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June 09, 2009

Silicone Breast Implants Still Not as Popular as Saline

In the current edition of the Aesthetic Surgery Journal, Drs. Reece, Ghavami, et. al., surveyed current practice patterns in breast augmentations by Board Certified Plastic Surgeons throughout the USA.  While the study was mostly predictable, I was shocked to read that plastic surgeons still use saline implants more frequently than silicone implants!

Here's what implants plastic surgeons seem to prefer...

  • 92% used smooth implants (rather than textured)
  • 96% prefer round implants (rather than tear-drop shaped)
  • Saline still outsells silicone.
  • At least 40% of plastic surgeons prefer saline implants over silicone implants.
  • 23% use saline implants exclusively!

Compared to my peers, my numbers are similar, except when it comes to saline versus silicone.

  • I prefer smooth.
  • I prefer round implants.
  • I do like saline implants.  Saline still has a role to play, especially when a patient wants the smallest possible scar.
  • However, in general, silicone is my preferred option.  I recommend silicone to 90% of my patients.

Why do I like silicone in most cases?

  • Silicone has a more natural feel.
  • Silicone produces less "rippling."
  • I think that silicone implants will probably be more durable.

Most of the other results of the study were predictable.  Overall, I am happy to say that I follow the standard, majority opinion in all of the following circumstances:

  • Most plastic surgeons and their patients prefer outpatient surgery centers rather than hospitals.  (I use both, but most routine breast surgery is done in a same-day surgery centers.)
  • About 2/3 of plastic surgeons work with physician anesthesiologists; the other 1/3 employ a nurse anesthetist.  (I prefer a Board Certified Anesthesiologist for maximum safety.)
  • Most (93%) do not use pain pumps.  (I place long-acting novocaine-type medication into the breast "pocket," but I do avoid pain pumps.  I worry that the pump tubing could increase risks of infections.)
  • Average implant size is between 300 cc and 400 cc.  However, there were minorities of plastic surgeons who usually placed 200-300 cc implants; still others seemed to preferentially use 400-500 cc implants.  (My average is in the high 300s.)
  • Regarding incision location, 64% prefer an incision in the fold beneath the breast, and 25% use an incision around the areola.  (These are the two approaches that I use.)  Very few use the arm pits, and almost none still use the belly button.  (I don't use these techniques at all anymore.)
  • Regarding implant location, 78% attempt some coverage of the implant beneath the pectoralis muscle.  (I place implants below the muscle in 95% of patients.)

What would be interesting to know is how California is different from the rest of the country.  Is California "bigger" than the other states?  In Ventura, Oxnard, and Camarillo, patients tend to be conservative; how would suburban Ventura County compare to Los Angeles?  Thoughts for the next research project....



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Glenn Mills Cosmetic Surgery

I think the question of silicone or saline is, as it should be, judged by a doctor on a case by case basis. This is where it really helps to have a doctor that knows what they're doing and can explain the pros and cons of each option and which could be best for that particular patient.

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