All implants have a silicone rubber shell and consist of three main components:

• the shell, which is the outside layer sometimes called the envelope or lumen
• the filler (either silicone gel or saline), which is inserted into the shell
• the patch, which covers the hole in the shell where the filler is inserted

Saline implants are filled with a sterile saline (saltwater) solution. They can be filled with varying amounts of saline to affect the shape, firmness and feel of the breast. In the unlikely event that the shell should leak, a saline implant will collapse, and the saline will be absorbed and naturally released from the body.

Gel implants are filled with an elastic silicone gel that feels and moves much like natural breast tissue. In the unlikely event of a leak, a gel implant might not collapse; the gel may remain in the implant shell or may escape into the breast implant pocket.

During your consultation, we can help you determine which type of implant is best for you.

In thinner women with average to little breast tissue, submuscular (under-muscle) placement is generally the preferred choice. Placement under the muscle helps avoid the phony look of implants that show under the skin and can create a shelf appearance. With submuscular placement, implants look and feel more natural since they’re under the double covering of muscle and breast tissue. This method also reduces visible rippling.

Submammary (over-muscle) placement may be more suitable for women with mild to moderate sag and adequate pre-existing volume. In patients who have tubular breast deformities, a submammary implant will be necessary to address the anatomic constriction at the base of the breast.

Your plastic surgeon will advise you about which type of implant placement is most appropriate.

At Plastic + Hand, an anesthesiologist from Spectrum Medical Group, the physician group that provides anesthesia at Maine Medical Center, will provide your anesthesia care. Your surgery will take place in our accredited outpatient Plastic + Hand Surgery Center located on-site.

Your surgeon will make inconspicuous incisions to minimize visible scarring. He or she will recommend an incision option based on the type of implant, the degree of breast enlargement, your anatomy, and your personal preference. These options include inframammary (under the breast), transaxillary (in the armpit), or periareolar (under the nipple).

After making the incision, your surgeon will insert a breast implant into a pocket either under the pectoral muscle (submuscular placement) or over the pectoral muscle (submammary placement).

He or she will then close the incision with layered sutures and skin adhesive or surgical tape. The incision lines will fade over time.

Full recuperation may take up to a month, but it’s likely you can return to work in just one or two weeks.

Breast augmentation lasts a long time but is not necessarily permanent. Studies show that for saline implants there is a 10% deflation rate over 10 years. A deflated saline implant will need to be replaced. Gel (silicone) implants should be monitored periodically, and the FDA recommends MRI examination 3 years post implantation, as well as every 2 years after the initial MRI to look for “silent rupture.” Self-breast exams continue to be essential for all women, and annual mammography for age 40 and over is still recommended, as for all women.

The usual risks and complications of breast augmentation are the same as with any surgical procedure: bleeding and infection. In addition, asymmetry is a potential pre- and post-operative problem. Women with naturally asymmetrical breasts will most likely remain asymmetrical, but often can be corrected with different-sized implants or a breast lift (mastopexy) at the same time as augmentation. One of the more vexing potential post-operative issues is hardening of the implant, related to thick scar formation around the implant itself. This condition known as “capsular contracture” may necessitate follow-up surgery, though it is an infrequent occurrence.

Gel implants do not have any association with disease as was once alleged. Years ago, it was suggested that certain rheumatological diseases (rheumatoid arthritis, scleroderma, lupus, etc.) were related to gel (silicone) implants. However, studies completed over the last 15 years have definitively shown no such association. You will have an in-depth discussion with your surgeon regarding the pros and cons of any planned surgery such as breast augmentation.

The best candidates for breast augmentation are healthy women who have realistic expectations and a thorough understanding of this procedure. An in-depth consultation at Plastic + Hand Surgical Associates will help you determine if breast augmentation is right for you.

You’ll first discuss your breast augmentation procedure options with your Plastic + Hand surgeon. During your initial consultation, your surgeon will evaluate your medical history, your breast augmentation expectations, discuss the best breast implant options for you, and set realistic goals for your breast augmentation surgery. Your Plastic + Hand surgeon will then recommend the breast augmentation procedure that will offer the best results for your desired outcome.

After this personalized consultation, our Patient Care Coordinator will prepare a cost estimate that is specific to your upcoming breast augmentation procedure. Costs vary by cosmetic surgery procedure, but all estimates include pre- and post-op visits, anesthesia, and use of the surgery facility. Our Patient Care Coordinator will also discuss payment options with you.