Last month the American Society for Aesthetic Plastic Surgery (ASAPS) surveyed their member surgeons to get an idea about current trends in breast augmentation, as well as statistical analysis of trends in all procedures. Most of the answers they received are not at all surprising, with one big exception.

The preference for natural looking results continues for the vast majority of plastic surgeons and their patients. For example, the average implant size used by most of the surveyed surgeons is 300 – 400 cc. For most patients, this size will result in full C cup breasts. More than 60% of surgeons place the implants under the chest muscle rather than on top of the muscle, again aiming for a natural appearance to the slope of the chest wall.

An overwhelming majority of ASAPS plastic surgeons prefer round implants as opposed to “anatomical,” or teardrop shaped implants. The survey did not detail the reason for the preference, but the plastic surgeons we’ve spoken with say that implants occasionally rotate and shift inside the breast capsule. Obviously, anatomical implants would look unnatural upside down. Additionally, most plastic surgeons feel that round implants look very natural when the right size and position is selected, and particularly for submuscular placement.

The ASAPS survey also found that 64% of surgeons prefer an incision near the crease underneath the breast. Although there are other options, notably around the areola, an incision under the breast can give the surgeon optimal access with the least amount of visible scaring.

The big surprise, is how many plastic surgeons and patients continue to choose saline-filled implants. The ASAPS survey showed that 60% of their members are still using saline implants, with an overwhelming majority of those selecting saline implants for first time patients. Furthermore, when silicone gel was chosen over saline filling, the reason most often cited was “patient preference.”

So, it would appear that many plastic surgeons still select saline-filled breast implants quite often. The question is, “Why?” Not only has the filling been shown to be safe and unlikely to leak, it both looks and feels more like real breast tissue.

Could it be that even though silicone gel implants were re-approved by the FDA in 2006, there’s still a lack of faith in the devices? Perhaps many patients, and even some surgeons, haven’t done extensive research on the options? Maybe the choice of saline is simply a result of habit?

Whatever the case may be, the president of the ASAPS noted that good results depend more on “patent-appropriate” surgical techniques more than on the type of implant chosen. If the procedure is done correctly, only a defective implant of either type would create a probable high-risk scenario.