Dr. Leonard A. Roudner

The evolution of breast augmentation surgery has not been without controversy. In the early years, particularly when the women’s liberation movement was at its height, the debate centered around many social constructs that had little to do with the procedure itself. As a woman’s choice to improve her body became more accepted and the practice of breast enhancement became less demonized, a new controversy would engulf the country. The conflict began when several patients claimed to suffer adverse effects due to their silicone gel implants breaking apart, allowing silicone to leak into the body. This resulted in the U.S. Food and Drug Administration placing a moratorium on the use of silicone implants that would last for 14 years. In November 2006, after years of intensive studies and vast improvements in the products, the FDA approved the use of a new silicone implant for breast augmentation surgery in women more than 22 years old, and for women of any age undergoing breast reconstruction surgery. This brings us to the new debate that patients must consider, which is the decision of whether to use silicone implants or saline ones.

Today’s silicone implants are much different than the ones that caused the stir in the early ’90s. The original silicone implants were very soft and filled with a thin, runny gel. Their fragile nature allowed them to leak and occasionally break, and the liquid form of the silicone to spread. The latest generation of silicone implants are now filled with a cohesive gel that sticks together and therefore should a break occur, the consistency prevents leakage into the body. When the FDA demanded that the makers of silicone gel implants (Allergan/Inamed and Mentor) conduct a 10-year core study, I was chosen as one of the principle medical investigators in our region. Due to this first-hand, in-depth knowledge of the subject matter, I have no qualms declaring the safety of the silicone implant products.

It is certainly not breaking news that silicone implants feel more natural than their saline counterparts, and are less prone to visible wrinkling and rippling of the skin. Another method for ensuring a more natural feel is through the technique of the surgery. In those early days, the traditional placement of the implants was between the breast tissue and the muscle. However, that particular method resulted in a high risk for developing capsular contracture, or the hardening of the breast. I have been placing the implants under the muscle for the past 28 years, and it is now the preferred method for the majority of surgeons performing breast augmentations. Although hardening can still occur, the risks of it happening are much lower.

While many doctors still prefer to make the incision under the breast or through the armpit, I find that entering through the nipple areola offers better control, a decreased chance of asymmetries, and delivers less chance of poor scars. In fact, I find the results of this technique to be so excellent that I do not perform the surgery any other way.

It goes without saying that the decision to undergo any kind of surgery is a serious one that is not to be taken lightly. When considering breast augmentation surgery, patients should be prudent in their research and perform due diligence, considering silicone versus saline, the location of the implants, and the type of incision the surgeon will perform. Verifying the credentials and the proper board certification of the doctor is of course a wise idea as well. In light of the fact that breast augmentation has recently surpassed liposuction for the top spot in preferred cosmetic surgical procedures, now is a better time than ever to educate yourself on the facts, dispel the myths (which include having to change the implants every 10 years or that implants cause breast cancer), and research the trends of this artistic procedure.


Leonard A. Roudner, M.D., F.A.C.S., P.A.
Aesthetic Surgery Center of Coral Gables
550 Biltmore Way Suite 890
Coral Gables/Miami, FL 33134