Saline Versus Silicone Gel Implants

Chest wall shape, gravity, and base coverage in breast augmentation.

Decision making and planning in breast augmentation cannot be overlooked. It takes a keen and critical eye to see the subtle features that can make or break an ideal breast augmentation.

The contour of the rib cage is often overlooked and its influence is underestimated particularly regarding implant selection.  Silicone gel vs. Saline filled, profile projection – high, moderate plus, or moderate, are integral decisions validated by a proper understanding of gravity influences on fluids on curved mobile surfaces.

For instance, a high profile saline filled implant may be a poor choice on top of a keel shaped dramatically curved chest wall, but may be a better choice for a patient who wants maximal projection of her breast with a relatively flat rib cage.

We all have a curved torso, it just depends where it curves as to how it influences implants! Again if we lived underwater or on the moon it wouldn’t matter as much, but here on earth, gravity WILL influence your breast outcome.

Next, let’s discuss the concept of base coverage. This is the footprint your breast makes on your chest. A patient may have an A cup breast but there are many ways that A cup breast relates to the underlying chest wall. A keen eye during evaluation before surgery should allow the surgeon to see what needs to be done out of the ordinary in order to help the patient get the best outcome possible. Some breasts are oddly angulated, sometimes asymmetrically so. Some are foreshortened. Some are widely set apart, even unusually so.  It requires then, the technical skill to convert this unfavorable shape to a more favorable shape for aesthetic breast augmentation with implants.

Look for my discussion regarding nipple location and how it influences decision making!


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Graphite/Pencil Hybrid-Painting by Dr. Scott Spiro