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Four Common Questions About Breast Augmentation

Posted on January 2, 2020

By: Dr. Asaf Yalif

Surgeon's gloved hands holding one silicone gel implant and one saline-filled implant

When suburban Atlanta women come to our offices in Atlanta or Alpharetta for breast augmentation consultations, we always discuss implant types and the different options available to achieve their desired outcome. In today’s blog post, we’re going to discuss the implant types and other options to improve your breast aesthetic. We will also touch on some of the concerns around texturing and what physicians think may be happening.

But first, watch the video below for a quick overview of breast implant options.

What are Implants filled with?

We have already devoted a whole blog to saline versus silicone implant options, you can see it here. I won’t rehash all of it but I will mention that there are implants filled with saline, or saltwater, and ones filled with silicone. The newer silicone implant filling is more viscous/thicker than it used to be. Because the gel is thick, if you were to cut the implant the inner gel tends not to move around as much as the older, more liquid gel. We think that this allows the implant to still feel good but makes it less likely for gel to leak outside the capsule if there is a problem with the implant shell. The implant shells have also been improved, even as they have gotten thinner. All of this is in an effort to minimize the chance of leakage of the inner silicone.

The anatomic breast implants are also filled with silicone but that gel is even thicker than the gel used in the round devices allowing the implant to maintain its’ shape. That means that that theoretically the gel is even less likely to migrate if it gets out of the shell. This is why we call them “gummy bear” implants.

What is Implant Texturing?

Implants can be smooth or textured. Each company produces their texturing in a particular, proprietary way. The ones we utilize, Mentor, are imprinted with the texture. We utilize texturing in a few situations – to reduce contracture after a contracture has occurred and in situations when we don’t want the implant to move around as much. What we have found though is that the texturing is associated with a very rare form of lymphoma. We are not exactly sure why the lymphoma develops but theories center around a chronic level of inflammation leading to a breakdown and eventual cancer. This was seen more so with the texturing associated with Allergan implants which is why they voluntarily removed those implants from the market. To be clear, the cancer is still very, very uncommon; so if you have textured implants already do not assume the worst! The recommendation is to continue to follow with your plastic surgeon yearly, even if you have Allergan textured devices. If detected early the lymphoma is readily treatable.

Can you use Fat instead of Implants?

There is a thought to try to replace implant surgery with fat grafting. This is where we perform liposuction elsewhere on the body, cleanse the fat, and then inject it into new locations, in this case the breasts. Classically this has been into the buttock – via a “Brazilian Butt Lift.” There are several caveats to this though. First and foremost is the makeup of the breast – usually part glandular tissue and part fat. If we add fat the normal makeup is changed and the “feel” of the breast may change. More importantly, the grafted fat depends on the breast to provide blood flow to it and help it to survive. This means is that not 100% of the transferred fat may survive. We anticipate anywhere from 50-70% of the fat to survive since the breast is unable to supply flow to all of the transferred fat. Further, we do not know which areas of fat will survive and which will not so this can lead to asymmetry between the 2 breasts and even areas of asymmetry within a breast. As such we always advise that if we are considering fat grafting we stress that we may have to perform a “touch up” procedure if there is an asymmetry afterward.

BIA-ALCL and Implant associated illness

As noted above – breast implant associated anaplastic large cell lymphoma is a very uncommon, but real phenomenon. It should not scare you away from implant surgery but it should give you pause and does merit a deeper discussion with your plastic surgeon, especially if you are considering a textured device. The same is true for patients who feel they have breast implant associated illness. There are an increasing number of patients who feel that their implants are causing, or worsening, their symptoms/illnesses, whatever they may be. While we do not have data to support implants causing or worsening illness we always recommend a thorough evaluation by your plastic surgeon to make sure that the implants are intact, and that you have no signs of contracture or other implant issues. If all seems well with the device and you still want it removed, that is your choice, we just cannot tell you that it will make the other signs/symptoms better. Hopefully with time and additional data we may better be able to answer these questions and make a firm recommendation.

I also I always caution, “buyer beware” since implants are still being placed by non-plastic surgeons in non-approved operating rooms throughout the world. We cannot vouch for the safety or sterility of those devices and what may or may not be happen to those patients. If you find that you are having symptoms and are concerned that your implants may be worsening those symptoms it is always reasonable to seek a medical opinion and work-up.

Still have questions –

None of this is meant to scare you away from implants or breast augmentation. We just want our patients to be fully informed about their choice of device and any possible adverse outcomes. The last thing we ever want is for someone to say, “no one ever told me that could happen.”

We are always happy to answer your questions online and in person. You can also call one of our offices at (404) 476-8774 (Alpharetta & Atlanta) to schedule an appointment.

As a Triple Board Certified Plastic Surgeon I make sure to spend significant time with you to help you realize your goals in breast augmentation and understand your breast implant choices. With my years of experience and technical expertise, I know that I am more than capable of providing you with a result that exceeds your expectations.

In addition here are a couple of links to information from the American Society of Plastic Surgeon (ASPS) and the Aesthetic Society.

Patient Safety Information

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