The advantage of silicone implants over saline is that they’re softer, hang more naturally (though still not as naturally as reconstruction made from your own body tissue), and assume a more natural shape than saline.
The advantage of saline is that, if you’re worried about silicone, a ruptured saline implant simply leaks saltwater into your body, not silicone. However, the new silicone implants are a "Gummi-Bear" type consistency, and much less likely to leak, even if they rupture; so many women are opting for silicone over saline.
So, which should you choose? Sorry, I have no magic answer here. Once again, do your research, make your decision, and don’t second-guess yourself. Go forward with confidence that you’ve done what’s best for YOU.
Q. What exactly happens during surgery?
A. There are two methods a surgeon may use to build an implant. First, he or she may simply place the implant behind the chest muscle (or, less commonly, in front of the chest muscle) after having removed your breast tissue, and close up the skin.
This works best for small-breasted women; or for women who are having a bilateral mastectomy, and are happy with small breasts post-implant.
Second, the surgeon may remove your breast tissue, then place an expander – a hollow sack – behind (or in front of) your chest muscle, and close up the skin. This expander is equipped with a valve, through which saline can be pumped. Over the course of several months, more and more saline is pumped into the sack, gradually stretching your skin. When the skin has been stretched enough to accept the size implant you want – generally, the size that comes closest to matching your other breast – the sack is removed, and the permanent implant put in its place.
This method works well for larger-breasted women. Its disadvantage lies in the fact that it can be a fairly uncomfortable process, and it involves additional surgery (to replace the expander with the implant).
So, are you a candidate for an expander, or would you do fine with just a one-step implant? Don‘t worry, your surgeon will take a good, hard look at your body and make a recommendation. (Be aware that some surgeons believe ALL women want larger breasts, and automatically suggest going the expander route. If you’re fine with small breasts, insist on foregoing the expander, no matter what the surgeon says!)
Q. Will an implant interfere with any future mammograms?
A. This is a tricky subject. First, you may not need future mammograms on your implant side; if you’re having a total mastectomy, there’s no breast tissue left to examine.
If you’re having a partial mastectomy, then depending on where the implant is placed, it could interfere with the ability of the mammogram to do its job. In addition, the compression necessary to get a clear reading increases the chance of your implant rupturing, which then requires another surgery to remove the implant.