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Stephen Miller MD PC FACS

Saline and Silicone Gel Breast Implants

The first decision you need to make is which incision to use. Incisions vary based on the type of breast implant, degree of enlargement desired, your particular anatomy and patient-surgeon preference.

Breast Implant Incision Sites

Your incision options are;

Periareolar Incision-this incison is made along the bottom 1/3 to ½ of your areola. Dr. Miller prefers this incision because he feels that it hides the nicest, sometimes it is almost invisible. There is a color junction change here so if the scar gets dark it will blend with the areola and if it gets light it will blend with the skin. This incision also allows the surgeon to be very precise in his placement of the implant and good access to control bleeding. This incison can be used again if you need any secondary surgeries in the future.

Inframammary Incision-This incision is made slightly above the fold where the lower part of the breast meets the chest wall. Because of it’s location this incision also allows the surgeon good access to control bleeding and more precison to place the implant than a transaxillary incision. One drawback is that it can often be seen in small bathing suits. This incision may be able to be used if you have any secondary surgeries in the future unless your tissue has thinned out in that area.

Transaxillary Incision-This incision is made in the crease of the armpit. The surgeon then either uses an endoscopic camera or they go in by feel, this is called the blind approach. This option is often less precise and can result in some breast asymmetries. Another drawback is the scar can often be seen in sleevless clothing. This incision can usually not be used again if you have to have any secondary surgeries in the future.

Submuscular or Subglandular Breast Implant Placement
After you’ve chosen your incision, you and your plastic surgeon need to decide whether to place the implant above (a submammary/ subglandular) or below (sub-muscular) the muscle.

submuscular breast implant incision site

Under the pectoral muscle (a submuscular placement), is preferred for someone who is young, has not had children, has little or no breast tissue or a moderate amount of breast tissue and their breasts are still up and perky. Under the muscle gives them a little more support, sort of like an internal bra, which helps fight sagging in the future due to pregnancy, weight gain/loss and aging. Under the muscle also gives the implants a little more coverage so the implant is less visible and to help hide any rippling. If you exercise and implant that is place behind the muscle is more likely to shift or move when you exercise your chest muscles. Recovery from under the muscle surgery is a little more painful the first few days because the muscle is fighting to get back against the chest wall. Under the muscle provide slightly better visual for mammograms and may have a little less risk of developing capsular contractor.

Over the muscle, behind the breast tissue (a submammary/ subglandular placement), is preferred with someone with a moderate amount of breast tissue who desires a more natural look or someone who has a bit of sagging but either not enough to warrant a lift, or in a woman who does not want a lift. In this case over the muscle is better as this will allow the implant to follow the natural shape of the breast. Putting an implant will not lift the breasts but can sometimes give the appearance of a lift by filling out your upper pole fullness. Furthermore, the weight of the implant, combined with gravity, can make your breasts sag even more. But if there is too much sagging a lift or a lift with an implant may be needed. Recovery is a little less painful from over the muscle surgery.

Implant Choice – Silicone or Saline

The next decision you and your surgeon need to make is implant choice. This involves several things such as type- saline (salt water) or silicone (also known as Cohesive Gel or Gummy Bear), size, shape, smooth or textured and profile.
The first thing you should understand about breast augmentation Las Vegas is that they are not lifetime devices. They are man made objects and they will eventually break. As they get older the chance of them breaking goes up. Unfortunately there is no timeline for how long these medical devices will last. The FDA does have some recommended guidelines for silicone. They recommend an MRI after 3 years and every other year after and they recommend you change them out at some point. They do not give a recommended amount of time for that change. These are recommendations not requirements. No such recommendations are given for saline.

Silicone gel−filled breast implantation devices have been under scrutiny for years, but after gathering detailed and meticulous research and data, the FDA has approved them for use in cosmetic breast enhancement surgery.

In 1997, the Department of Health and Human Services requested the institute of Medicine (IoM) of the national Academy of sciences to conduct a comprehensive evaluation of the safety of medical device. The IoM panel of independent scientific experts included members of the medical, scientific and educational communities with experience in radiology, women’s health, neurology, oncology, silicone chemistry, rheumatology, immunology, epidemiology internal medicine, and plastic surgery.

After reviewing years of evidence and research concerning silicone gel filled breast implantation devices, the IoM found that “Evidence suggests diseases or conditions such as connective tissue diseases, cancer, neurological diseases or other systemic complaints or conditions are no more common in women with breast implants than in women without implants.”

In addition, the FDA has approved the following three companies to develop and market breast devices and continue to collect data on their long-term safety and efficacy.

Mentor MemoryGel® (silicone) Breast Devices

Silicone gel filled breast implantation devices have undergone changes over time to meet increasingly sophisticated consumer expectations. The very first silicone device used thick shells and contained firm gel. The second generation introduced in the late 1970’s had thinner shells and used less firm gel to address concerns of patients and surgeons who believed that they were were too firm, palpable and visible. In the mid-1980s, concerns related to rupture rates of the second generation thinner-shelled device led manufacturers to introduce a third generation. The shell and gel of these third generation devices were slightly thicker but still soft. Today these third generation silicone gel are typically referred to as cohesive gel. Fourth generation, including MemoryGel® were introduced in the mid-1990s with further refinements in the manufacturing process. Today newer, fifth generation devices are available, such as with Memoryshape® , which are filled a uniquely formulated cohesive gel that provides shape retention.

Mentor MemoryGel® are filled with a proprietary cohesive gel that holds together uniformly while retaining the natural give that resembles breast tissue.

 MenTor® Memoryshape® Breast implant

Seeing is believing! A MenTor® Memoryshape® Breast implant is cut in half illustrating cohesive gel fill.

They have a set fill volume for predictable results. They come in four projection options: Moderate classic, Moderate Plus, High and ultra-High Profiles and smooth or textured surfaces.

Allergan Natrelle INSPIRA™ Silicone

In June 2015, Allergan introduced the INSPIRA silicone gel breast implant to the U.S. This implant design, which has been used safely in Europe for many years, is now U.S. FDA approved. The Natrelle INSPIRA™ Silicone implant offers both surgeon and patient an ideal option to further enhance upper breast fullness.

Historically, one of the best options for patients seeking more dramatic upper breast fullness was to use overfilled saline implantation devices to achieve the patient’s desired look. The downside to overfilling the saline implants, however, is that they sometimes feel too firm. Although, patients love the look!

With regards to silicone devices, they are prefilled, and it turns out that the traditional Allergan Natrelle implantation devices are only about 86-87% filled with silicone gel, whereas the Mentor MemoryGel are 91-92% filled. Hence, the enhanced upper breast fullness that many patients liked better with Mentor implantation devices.

Now, the Natrelle INSPIRA™ devices are available from Allergan, giving patients and cosmetic surgeons an additional option. The INSPIRA silicone gel implant is an “over-filled” or “fully-filled” silicone implant – 96-97%. Hence, a moderate-plus profile INSPIRA implant can give patients who need a moderate-plus profile implant, the high-profile look they desire from Mentor. The advantages of silicone implantation devices include a decrease in the risk of capsular contracture, an enhanced warranty, a more natural feel, and less palpable rippling.

Every silicone gel-filled breast implant in the NATRELLE® Collection has a cohesive silicone gel-filler. Basically, this means that silicone inside the implant acts more like a soft solid than a liquid. All Allergan gel-filled breast implants have a patented INTRASHIEL™ Barrier Technology. This barrier in the shell reduces shell permeability and minimizes gel diffusion or gel bleed.

Natrelle INSPIRA™ breast implantation devices come in low, low plus, moderate, high and ultra-high profiles and smooth or textured surfaces.


Breast Implants with High-Strength Cohesive Silicone Gel. Sientra implants are currently not available in the US.

Saline -Filled are filled with a saltwater solution similar to the fluid that makes up most of the human body. Saline implantation devices are inserted into the body without fluid and then filled with the saline fluid through a fill tube during the surgery to adjust and achieve optimal volume. They have a slightly firmer feel than gel implants. They are available in Moderate, Moderate Plus, and High Profiles and both smooth and textured surfaces.


Round implants fill out the existing breasts by adding volume to the upper pole of the breast resulting in a “rounded” look. The upper pole of the breast can lose fullness over time due to gravity, resulting in a flatter emptier look. If you want a look that is more “round” at the top of your breast, you should discuss MemoryGel® Round Breast Implants or Natrelle Inspira with your surgeon. Round implantation devices come in several different profiles.

Teardrop-shaped implants are made to match the silhouette of a natural breast with more fullness at the bottom than at the top. The implantation device fill out existing breast tissue by a subtle increase in upper pole volume and a greater increase in lower pole volume. If this is the look you want, MemoryShape® products may be right for you.


To determine the ideal implant size for you, the width of your breast needs to be taken into consideration. Choosing the right size implant is generally the most important decision a woman and her surgeon will make. Breast implantation devices are sized by cc volume (cubic centimeters – cc’s) not cup size. CC volumes do not accurately translate to bra cup sizes. All bra manufactures size differently and therefore bras from different manufacturers will fit differently. You may be a 36 C in one bra and a 34 D in another. About every 150 to 200 ccs equates to an increase of approximately one cup size. At our office we have sizers so that each patient can try on to see what size looks best on her. Your plastic surgeon will also evaluate your existing breast tissue to determine if you have enough tissue to accommodate the desired size of breast implant. Your surgeon is the best resource for determining what size implant is best for your body.

The NATRELLE® Collection offers a wide range of volumes from 110 ccs to 800 ccs, so you and your surgeon can find the volume that you are looking for. The final volume is determined by combining the base width that fits your chest with the projection you desire. It is important to be aware that a larger volume implant may not necessarily mean that your breasts will look bigger – it depends on your body type and shape.


Profile refers to the width at the base of the implant and the level of forward projection from the chest wall.

natrelle breast implants

Examples of Natrelle Inspira Round profiles.

Low to Moderate profile are the widest at the base of the implant. They have the least projection from the chest wall. They are best suited for someone with a fairly wide chest or someone who wants to create some upper pole fullness without adding as much volume to their cup size.

Moderate Plus profile have a wide base but a little more projection than a low or moderate profile. They are best suited for someone with a slightly wide chest or someone who wants to create some upper pole fullness without adding as much volume to their cup size.

High or Ultra High profile have a narrower base with the most projection from the chest wall. They are best suited for someone with a narrow chest or someone who wants create a more prominent breast.

Smooth or Textured

Smooth breast implants are round and have a soft silicone rubber shell. Smooth implants have a shiny, smooth outer shell. Smooth implants feel like natural breast tissue. They do not attach to surrounding breast tissue and can move freely around the breast pocket.

Textured breast implants have a slightly thicker, bumpy silicone shell, with a soft textured surface almost like soft rubber sand paper. Textured implants come in both round and teardrop shapes and attach to the tissue and prevent rotation and movement.

Try on Implants

After you are comfortable with the choices you and your surgeon have made to get the look you desire we will try on implants. This gives you the opportunity to see approximately what size you will be after surgery. We will then go through our before and after photos and find a few photos of someone who is similar to your body type so you can get an idea of how you will look after surgery.

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