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 and implant choices.

Implant Choices: 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 and 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.
  • When they first re-release silicone gel implants for unrestricted use, they were recommending an MRI every 3 years, but they have since lifted that recommendation.
  • The only restriction on silicone gel breast implant use for cosmetic purposes I that the FDA has stipulated that you have to be 22 years of age or older to qualify for silicone gel implants.

Implant Type Summary


  • Filled in Operating room.
  • Tend to feel and look slightly less natural.
  • Inexpensive. Cost is less than $300 each.
  • When they leak, it is easy to detect the leak because the body absorbs the fluid as fast as it leaks out and the breast becomes noticeably smaller.
  • Available to anyone over the age of 18 for cosmetic purposes.


  • Allergan NATRELLE implants come in several different types of silicone implants available. They are all related to the amount of cross-linking between the silicone molecules. The more cross-links between the molecules, the more viscous the gel material is.
  • They come pre-filled from the factory.
  • Definitely more expensive than saline implants.
  • When silicone implants leak, it is a very gradual thing over time and early leaks can be hard to detect because the body does not absorb the gel material and it stays in the pocket the body forms around the implant.
  • The FDA has made silicone implants available to anyone 22 years and older (no one seems to know why age 22 and not age 21 or age 18).

Additional information about Silicone Gel Implant Choices

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 introduced round smooth cohesive gel implants in 2017. 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. There are three types of Allergan gel smooth implants; the “traditional gel”, the “soft touch”, and the full “cohesive gel”.

Type 1. Natrelle INSPIRA® Responsive. Least amount of cross-linking. Has softer, more-natural appearing upper pole result. This is the least expensive of the Natrelle INSPIRA® product line at about $800 each.

Natrelle Inspiria Responsive

Type 2. Natrelle INSPIRA® SoftTouch. Has more cross-linking between molecules. We feel this offers the best combination of upper-pole fullness, price and gel stability at about $875 each. This is the most common implant we use at Salinas Valley Plastic Surgery. We have it in stock at the Surgery Center on the shelf for most sizes we use so the implants are not special order for your surgery.

Natrelle Insiria SoftTouch

Type 3. Natrelle INSPIRA® Cohesive. This is the full “gummy bear” smooth gel implant. It gives the most upper pole fullness and is slightly firmer than other silicone implants. This implant is the most expensive of the Natrelle INSPIRA® implant line at about $1175 each.

Natrelle Inspiria Cohesive

Type 4. INSPIRA®Textured Shaped cohesive gel. This is the original “gumy bear” implant approved in the United States. At Salinas Valley Plastic Surgery we have used this implant commonly for breast reconstruction, but only occasionally for cosmetic augmentation. As of mid-2018, we have stopped using these because of concerns outlined below about BIA-ALCL.

Natrelle Inspiria Textured Gel

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 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 FDA.

Information from the ASPS (American Society of Plastic Surgeons).