According to the American Society for Plastic Surgeons (ASPS), breast augmentation is the No. 1 cosmetic surgical procedure in the United States. In November 2006, the U.S. Food and Drug Administration (FDA) reapproved silicone gel-filled breast implants for use after several studies failed to link silicone implants to disease. Now that women have a choice between saline and silicone implants, the popularity of this cosmetic procedure is expected to grow even more.

In the 1960s, the original breast implants were silicone. In 1990, a program aired on Face to Face with Connie Chung regarding the dangers of silicone implants. The FDA determined there was insufficient information as to whether or not the implants were safe, so they were removed from the market. During the next 10 years, numerous studies demonstrated the safety of silicone implants and the FDA approved them last year for use in all patients, for both cosmetic and reconstruction purposes.

"Leakage can occur with all breast implants, whether they are saline or silicone," explains Roy Hong, M.D., a cosmetic surgeon in the Palo Alto Medical Foundation's (PAMF) Department of Cosmetic Surgery. "A saline implant is essentially a water balloon. If it leaks, the water is just absorbed into the body and the breast goes flat."

With silicone, on the other hand, the body can't absorb the gel and it becomes surrounded by a capsule of scar tissue. If an implant leaks, it may not be apparent because the breast does not deflate.

"We don't want silicone leaking into the surrounding tissues, so there is potentially more follow up involved as the years pass," Hong explains. "With saline implants, 30 years can go by and I can say with certainty that the implants are not leaking. With silicone, there is the element of the unknown and a patient may need further studies to feel confident that no leakage has occurred."

An upside to silicone implants, according to Hong, is that they tend to appear and feel more natural. This is especially important for a woman who is thin and small-breasted and wishes to be much larger in size, because there is little natural breast tissue to soften the feel of the implants. While most surgeons place the implants under the muscle, this still may not provide enough soft-tissue coverage.

"If you are very thin, saline implants may create a rippling effect that does not appear natural," Hong explains. "If a patient has more existing breast tissue, the saline implant will look and feel more natural."

According to Hong, the breast-augmentation procedure is the same regardless of whether a patient chooses saline or silicone. The recovery time is the same, a similar percentage will have to come back for adjustments and the same risks of surgery apply.

"The surgery takes about an hour to an hour and a half," Hong says. "The patient goes home the same day and returns one week later for a checkup. Patients generally take about one week off work, but it takes about three months for the swelling to go down and for the breasts to appear normal."

According to Hong, breast augmentation is becoming increasingly popular among women who have recently completed their childbearing years. "We have more women in this category who want to get their figures back," he says. "Increasingly more women are having breast augmentation-and even more are expected to seek the surgery now that people have a choice again between saline and silicone."

While breast augmentation is more commonplace than ever, Hong stresses that it is still surgery. He advocates the importance of consultations, which involve education and communication between the doctor and patient.

"The procedure is simple, but it requires thought from the patient and doctor," Hong says. "Some people think of it as a trip to the spa. But it is surgery and patients have to do their homework and be educated and well-motivated. Patients should find doctors they trust-who are qualified and will take care of them."

Cosmetic surgeons at PAMF's Palo Alto Clinic and Fremont Center perform breast augmentation. To schedule a consultation, call the Palo Alto Clinic at 650-330-5804 or the Fremont Center at 510-498-2134.