Silicone implants have been used for breast enlargement since 1962, and have remained one of the most frequent cosmetic procedures plastic surgeons perform.

The following should help patients understand how ideal results can be achieved consistently. For best results, patients should be well informed prior to any surgical procedure.

  1. What is a “rapid recovery breast augmentation”?

This term implies that the surgery has been meticulously performed, never touching the periosteum of the ribs (which causes pain), using a cautery designed to cut and coagulate for dissection, instructing the patient on medications and foods to refrain from before surgery so bleeding is minimal, meticulously coagulating any bleeding points and giving special stretching exercises. Most routine chores can be started within the next day or two.

  1. What is an “auto-augmentation”?

“Autologous” means using one’s own tissue. Often the patient’s own tissue can be used with an uplift to give more fullness at the upper part of the breast – always desirable, but the patient has to have enough tissue for this. It gives the appearance of an uplift with implants.

An excellent alternative is fat transfer (grafts), but the patient must have enough fat elsewhere to liposuction and use.

  1. Breast implants, an uplift or both?

If the nipples are below the infra-mammary (IM) crease or if they point downward, the patient probably needs an uplift (mastopexy). If the breasts also are too small, implants or fat grafts can be used to increase the size. If the nipple is above the IM crease, implants should suffice.

  1. The difference between saline and silicone gel implants?

Saline implants are silicone bags with salt water used to inflate the bag. They are excellent implants and less expensive.

The problems are wrinkles might be seen and felt, and eventually even deflation may occur. One of my patients had a deflated implant the night before her wedding. Timing is not always convenient.

The memory-type cohesive silicone gel implants are probably best over the long run. They feel and look more natural and are very durable.

  1. Implants in front of or behind the muscle?

Both techniques are good but neither is perfect – otherwise there would be only one technique.

If a patient has enough breast tissue, in front of the muscle is fine. Recovery is slightly faster, and there is no distortion of the implant when the patient moves her arms in certain positions, contracting the pectoralis muscle.

If breast tissue is minimal, the implants should be placed behind the muscle.

Both techniques should look very natural. However, the encapsulation rate might be lower with behind-the-muscle implants. Encapsulation is when the body creates scar tissue that tightens around the implant, making it feel firm.

Each patient should be evaluated very carefully and pros and cons discussed with the surgeon prior to making a final decision

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. www.fingerand