Breast augmentation with round, smooth saline or gel implants: the pros and cons.

Breast augmentation is a procedure that can be performed successfully in many different ways. Large series are reported routinely, with greater than 95% patient satisfaction. It is clear that this is a procedure that has greatly benefited women and thereby society in general. It is inappropriate to be too dogmatic about each individual's technique, because many different techniques have achieved a high degree of success in terms of patient satisfaction and final results. That is not to say, however, that surgeons still are not plagued by the two most common downsides to this operation: capsular contracture and implant leakage. Certainly, strides have been made in the cause of prevention of capsular contracture in the past 20 years of the author's association with plastic surgery, but the author's opinion is that research has been hampered by the Food and Drug Administration's overprotection of women. There is no doubt that progress toward solving these two problems has been slowed by the current implant environment. Despite these handicaps, however, plastic surgery has continued to improve this procedure and now is delivering a successful and reproducible surgery using the saline implant. Most surgeons doubted this in the early 1990s, however. Plastic surgeons must continue to strive for improvements that serve patients and themselves in this new century.