What’s the Best Type of Breast Implants & Other Top Breast Augmentation Questions

Choosing the best breast implants depends on your anatomy, lifestyle, and cosmetic goals. Below, I answer some of the questions I hear most often during breast augmentation consultations and share the perspective I’ve developed over more than 25 years in practice.

My Perspective on Breast Augmentation

I specialize in both primary breast augmentation and revision breast augmentation. We understand the unique and personal decision that is made to proceed with breast augmentation. Many patients have done their homework and have sought out answers to their questions on the internet, but often, these answers are not exactly what I would say to the questions. 

For that reason, I want to share my own perspective on these common questions. Each plastic surgeon has her own history and perspective on these questions, which explains the variation. And each patient is unique, so there is never any one set, pat answer. For the most part, though, these are the answers you will hear from me when you come in for your consultation. 

What Types of Breast Implants Are Best?

For most of my patients, today’s highly cohesive silicone gel implants are good options because they provide a more natural look and feel than saline implants.

I must preface this entire blog, though, with the fact that I have been in practice for over 25 years, and a lot has happened in that time regarding implants. When I first started, in 1996, the only implant on the market was saline. And so I put in thousands of these. But when the silicone gel implants were released back onto the market in 2006, the use of saline implants dropped off dramatically. This is because they do not feel as natural.

First-generation silicone gel implants were very soft but not very cohesive. So when the outer envelope broke, the gel on the inside would ooze out. Now we have 5th-generation gel implants that are highly cohesive, and when the outer shell breaks, the inside gel holds its form (so sometimes they’re also called form-stable or gummy bear breast implants). This is a good thing, and I feel it’s a true game changer, so now I prefer the highly cohesive gel implants.

Today’s highly cohesive silicone gel implants also come in a variety of sizes and profiles, allowing me to tailor the procedure to each patient’s anatomy and cosmetic goals. While patients sometimes ask for a specific implant they’ve read about online, I find that the best choice is usually the one that best matches their body rather than any particular brand or style.

Saline implants can be an acceptable option if the patient has enough fatty tissue and breast tissue to make the implant look and feel natural. So the choice is made in the consultation, with each patient’s unique anatomy and history in the equation. 

Comparing Saline & Highly Cohesive Silicone Breast Implants

Feature	Saline Implants	Highly Cohesive Silicone Gel Implants
Feel	Firmer	More natural-feeling
If rupture occurs	Saline absorbed by the body	Gel generally holds its shape
Best for	Patients with adequate tissue coverage	Most patients seeking the most natural feel
My perspective	Good option for select patients	My preferred choice for many patients

What’s the Best Breast Implant Placement: In Front of or Behind the Muscle?

There isn’t one placement that’s best for everyone. The decision depends on your anatomy, implant choice, tissue thickness, and aesthetic goals.

Before I continue with my perspective, the history about pocket placement should be highlighted, since after all, the breast tissue sits on top of the chest muscle—not under it. So why did plastic surgeons put the implant behind it in the first place?

The first implants on the market were silicone, and they were placed on top of the muscle. But when they were on hold during the 1990s and early 2000s, the only implants available were saline. And for many of the patients, the visible rippling of the saline implant was not acceptable. So, why not cover the implant with the pec muscle—great idea! This is how I did saline implants for almost all my patients, except again if they had enough fatty tissue to cover it.

Over the ensuing years, when silicone gel implants were released back onto the market, we all just continued to place them under the muscle. This also had the benefit of better mammograms and was thought to help with the prevention of capsular contracture. But now, with the advent of highly cohesive gel implants, the question is even trickier. I am in favor of placing the implants above the muscle if possible. When the patient is very lean, this will not be possible. 

When Can I Go Back to Work & Exercise After Breast Augmentation?

Most patients with desk jobs return to work within a week, while physically demanding jobs often require several weeks away. The thing to remember is that it is a short-term inconvenience for a long-term payoff. 

Exercise is reintroduced gradually as you heal. I recommend that you do not do any high-impact cardio for about 3 weeks, but walking is fine by me, starting the day after surgery.  

How Do You Know if You Have a Ruptured Breast Implant?

Most silicone implant ruptures don’t cause obvious symptoms, which is why routine imaging is recommended. While there is no test that is 100% accurate, the most sensitive for implant rupture is MRI. This, however, is a burdensome and potentially expensive test. 

Mammograms can be helpful but not foolproof and also require a visit to an imaging center. The good news is the development of a digital bedside ultrasound that can be used in the office to help answer this question. Again, it is not 100 % foolproof, but it can be used as another tool to provide more information and peace of mind. 

Current FDA guidance recommends imaging beginning 5 to 6 years after implantation and every 2 to 3 years thereafter for asymptomatic silicone implants. For my patients, we do implant ultrasound starting 5 years after surgery or if they have any symptoms or other reason to take a look, like trauma. There is a nominal fee for this, which is offset by the comfort it can bring. If it is not clear from the bedside ultrasound, it is also possible to send the patient at that time for more imaging. 

You can learn more about breast implant longevity, imaging, and rupture detection in my related blog post.

Can My Breast Implants Be Too Big? 

This probably is the hardest question to answer. Everyone wants to be bigger, but bra sizing is non-standardized, and to make matters worse, our breasts are constantly changing with weight fluctuations, aging, and hormonal influences. The thing I like to tell my patients is that you can always make them look bigger with a pushup bra. This seems ironic after a breast augmentation, but it is harder to make them smaller without breast augmentation revision.

So this is a conversation that I have with each patient. For my glamour girl patients, I am more likely to recommend a little bigger size than for my sporty gal patients—most endurance athletes do not have breasts that are bigger than a full B or C cup.

The other thing to mention is that for the gals who want to go as big as possible, it all depends on their skin envelope. I physically cannot place an implant that is so big the skin will not stretch enough to accommodate it. I have to be able to close the incision! The answer for these patients is that I bring a few sizes to the OR and place the biggest I can, and then after the skin has stretched out, usually in a few years, they can go up in size. 

You can take a look at my patients’ before and after pictures below and in my photo gallery to get an idea of how different implant sizes look in real life.

I hope that by answering the common questions about breast augmentation, you have learned a little more about the operation and are ready to proceed. Feel free to give us a call at (614) 569-2649 or use our online form to request a consultation. We look forward to serving you. 

Breast Wishes!

From Dr. T. and the A-team at Aesthetica