As a background, there has been a large split in which implants are used in the U.S. versus Europe. Most of the difference can be attributed to the false concern in the early 1990s that silicone might cause autoimmune disorders. Thankfully, after massive medical studies, it was conclusively shown that silicone implants do not cause these disorders. Unfortunately, once the legal system was involved, it took about 15 years before silicone implants were again released for first-time breast augmentations.
During this period of time, plastic surgeons in the U.S. were forced to use saline implants, which have an inferior appearance and feel when compared to silicone breast implants. Phoenix and Scottsdale plastic surgery patients often reported that these round saline implants with smooth surface shells (implant bags) had a propensity to look and feel less natural than real breast tissue. The textured saline implants felt even less natural and were prone to rupturing prematurely.
I was very thankful when the FDA finally lifted the ban in 2006, after overwhelming evidence supported the safety of silicone implants. Silicone implants were always used in Europe, and were also allowed in the U.S. during this time for breast reconstruction, breast lift surgery, and implant replacement surgery. It never made sense to me why first time patients were deprived of these superior quality implants. The newer silicone implants themselves were vastly improved over older versions in the sense that the gel was cohesive (as opposed to liquid) and the shells were much stronger and resistant to rupture.
In any case, I was thrilled to once again be able to use silicone implants in my primary breast augmentation patients. Like the majority of surgeons in the U.S., I had used smooth, round saline implants. Naturally, most of us transitioned to smooth, round silicone implants. These implants generally gave me excellent results, but in certain cases they could shift positions over time. This was common in patients with rounded ribcages, where the implants occasionally migrated laterally (to the sides) when the patients were lying on their backs. This could be a frustrating experience, but I was not particularly interested in trying textured implants as I had been told during my residency that they were more prone to rupture and could be felt more through the skin. This was outdated information that I would soon overcome.