might read about on the Internet. I use endoscopic equipment, allowing a precise and controlled procedure.
4)  Are breast implants safe?
Both silicone and saline breast implants have evolved over the years, and have a very good safety record. Controversy led to a 14 year moratorium on silicone gel implants in the United States beginning in 1992. After years of studies, panels, and investigations by physicians and government agencies, silicone gel implants were brought back to the general cosmetic surgery market (they were always available for breast reconstruction and certain cosmetic applications) in 2006.  Nevertheless I believe there is plausible evidence that rare women can have adverse effects from implants, and it is currently not possible to identify these patients prior to surgery.  Additional extensive information from the FDA can be found here.  Please read our page on BIA-ALCL.
5)  I have heard that breast augmentation is a very painful procedure. Is that true?
For subpectoral placement of implants (the way I and most plastic surgeons perform the surgery) the answer is yes. However, the good news is that this can be significantly reduced with several non-narcotic medicines before, during, and after surgery. Exparel is another option that can provide sustained pain reduction for 72 hours after surgery.
6) How do I know if I need a lift?
Please see the page on mastopexy. Generally, if your nipple has dropped to a level equal or below the fold under the breast, you will need a mastopexy. The type of mastopexy will be determined by the degree of ptosis (sag).
7)  Will I be able to breast feed if I get breast implants?
Yes. The implant is placed beneath the breast gland, and typically beneath the pectoralis muscle that lies under the breast. The axillary and inframammary approaches do not dissect through breast tissue although the periareolar approach does. As the periareolar approach does affect some breast tissue, it could conceivably diminish breast milk production. Very large implants could also have a detrimental effect on breast feeding.
8) Are shaped implants better?
Shaped (anatomic, teardrop) implants are an excellent choice for many patients and during your consultation we will determine that. Most patients however do well with round implants. Sientra currently has the largest selection of shaped implants and are the ones I use.
9) What is BIA-ALCL and should I be worried about it?
We have a whole page on this topic.  Please click on BIA-ALCL.

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