Silicone implants have several drawbacks but in the opinion of many plastic surgeons, such shortcomings are far outweighed by the benefits afforded by their use in breast augmentation. Silicone breast implants are thought to produce a softer breast, less breast contour deformities, and a substantially more natural feel on breast contact than saline breast implants. The drawbacks to silicone mammary prosthesis use are twofold. The first is difficulty in the detection of breast implant rupture. When silicone breast implants rupture, the saline that was used to fill them is reabsorbed, and the discrepancy between what was and what is, or between what the size of the unaffected breast and the side of the affected breast is very obvious. When silicone breast implants rupture, the silicone fill is not absorbed. The change in the affected breast is more consistent with a shape change than a size change. As a consequence, this becomes much more difficult to detect. This would not be a problem, however, silicone incites a significant inflammatory reaction in many patients, leading to a dense capsule, and making it difficult to remove the old breast implant, and achieve a predictable result in placing the new one at the same operation. Staging, or breaking the operation presents the patient with the nuisance of two surgeries. For this reason, a patient with silicone breast implants must be very vigilant in monitoring for signs of implant rupture, as early detection, and re-implantation, makes it much less likely that a significant inflammatory reaction, or a tough breast implant capsule will form
The ideal candidate for a primary breast augmentation with silicone, therefore, is a patient who is secure with silicone as implantation material, is very aware of the shape of her breasts, and vigilant in monitoring for rupture, has a very small amount of native breast tissue, or has a significant amount of droop and desires sub-glandular placement to correct it with minimal
