Silicone Breast Implants. Saline Breast Implants.  Round Breast Implants.  Shaped Anatomic Breast Implants.  Smooth Implants.  Textured Implants.  Some many choices, but which one is best for you?  Breast augmentation requires proper planning on your part as well as on the surgeon's part.  Yet most people probably spend more time chosing a microwave than they do on chosing their surgeon and their implant options.

Choosing your Plastic Surgeon .  In the US you need to look for a surgeon who is Board Certified in Plastic Surgery.  Board Certification means that the surgeon has gone through the proper training and at the end of this training the surgeon has passed an oral and written test and has proven that he is a competent and safe surgeon.  Some 'Cosmetic Surgeons' are not surgeons at all, while other are surgeons who advertise themselves as "Board Certified" but they don't say what specialty they are certified in.  Board-Certified in Internal Medicine is not a qualification for Plastic Surgery.  Board-Certified in Cosmetic Laser Surgery is not a qualification for Plastic Surgery (in fact, Cosmetic Laser Surgery and other "cosmetic" and "Aesthetic" boards are often nothing more than a marketting scheme... there is no specialty in Cosmetic Laser Surgery.  It's a make-believe specialty).

In addition to Board Certification in Plastic Surgery, ask your surgeon which hospitals he/she work at.  Hospitals require surgeons to provide proof of their competency to perform procedures... thus if a surgeon is not allowed to do cosmetic procedures at a hospital, it's probably because his peers did not feel he/she had the proper training and skills.  Finally, you want to know how many breast augmentations he/she performs per year.  Is it one of his/her most common procedures?  You cannot expect anyone to be a master of all of Plastic Surgery.  Each surgeon has his or her area of interest and expertise.

In summary, when chosing your Plastic Surgeon, look for:

• Board Certification in Plastic Surgery
• Hospital privileges
• Experience (procedures/year)
• Area of interest

Once you have chosen your Plastic Surgeon, you need to discuss your surgical options and you need to chose your implant.

The surgeon will examine you and tell you what options you have.  When you do not have options (without a logical explanation) it may be because you're dealing with someone who does not have the proper training to either perform various types of breast augmentation or lacks the understaning to think of the other options.  Surgical options include scar placement and breast implant placement.

Finally, the breast implants.

In the US until recently Silicone Breast Implants were restricted to only breast cancer patients (why?  I never understood that).  In Canada Silicone Breast Implants have been available for some time now, and in the rest of the world they have never been taken off the market.  Silicone Implants do not cause illnesses.  The hoopla around silicone implants is too big to describe in this article, but the bottom line that after years of intense scrutiny, FDA found no links to any illnesses and has once again allowed silicone breast implants to be used for cosmetic purposes.  Silicone has a more rubbery consistency than saline breast implants (which are pretty much nothing more than a water balloon).  They maintain their shape better and thus ripple (wrinkle) less.  This is important in thinner patients where the implant outline can be seen and wrinkling/rippling creates a noticeable irregularity on the breast.  Silicone implants are much better at limiting rippling than saline implants.  Additionally, the new highly cohesive silicone ("gummy bear implants") has a "form stable" consistency.  What this means is that if you cut the implant in half, it will just sit there, it will not spill out unlike the older more liquid silicone.

Saline implants are nothing more than sophisticated water balloon.  They add volume to the breast and should ideally be limited to patients with existing breast tissue that will cover the implant, thus the water-balloon feel and rippling will be obscured.  Additionally, placing saline implants under the muscle hides the implant so that the rippling and the abnormal feel is once again obscured.

Breast Implant shape is also important to consider.  Round breast implants create more of the 'stripper' look, with fullness on top.  Young patients tend to like the look of the round implants.  Shaped breast implants have more fullness on the bottom, which is 'anatomic' ... meaning that the implant better resembles the anatomy of a normal breast.  These implants have a more natural look.  They are also ideal in patients who have some droopiness/sagging to their breast but do not want a breast lift.

Breast Implant placement refers to where the implant sits.  In can be a submuscular breast implant location or a subglandular breast implant location.  Submuscular implant means that the implant is placed under the pectoralis major muscle.  The benefit of putting the implant under the muscle is that it has been shown to decrease the risk of capsular contracture.  Placing the implant under the muscle also adds an additional layer of padding on top of the implant to obscure the implant edges and rippling.  The downside of going under the muscle is that it is much more painful, takes much longer to recover and to see the final result.  Finally, contraction of the muscle will make the implant move and thus breast 'jiggle' when you move your arms.

Finally, breast implant surface.  Implants are smooth or textured.  Smooth breast implants are able to move around.  Textured Breast Implants have a rough surface that sticks to the surrounding breast tissue like velcro.  It is thought to lower the risk of capsular contracture.