Saline is salt water. Silicone is an inert (unreactive) substance which can be a solid, a liquid or a gel. All breast implants have a solid silicone covering. The difference is in the filling. Silicone filled implants always feel, and often look, more natural than those filled with saline. Saline breast implants ripple and this can usually be felt through the skin and can also often be visible, especially if the person leans forward. This is known as the 'waterbed effect'. Saline implants also tend to feel firmer than natural breast tissue. Should they leak, the saline is absorbed by the body and does not cause any health risk. Despite their disadvantages many women are happy with the look and feel of their saline breast implants.

Modern silicone implants are filled with silicone gel. They feel very similar to natural breasts and they do not usually cause visible rippling. Even though silicone implants look and feel better, women are still anxious about their safety record so it is important to get the facts straight. There are two main differences between the silicone breast implants of today and the original silicone implants. Firstly the covering or shell is much stronger and therefore much less likely to leak. Secondly, the gel inside is no longer a liquid. All the silicone implants we use contain a cohesive gel which has the consistency of Turkish Delight. Even if the covering ruptures this gel should not leak out.

It was claimed that silicone in the body might cause disease. This has been completely disproved by numerous studies comparing women with silicone implants with women with no implants at all. There is no difference in the disease rates between these two groups.

The options are in the fold underneath the breast, around the nipple, under the arm or (for saline implants only) via the tummy button. Each approach has its pros and cons and usually a doctor will have a preferred site. Because saline breast implants are inserted empty and then filled, they need a smaller incision (about 3cm long) compared with silicone implants, which are inserted already filled. The size of the incision for silicone depends on the size of the implant and ranges from 4.5cms to 6.5cms. Typically, scars from implants heal well and should ultimately be a fine, white, barely visible line. The photo shows an incision under the breast in a silicone implant patient six months after her procedure.

Working from the inside out, on top of the ribs are the chest muscles or 'pecs'. On top of these is the breast tissue then a layer of fat, then the skin. Breast implants can be placed either under the chest muscles or in front of them but still behind the breast tissue. Since in both cases the implant is behind the breast tissue there should be no interference with subsequent breast-feeding. There are advantages and disadvantages with both placement sites. For example, saline breast implants in front of the muscle is more likely to have visible rippling than if placed behind. This is because if it is behind the muscle there is more of the patient's own tissue between the implant and the skin to conceal it. This is especially important in thin women with the saline implants.

A breast implants placed under the muscle will generally have a more gradual 'take off' at the top edge of the implant giving a smoother silhouette and minimising the very round tennis ball appearance often seen on TV's Baywatch. Some patients benefit from a special technique called "dual plane" in which the implants are placed half under and half in front of the muscle.

We offer all types of placements and will listen carefully to the description of the look you want and advise on which placement will be most likely to give it.

All surgery, including cosmetic surgery, carries risks. Although the vast majority of breast implants patients do not suffer complication and are very happy with their results, you should not undergo breast augmentation without the risks having been explained to you. There are two types of risk; those who apply to any operation, such as bleeding, anaesthetic risk, and wound infection; and those that apply only to breast implant surgery. You must discuss these at length with your doctor at the end of your consultation, an information sheet about the risks to take away and consider carefully at home. The following explains some but not all of the risks specifically associated with breast implants.

• Leakage - If saline leaks the salt water is absorbed into the body and there is no health risk. The breast implants can be replaced. If liquid silicone leaks, there can be problems with inflammation and even scarring in the breast. Therefore we only use the cohesive gel silicone implants which have virtually eliminated this risk.
• Breast implants infection - An infection involving the surface of one of the breast implants will probably need removal of the implant and a settling down period of about three months before the implant is replaced. The final result should not be affected.
• Capsular contracture - for reasons that are not known the tissues which form around the implant, and which are normally not visible or palpable can shrink making the implant feel hard. A mild degree of this would probably be accepted by most patients but in the severe cases where the implants can feel like a stone revision surgery will be needed. The overall risk of problematic capsular contracture with textured implants is usually quoted as about 5 % but with smooth implants it is substantially higher. If capsule contraction does occur it may be treated successfully by a course of tablets for 3 months. If this doesn't work further surgery is needed and then implants will feel soft again. In a small number of women the contraction can happen again. For a women considering a breast implant the risk of being a patient who gets recurrent capsule contraction is about 6 in 1000.
• Cancer - There is no increase in the risk of death from breast cancer in women in any kind of breast implant. Indeed, studies have shown a reduced risk of breast cancer in women with silicone berast implants. Breast self-examination and mammograms can be performed effectively in women with implants.
• Sensation changes - Temporary sensation changes in the breast skin and or nipples are common after implant surgery. In the vast majority of patients sensation will return to normal over the period of months. There is a small risk of a permanent loss of sensation which could involve the nipple.

Implants are available as round of teardrop in shape. Also different profiles (the amount of projection compared with the diameter of the implant) can be chosen. The best shape for you depends on the look you want to achieve and your existing shape. For example, a patient who has lost upper breast fullness after breast feeding would probably not do best with tear-drop implant. A patient with small, high breasts who does not want the round "Baywatch" look, would be better suited to a medium profile or a tear drop shaped implant. There is an extra risk with tear drop implants; they can rotate giving a vary unnatural appearance. The risk of rotation with tear drop implants is 15-20%. Once rotated they have to be removed and replaced with round implants since, if they are merely straightened, they will rotate again. Patients worry that a round implant will look "like a ball". Round implants come in 6 different profiles or degrees of roundness (see grid). A wider flatter implant will look very like a tear drop implant once in the patient, whereas a very high profile (or very sticky out) implants will tend to give the Baywatch look.

This refers to the implant covering. Originally, implants had a smooth surface like a plastic bag. Today the surface can be smooth or slightly textured rather like velvet. It has been shown that textured implants reduce the chance of the tissues around the implant contracting making it feel hard. Although most doctors therefore prefer textured implants, some still prefer to use smooth implants because with smooth saline implants visible rippling may be reduced.

We offer both types of anaesthetic and it is always given by the specialist anesthetist whose fee is included in our all up cost. In the case of general anaesthetic puts the patient "to sleep" using drugs to induce a comatose state, and will usually provide artificial breathing by means of a tube placed in the windpipe. With sedation intravenous drugs are used to sedate the patient and then local anaesthesia (similar to dental anaesthesia) is used to numb the breast area. Both methods are safe and effective with the patient remembering little or nothing of the procedure.

We preform all our breast implant surgery in an accredited hospital or licensed day surgery. Most breast implant surgery is done as a day procedure. Drain tubes or bandaging are rarely needed. It is not usually necessary to stay overnight in hospital provided you have a responsible adult to take you home and stay with you for at least the first 24 hours.

Usually we contact patients daily for the first week after their operation. Our irish based surgeon is contactable 24 hours a day if you need him. There will be pain and discomfort after breast implant surgery. This varies from the patient to patient and is relieved by the pain killers we will prescribe for you. Typically patients take one week off work and six weeks off vigorous upper body exercise.