Answers to Questions on Silicone and Saline Breast Implants

Dr. Francis Collini is not your typical artist. There are no brushes, nor paint and an easel in his ‘studio’. Instead, his canvas is the human body. The result is a transformation: younger to older, small to bigger, bigger to smaller or loose to tight- masterpieces that paint smiles on the faces of women all over Northeast Pennsylvania.

Dr. Collini’s waiting room is mini art gallery, is filled with elegant furniture and artwork depicting the changes mentioned above. There are beautiful pieces of a surgeon’s hand painting a woman’s breast, a gloved hand chiseling a woman’s chest and a gloved hand holding a genie’s lamp releasing the image of a beautiful upper body. There is also a sculpture with two masks of a dull old face and then a shiny young face, among many others. Above the sculptures is a large, flat screen TV which brings to life images of cosmetic surgery to inform patients.

Behind the ‘gallery’ walls is where Dr. Collini performs hundreds of cosmetic surgeries each year, ranging from face lifts, liposuction, tummy tucks and breast enlargements. Donna Talarico recently sat down in Dr. Collini’s Renaissance Center for Plastic Surgery in Shavertown to discuss

Donna: Have you seen a surge in breast implants since the rise in popularity of shows like Nip/Tuck and Dr. 90210?
Collini: I haven’t seen a surge in implants, but overall in cosmetic surgery I have. Botox, my thread (face) lift- the non-invasive procedures- have really skyrocketed. I started keeping stats in 1996. That year I did 30 Botox injections. Last year I did 360. That’s a 100-fold increase.

Donna: What is your most popular procedure?
Collini: Liposuction. I did 266 (liposuction procedures) last year.

Donna: How many breast implant surgeries do you do in a typical year?
Collini: 45-60.

Donna: Why does silicone have such a bad reputation?
Collini: My own personal feeling is that silicone was given a bad rap by Connie Chung in 1994, around the time they were taken off the market. Since, there have been five major world-wide studies to see if those with silicone implants tended to develop connective tissue disorder�.none have showed a connection to CTD.

Donna: They are back on the market now, right?
Collini: Mentor Corporation has developed a new cohesive gel silicone implant (the gummy bear). If the implant is torn or damaged, the gel will not leak out.
(Note: Dr. Collini demonstrated this by showing a cohesive gel implant with a tear. He squeezed the implant and through the tear, the silicone gel busted out in a big gel bubble. When he released the pressure, it went right back in. You can turn it upside down too; the gel will not come out.)

Donna: So which do you prefer?
Collini: I feel silicone is better in many ways; there is less rippling, they feel more natural and have a more natural shape. I put in silicone every chance I get. I have had no problems with them. Still, the vast majority and 99% of my patients go for saline. It is very difficult to convince someone; there is still that fear.

Donna: What are some other differences between saline and silicone?
Collini: Unless they are 200ccs or less, silicone are placed through an incision under the breast. Many are placed that way anyway. I usually place mine (through an incision) in the armpit. The scar goes away there in a about a year. There are still some restrictions with silicone- the implants should be accompanied by a lift or skin removal, although the FDA doesn’t define how much. Silicone are also approved for those who had problems with saline, like leakages or hardening, and for breast reconstruction. Saline implants can be adjusted after they are in through an incision- like getting a mole out. Through the port, the implant is filled with saline. It’s a 15-minute process. You can’t add silicone gel to a silicone implant. Silicone is more expensive. (After checking with his business manager, the base price for silicone is $2000/pair, while saline is $1300/pair. This price does not include other costs such as the surgery itself.)

Donna: What about shape? I heard there is a pear-shaped and round.
Collini: There are several shapes. (Note: Dr. Collini showed a booklet of all different shapes and sizes, which were mainly written in medical terms.) The pear-shaped- or anatomic shaped- are the saline implants. I generally choose the moderate profile. It is a natural shaped and in my opinion looks better and feels better.

Weekender: Now another “s”. How do you tell the right size for body type?
Collini: People will have an idea of what bra size they want to be afterwards- maybe from a B to a D or an A to a C. Not too many people want to be a double-D. Then, I can figure out what volume implant meets their desire. (Note: Implants are measure by ccs, not cup size.) The patient always has the final say.

Donna: Say I was interested in getting breast implants. What is the typical process?
Collini: First, you would decide when to come in for you consultation. I have those available on Tuesday and Thursdays. There, you would have an exam, I’d take a history, we’d look at implants (you can bring a bra with you and place implants in them), take photos, decide on appropriate implants and discuss the benefits, risks and procedure. If you are comfortable with that, I’d bring you to my business manager and you’d discuss costs and payment options. Then, we’d schedule you for your procedure. It will take about an hour and a half, we use sedation, not general anesthesia. The stitches dissolve (meaning one does not have to return to get them removed.) You will probably have to take about a week off work. There is a two week recovery period. There will be some swelling and bruising.

Donna: How are the implants placed? I heard they can go under the breast or underneath the muscle.
Collini: I place my implants above the muscle. For thin-chested women, those with little body fat, 90-100 pounds, I will place them under the muscle so they have a more natural look for them.

Donna: Are there age limits?
Collini: Yes. I would not do someone under 18 unless there was a congential problem- if one breast was smaller than the other and was a social impediment. Or, where one was traumatized. Breasts are still developing during this time.

Donna: What about nursing and pregnancy. What if someone has implants, and then becomes pregnant. How do they affect nursing and the normal changes to breasts during pregnancy?
Collini: It doesn’t affect nursing at all. The lactating ducts are not disturbed. With pregnancy there is a hormone surge where the breasts are engorged. The breast skin may sag, but the implants won’t be affected.

Donna: Why should a women get breast implants? Or- why not?
Collini: I think the one thing that needs to be stressed is that woman should desire this for themselves. They can’t be hoping to enhance their ability to pick up guys, make marriage better, enhance job performance or change personality. Now of that will happen with the implants alone. You’ll find out quickly that implants will not change your life that dramatically.

What breast implants will do can increase self-esteem and self-confidence, allow women to project better and with more confidence in groups, take away shyness and embarrassment and allow them to fit into clothing and bathing suits with more ease. The swimsuit top won’t fall off. If all that translates into a better relationship or enhance a job, that’s different. Implants alone will not make that happen.

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