7 Things a Plastic Surgeon Wish You Knew Before Getting Implants

Deciding to undergo a breast augmentation is no small decision, and with so many choices (and misinformation) out there, it’s important to get all the facts first. We spoke with San Antonio plastic surgeon, Constance Barone, MD, to get some of the most important information you need to know, even in the earliest stages of your research. 


Silicone implants are FDA-approved—with a bunch of caveats.

“Most women who receive silicone gel implants are not aware they it's recommended to get an MRI three years after the initial operation and every two years thereafter,” says Dr. Barone. “MRIs are thousands of dollars, and when getting them for breast augmentation monitoring, they are not covered by insurance. Silicone gel implants also need to be replaced every 10 years because the silicone shell wears down and leaking of the gel may occur. Silicone gel implants were pulled by the FDA, and when they were rereleased, they were only approved with those caveats.”


The safest implants are saline implants.

“Saline implants, whether the Ideal Implant or regular saline-filled implants, do not need to be replaced unless there is a deflation. Saline implants do not have MRI recommendationss unless there’s a specific doctor request due to a breast cancer concern. In that case, the MRI would be covered by insurance,” says Dr. Barone. 

In terms of safety, “Ideal Implants have the lowest rate of capsular contracture or scar tissue forming around the implant out of any implant today,” says Dr. Barone. “Next in line is regular saline-filled implants, and silicone gel–filled has the highest rate. Many women perceive that silicone gel implants give a more natural look, but Ideal Implants are able to give women that natural look they desire with the safety of saline.”


Know the pros and cons of placing implants above or below the chest muscle.

When deciding on implants, patients and their surgeons must decide whether to place the implant above the chest muscle or below it. Each placement comes with advantages and disadvantages.

Placement above the chest muscle does not distort the shape of the implant when the pectoral muscles are flexed (during exercise or sex). However, there is more risk of the implant bottoming out (when the breast is too low in relation to the nipple), more visible rippling and makes mammograms more difficult (more on that later).

Placement under the chest muscle gives a more natural slope to the breast and the muscle hides the rippling of the implant, however the implants contract and move laterally when the pectoral muscles are flexed.  


When you get implants, it whites out a mammogram.

All breast implants, silicone gel or saline-filled, white out a mammogram, making it more difficult to find and evaluate a breast lesion, says Dr. Barone. “Because 1 in 8 women have breast cancer, I feel it’s important to put the implant under the muscle. When the implant is under the muscle, you can push the implant out of the way to do displacement mammography. The additional mammographic views that have to be taken in displacement mammography may not be covered by insurance. However, if you get an implant above the muscle, it becomes very difficult, if not impossible, to do a displacement mammography.”


When you have a breast augmentation, it can cause decreased sensitivity, loss of sensitivity or hypersensitivity.

Your nerve goes through the space between the ribs and enters the breasts underneath the armpit laterally, so nipple sensation and loss of nerve function happens in 10–15 percent of patients,” explains Dr. Barone. “Sometimes, when the nerve comes back, they get a severe burning or hypersensitivity. If you get a larger implant, it can cause stretching of that nerve, which can cause hypersensitive or nerve damage. However, for the vast majority of women, the numbness is temporary (but it could be permanent). The majority of patients do not have altered nipple sensation after a breast augmentation.” 


There is a size limit to your implants.

“The size of implants is limited to the diameter of the patient’s chest wall,” says Dr. Barone. “If the patient has a small chest wall diameter and desires to go with a very large implant, then the base diameter of the implant my not fit and may cross over and join in the middle, causing symmastia, a condition where the implants join in the middle and there is loss of the normal cleavage line.”


Make sure you get all the facts from your plastic surgeon.

Your doctor plays a very big role in helping patients choose the right implant and educating the patients. “It depends on the facts and the information you get from your doctor,” says Dr. Barone. “When my patients come in, they get booklets on all the implants: silicone gel, saline filled and Ideal Implant. I let them read the booklets first, then I go through important facts with them and let them see and feel all the implants.”

  • William P Aiello, M.D.
    Posted on

    It is not true that the size of the implant is limited by the base diameter of the woman's chest (or breast). This idea has been popularized by a limited number of physicians and the implant manufacturers. Any surgeon who does a lot of breast augmentations using larger implants knows this to be false. Nor is it true that using a large implant will give you symmastia. This is a very rare surgical complication usually the result of a complicated re-operation with capsulectomies or when there was aggressive dissection toward the midline. It is not caused by large implant placement and a woman shouldn't be scared into going smaller for this reason.

  • Ideally Happy!
    Posted on

    Appreciate the "thoughtfulness" rather biasedness offered by Dr. Perlman. We know that 20% of all breast implants fail within 10 years. Yet very few surgeons encourage their silicone patients to have MRI’s done to detect rupture. I am glad some surgeons care about a women’s health and wellbeing. I am glad that my surgeon recommended Ideal Implants for me!

  • Jon A Perlman MD FACS
    Posted on

    "One in 8 women have breast cancer?" "Silicone implants need replacement every ten years?" I strongly disagree. If you're getting breast augmentation please seek unbiased opinions. I base this on three decades of experience with both saline and silicone implants (including the "Ideal" implant). There are important decisions and choices and being well informed is critical.

  • Anon
    Posted on

    The scar tissue or implant itself causes cancer, anaplastic large cell lymphoma. Anywhere from 1 in 1,000 to 1 in 10,000 women with implants will develop ALCL. Luckily, it takes slow-growing and takes 6-8 years to develop it.