Dr Cheski Discusses Issues in Breast Augmentation.

Issue: Saline versus Silicone implants
There is a lot of misinformation about this because much of the literaturerumours, and word of mouth about silicone implants is based on liquid silicone implants from the 1970’s, 80’s and early 90’s. The silicone implants used now are a cohesive gel implant, and they behave much differently . The silicone implant has a higher rate of leakage and the leaks are harder to detect and correct. Silicone implants come pre-filled and thus require a larger incision/scar and are much more difficult to match size in patients who have one breast larger than the other. Further, the silicone implants are more expensive.
Some people think cohesive gel implants(modern silicone) have less rippling and a more natural feel. This is true with the old liquid silicone implants, but I, and many other surgeons, have found that the new implants actually have more ripples and a higher rate of capsule contracture(hardening of the breasts) . To get FDA approval, the implants are now safer but the trade off is a higher rate of rippling.
In contrast, the new saline implants are far superior to the saline implants of old. I have found that there is a significant decrease in rippling and more natural feel, especially among the high profile saline implants. The implants are inserted uninflated and are inflated in place, thus they can be inserted through a much smaller incision, resulting in a much smaller scar. A leak or deflation is much safer and is easier to detect and correct. Further, there is a much lower risk of capsule contracture, especially when placed through the belly button.
I use both saline and silicone implants, but I much prefer the saline implants.

Issue: Minimizing and Treating Rippling
Place the implant under the muscle. I prefer the High Profile Saline Implant. Their configuration has a sidewall that ripples less. Also, more of the implant is under the muscle and less hanging toward the armpit.
I have developed a unique technique to minimize the risk, or treat, rippling. For very thin patients or for patients who has rippling, I suggest fat grafting to the area of rippling which provides a cushion between the skin and the implant. This masks any potential rippling.
Issue: Capsule Contracture:
To minimize the risk of capsule contracture, I prefer to use saline High Profile under the muscle and use massage post operatively. Also, placing the breast implant through the belly Button, or TUBA) greatly reduces the chance of Capsule Contracture

Issue: Need to change implants every 10 years.
This used to be true with the old implants, but it is no longer the case. In fact the implants are guaranteed for life by the manufacturer, which covers a replacement implant plus provides money toward the surgery.

Dr Peter Cheski, MD FRCS, FAACS www.DrCheski.com 310 575 1500 818 991 6300
Offices in Agoura/Calabassas, West LA, and Lancasstser