Breast augmentation is still by far the most popular and common type of cosmetic surgery. I spend a lot of time with patients in my San Francisco practice answering all sorts of questions about breast surgery and about silicone and saline implants.

Here are some questions I’ve received recently. Perhaps you are considering breast implants and have wondered about these issues, too.

Q: When you get silicone implants, how long does it take for them to feel natural?  When my sister got saline implants in 2002, they felt very hard for a long time, nearly 6 months. Is this the case for silicone implants, too?  Or do they feel softer sooner?

A: With silicone implants, the implants feel very natural very quickly –  typically immediately.  When the swelling goes away over the first couple of days after surgery, the breasts feel extremely natural.

Silicone implants have an outer shell with a cohesive gel filling. Here’s a visual for you: Think “Gummy Bear.” Silicone breast implants are very much like the popular little candies. They are soft, pliable, squishy and will return to their original shape very quickly. Plus, if you were to cut one in half, the gel wouldn’t leak all over the place. It holds its shape, just like a Gummy Bear.

Saline implants will feel more hard than silicone implants. It’s simply due to the filler material.  Even when the swelling goes down, the saline breast implants will never feel as soft and natural as silicone breast implants.

Q: Okay, so speaking of Gummy Bears, are all silicone implants on the market today considered “Gummy Bear” implants?  Meaning, are they all self cohesive or are some silicone implants still made of silicone that can leak?

A: Well, I know I just used it, but the term “Gummy Bear implants” is very confusing, even to me.  This is not a medical or plastic surgery term, but rather, a term that some marketing person seems to have made up.
Some plastic surgeons talk about Gummy Bear implants to mean the next generation of silicone breast implants that have undergone FDA studies but are not available to the general public yet.

Some people. like me, use this term to describe the consistency and character of CURRENT silicone breast implants that have been out since November 2006.  So, I know this is a wish-washy answer, but I guess the answer is –  it depends.

Because of the self-cohesive nature of silicone implants, they cannot technically leak. If there’s a problem with the shell of the implant, the internal silicone gel filler will “stick” to itself and will not run out all over the place or look like the slimy goo you saw in the movie “Alien”. The makers of silicone breast implants, Allergan and Mentor, refer to it as “coherent gel” or “memory gel.”

Q: Why do silicone implants cost more than saline implants?

A: Silicone breast implants do cost more than saline.  Obviously, since I don’t work at Allergan or Mentor, I don’t completely know why.  I don’t know if silicone filler material is actually that much more expensive than saline. I imagine that they are simply charging more because they can.

I could, however, put forth a couple of theories. One, more plastic surgeons and patients seem to prefer silicone implants over saline. So it could be the basic economic theory of supply and demand.

Or, two, perhaps the manufacturers are using a bit of reverse psychology. Silicone implants were pulled from the market for 14 years before being deemed safe and reintroduced in 2006. If they were cheaper than saline, people might have trouble shaking the stigma of silicone implants somehow being an inferior product.

A third and more probable reason why silicone breast implants cost more would be due to the legal costs and the associated paperwork concerns. Silicone breast implants are still being followed very closely by the two breast implant companies, and they have a database of patients and their associated breast implants with their serial numbers.   This obviously costs some money to maintain.

Notably, most breast implant companies in the world AND most health ministries in other countries do NOT have a patient registry. This has caused loads of problems in Europe during the recent PIP breast implant controversy. Once it was determined that PIP implants needed to be removed from hundreds of thousands of patients, there was no way to find out who had them.

Note that the U.S. government actually does not have a “registry” for silicone breast implants, although Allergan and Mentor do maintain a database for just this type of emergency.

I hope that these answers were helpful to you if you are debating undergoing a breast augmentation.

 Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at, or call our office at 415-362-1846.


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