Breast Augmentation: Salinas and Monterey, CA

Breast Augmentation: by Matthew Romans, MD

I have been doing breast augmentation in private practice since 1996. During that time, I have developed a list of important issues that patients need to know about breast augmentation.

Implant Choice: Silicone gel versus Saline

The first decision that most women who are considering breast augmentation need to make is what type of implant to use. I tell each of my potential breast augmentation patients the following:

  • No implant is a lifetime device. Both saline and silicone gel implants can leak or rupture. The average life span of most implants is 10-20 year. If you choose to have breast augmentation, at some point in your life you will almost certainly need to have surgery to remove and/or replace your implants.
  • If you have a saline implant and it starts leaking, your body will safely absorb the saline and you will call us to tell us your implant is leaking.
  • If you have a silicone gel implant, when it starts to leak it is very gradual and the leaking gel does not go anywhere. You likely will not know right away that your implant is leaking. The first clue is usually a gradual hardening of the pocket around the implant, causing your breast to become more firm.
  • The most accurate test to detect a leak in a silicone gel implant is an MRI, but this test is only accurate about 80% of the time.
  • Saline implants tend to look less and feel less natural than silicone gel implants.
  • Silicone gel implants are softer and look more natural.
  • Silicone gel implants were unavailable for widespread use from 1992-2007 because of concerns that they could cause autoimmune diseases, connective tissue disease, or cancer. Over the 15-year period, numerous studies were done in thousands of patients. No study has ever shown a link between these diseases and silicone gel implants. Because of this, in 2007 the FDA lifted the restriction on their use.
  • The FDA has stipulated that you have to be 22 years of age or older to qualify for silicone gel implants.
  • There are now silicone gel implants available that have a very viscous gel material in the center (the “gummy bear” implant). They originally came only as shaped and textured implants but Allergan recently introduced round smooth cohesive gel implants. The gel material is very cohesive so the center is “less liquid”. The cohesive gel round implants hold their shape better so there is some consideration that they may have less rippling. They are more expensive than traditional gel implants and are not for everyone.
Summary Silicone Gel Breast Implants Silicone Breast Implants “Gummy Bear” Implants
Appearance More Natural Less Natural Very Natural, Less Upper Fullness
Feel More Natural Less Natural Slightly Firmer than Gel
Cost More Expensive (about $850 each) Less Expensive (about $250 each) Most Expensive (about $1350 each)
Leak Detection Harder to Detect Leak Easier to Detect Leak Nothing to Leak!
Availability Only for age 22 or older Only for age 18 or older 22 and older


Surgical Plane Choices: Subglandular versus Submuscular:


  • Implant is more visible and palpable, especially in thinner women with less breast tissue
  • Less discomfort immediately after surgery
  • Mammograms are more difficult
  • Tends to stretch and thin the tissues over time


  • Better long-term support of the implant
  • More discomfort immediately after surgery
  • Better for mammograms
  • More long-term tissue support for the implant

Smooth implants versus textured implants, round implants versus shaped implants

  • About 85% of the implants used in the United States are smooth and round.
  • I use only smooth implants because I feel they leak less and develop fewer capsular contractures, which is a tight scar tissue pocket around the implant.
  • Tear-drop shaped implants were popular for a while because they were felt to be more natural in appearance, but they have to have a textured surface to keep them from rotating.

BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma)

  • The FDA (Federal Drug Administration) started issuing alerts or warnings in 2011 about a rare form of cancer that can form around breast implants that have been in for a long time. It is not breast cancer but a form of non-Hodgkin’s Lymphoma.
  • If accurately diagnosed, it is very treatable and almost always curable.
  • It seems to be associated almost exclusively with textured implants.
  • Worldwide confirmed cases number somewhere around 400.
  • As more is learned about BIA-ALCL, the apparent incidence appears to be climbing.
  • Current (June 2018) incidence seems to be somewhere in the 1 case in 3500 patients. Estimates just a few years ago were estimated closer to 1 case in 30,000 patients.
  • With the uncertainty surrounding these implants, we at Salinas Valley Plastic Surgery have decided to stop using textured implants.
  • Information from the website of the FAD
  • Information from the ASPS (American Society of Plastic Surgeons)