I just saw a breast augmentation patient for a consultation. I was her third doctor interview, and she got different opinions from each of us.
How can that happen?
There are areas of grey in all aspects of medicine. Add to that different experiences of doctors, how long they have been in practice how up to date they are, what their aesthetic is and you will get different viewpoints. There are well known trends: certain areas of the country tend to skew to larger sized implants (ie Florida, Texas) vs smaller implants (California). Southern California tends to put in larger implants than Northern California. Male surgeons tend to recommend larger implants than female plastic surgeons.
So what was my patient’s experience today? One doctor didn’t offer her the option of saline implants at all. Another doctor told her that saline implants never need to be replaced but silicone gel implants must be replaced every 10 years. One office told her she should do 445cc silicone implants but never had her try on sizing implants at all.
My thoughts?
If you are on my website, have had a consultation with me, or read my reviews, you will know I believe in education. You should understand
- What are all my options?
- What are the risks? They should discuss ALCL, breast implant illness, biofilm, capsular contracture, et al.
- You should be guided to help you figure out sizing. This includes profile of implant, which involves doing measurements of your chest wall to figure out the best width of implant for you.
- What do I need to do in the future? When do you need to replace and what does that surgery look like?
- Timing. Recovery, time off work and exercise. Should you do this pre babies and breastfeeding? After? What are life considerations to take into account?
As for breast augmentation, your doctor should review the basic points below. I have tons of information on my website and blogs about all of this.
- Silicone gel vs Saline breast implants. Pros and cons of each.
- Size. For this, do not pick a size by looking at photos. YOU MUST USE SIZING IMPLANTS. See my blog on the rice test for implant sizing to make your own at home.
- Profile.
- Scar position
- In front of or behind the muscle.
- The underbelly of implants: ALCL (textured implants), Breast implant illness, biofilm and capsular contracture. What steps is your doctor taking to minimize these risks? BII RISKS HERE
- Warranty
- Future issues. When do you need to replace, how you know something is wrong, etc.
As for my patient?
She had felt uneasy after her prior consultations. The fact the first doctor didn’t offer saline as an option and chose the implant size for her without sizing implants was a turn off. The second doctor stated saline implants never need to be replaced- I don’t understand that one, as all implants can eventually fail. I have been in practice for over 2 decades. I for sure see saline implants that have deflated. Frequently they are over a decade out, but they are fallible objects. As for replacing silicone implants at 10 years regardless, I disagree. I have many patients who are over a decade out with no issues. That being said, if you want to remove the implant before you wait for it to have an issue, I could understand that. I did a surgery yesterday with implants that were over 20 years old. One side was ruptured, which had caused the capsule on that side to thicken and harden. The other implant looked fine, and had a thin pliable capsule.