Frequently Asked Questions: Breast Augmentation

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1. What should I expect to pay for breast augmentation surgery?
In Central Ohio, the average cost for breast augmentation surgery with saline implants is about $5200 and around $6300 for silicone implants.  This includes the cost for the implants, surgery, anesthesia and the facility but not your medications.  These can usually be purchased using your insurance prescription card.  Beware of those charging significantly more or less than this!  You get absolutely nothing for paying much more.  If anyone is charging much less, there is a reason for it and it’s probably not a good one.

2. Are silicone implants available?
The FDA has recently approved silicone gel breast implants for any woman considering breast augmentation who is at least 22 years of age.

3. What is the implant shell made of with saline implants?
The shell of all saline implants is made of silicone.  It is a solid silicone rather than a silicone gel so there is very little risk of silicone leaking out into the tissues.  It is essentially the same shell as the new silicone gel implants except that they have a fill port which is used to inflate the implant through a tube after it has been inserted.

4. What is saline?
Saline is a sterile salt water solution that is inserted through a fill tube into the implant after the implant has been placed into the breast.  It consists of water, sodium and chloride in similar concentrations to what is found naturally in the body.

5. Is sterile saline safe?
Yes.  It is the same solution that is injected directly into the veins of almost every hospitalized patient or those undergoing surgery.  It is only unsafe if it is contaminated or in excessive amounts, much more than what is placed in breast implants.

6. How are saline implants different from silicone implants?
Since silicone gel is much thicker than saline, silicone implants tend to feel more like natural breast tissue.  While saline implants come empty so that they can be inserted through smaller incisions and filled after they are placed in the breast pocket, silicone implants are pre-filled, so they require a longer incision to be inserted. 
When silicone implants rupture, the over-whelming majority of the silicone stays in the pocket within the breast capsule so the size of the breast doesn’t change.  For this reason, it can be very difficult sometimes to tell when a silicone implant is ruptured.  There are no good tests, such as mammograms, ultrasound, CT-scans or MRI to determine whether a silicone implant is intact or not. MRI is probably the most accurate at detecting a rupture.   When a saline implant ruptures, the saline escapes, it is absorbed by the body and is eliminated.  This generally results in a loss of breast volume which indicates that the implant has lost its integrity. Therefore, it is typically very obvious when a saline implant has ruptured because the breast becomes much smaller. Silicone implants also usually have somewhat of a higher risk of capsular contracture, which is firm scar tissue forming around the implant, causing the breast to feel harder than normal. However, the new cohesive gel silicone implants not only have a thicker shell, but also are composed of a thicker silicone gel than the old silicone implants.  Therefore, the risk of capsular contracture should be much lower for the new implants compared to the old silicone implants.

7. Is there a warranty which covers a ruptured implant?
Both Allergan and Mentor, the two major breast implant companies, provide lifetime warranties for their breast implants.  If an implant ever ruptures, they provide you with a free implant.  Although there are slight differences between their coverage, both also provide up to $1200 for saline and $2400 for silicone implants to cover the costs of replacement if the rupture occurs within the first ten years after surgery.  Believe it or not, they also offer extended warranties which can be purchased after surgery.  It’s kind of like buying an appliance.

8. How do I know that my plastic surgeon is qualified?
There is no way to get a guarantee of results.  You should, however, at least make sure that your surgeon has had adequate training.  There are many physicians, some not even surgeons, masquerading as plastic surgeons with very little or no training at all in plastic surgery.  Neither the internet nor the telephone book company care about the truth, honesty, training or credentials.  They’ll let almost anyone advertise as a plastic surgeon.  Make sure that your surgeon is certified by the American Board of Plastic Surgery.  It is the ONLY legitimate plastic surgery board.  It is the only one that evaluates a surgeon’s prerequisite training, plastic surgery training, practice performance and requires passage of rigorous written and oral examinations.  One way to find out if your surgeon is truly board certified is to see if he or she is a member of the American Society of Plastic Surgeons, Inc. (ASPS).  All members of the ASPS are certified by the American Board of Plastic Surgery. Visit their website at www.plasticsurgery.org.
I would also recommend that you go one step further.  To make sure that your surgeon specializes in aesthetic surgery and, therefore, is not only well trained, but is also very experienced, make sure that he or she is also a member of the American Society for Aesthetic Plastic Surgery (ASAPS).  Surgeons that are members of ASAPS are all certified by the American Board of Plastic Surgery, members of ASPS, and have a practice that is dedicated to aesthetic surgery.  You can visit their website at www.surgery.org.
Would you let a plumber do the electrical work on your house? Would you have a mechanic do your taxes?  How about an orthopedic surgeon operating on your heart?  Then why have an untrained physician, maybe not even a surgeon perform cosmetic surgery on you?  If you wind up in someone’s office that doesn’t have the above credentials, don’t walk but run out of that office.  And forget the consultation fee. They don’t deserve to be paid for trying to deceive you.

9. What is the difference between smooth and textured implants?
Textured implants have an additional shell attached to a smooth implant to create a rough surface.  The purpose of texturing is to try and reduce the risk of capsular contracture.  There is no good evidence to show that texturing is successful in reducing the risk of capsular contracture, particularly when the implants are placed under the pectoralis muscle.  There are a few problems with textured implants.  Since the shell is thicker, they are easier to feel through the skin and breast tissue than smooth implants.  They also have a higher risk of implant rupture and wrinkling of the skin. Textured implants are somewhat more expensive than smooth implants. 

10. Is it better to put the implants under or over the muscle?
There are very few circumstances where implants should be placed on top of the muscle.  Up until the late 1980’s, implants were routinely placed on top of the muscle.  Since then, multiple advantages of subpectoral (under the muscle) placement have been discovered.  These include a lower risk of capsular contracture, less visibility and palpability of the implants, less interference