American humorist Will Rogers once advised people:  “Don’t believe anything you read and only half of what you see.”

If you’ve been reading anything at all about breast implants, you may come away thinking that silicone is the hands down favorite.

Well, to quote many other famous Americans: “It ain’t necessarily so!”

Philadelphia cosmetic breast surgeon Ted Eisenberg, D.O., begs to differ about silicone and put his opinion into a recent issue of the American Journal of Cosmetic Surgery. Dr. Eisenberg claims 4,000 breast augmentations to his credit.

The quick take? Dr. Eisenberg’s patients prefer saline over silicone.

(Here’s the breast implant editorial.)

For the record, of the 355,671 breast enhancements counted by the American Society for Aesthetic Surgery in 2008, the most current year for which statistic exists found:

• 53.9 percent used saline
• 46.1 percent used silicone

So breast enlargement procedures officially use about half silicone and half saline. If the silicone breast implants are purported to be so much better, then why all the saline implants?

Let’s drill down and take a look at what is going on in Dr. Eisenberg’s practice.

He grants that if you hold a saline and silicone breast implant in each hand, you would say the silicone is softer, but according to Dr. Eisneberg, only four of his 709 breast augmentation patients have asked for silicone during a two-year period from November, 2006 to October, 2008.

Of course surgeons’ experiences vary widely and that’s just one example.

He doesn’t say, but the cost of breast augmentation may be the deciding factor. Saline usually costs about $1000 less than silicone.

Another factor: Scarring. Because saline implants are empty and are rolled up like a cigar for filling after implantation, the incision is only three centimeters (about one and one-half inches.)

But the silicone breast implants - which are pre-filled - require average incisions of five to seven centimeters (about two to three inches) long.

Of course, in the first place, the scars are hard to see. In the second place, they lighten and fade over time.

Long story short: If you have enough breast tissue to cover the implant and do not go too large for your body type, saline can appear just as natural as a silicone implant. Ask your surgeon which will look more natural with your body type.

On a recent episode of The Real Housewives of New Jersey, Jacqueline, Caroline and Dina joined Teresa as she took her 34A chest to see a plastic surgeon about breast augmentation.

The housewives were having a lark but, actually, taking a friend or two or a relative to your first surgical rejuvenation consultation is a pretty good idea.

Especially if your companion has already had breast enhancement, you are ahead. Usually, what one forgets to ask, the others will.

By the time you get to your first consultation, you should have done enough plastic surgery homework to know:

• If  your surgeon is a board certified plastic surgeon
• How often he or she does the procedure you want
• If there is a charge for the first consultation
• If so,  if it is applied to the cost of plastic surgery

According to surgeons who have seen it hundreds of times over, a breast augmentation patient knows she is really, really ready for surgery when she just can no longer stand the site of her partially filled bra or can’t bear to drum up another excuse to avoid the beach or pool.

Selecting the size is extremely important; a high percentage of breast revision patients go back under the knife again soon because they did not like the size after the first operation healed.

Watch this ‘reality tv’ show version of a breast augmentation consultation.

A couple of things the housewives should have discussed include:

• Questions about time required for healing
• Another two or three such consultations with other plastic surgeons
• The location of any possible scars
• Slim but possible surgical risks
• The surgeon’s before and after plastic surgery pictures
• The completion of various medical tests before plastic surgery
• Various types of financing, including cash, credit cards and plastic surgery financing
• The person who will spend the first 24 hours after surgery with Teresa

Of course, why worry about a companion for after surgery? For somebody who can easily find three friends to go along on a first visit to a plastic surgeon, having a person present during recovery should be a snap!

In retail, nothing sells like samples.

In cosmetic plastic surgery, the equivalent of the sample is a set of before and after breast augmentation pictures.

When we told you in a previous post about breast enlargement with Macrolane , we did not have any samples to show.

Now, a British lass has solved that. A plastic surgeon, entertaining a very select audience, brought out an extremely, shall we say, bosom challenged young miss and then took her away for Macrolane injections.

Five days later, the surgeon then fetched his lovely subject back before the same group, to complete the before and after viewing experience.

And we’ve got the pictures!

Look for yourself how quickly - and naturally — a Macrolane breast enhancement takes effect.

Such a shame the Macrolane goes away in one to two years!

You already know about breast reduction but there is a step beyond large breasts in which a woman’s bosom is so huge she is medically described as having gigantomastia. (It literally means giant breasts.)

To qualify, each breast must weigh at least 10 pounds. Today, many teens afflicted with the condition go under the knife before the age of 17 to reduce both breasts into a more manageable size.

You may have noticed Soleil Moon Frye was in the news for winning a best documentary at the San Diego Film Festival for a film, Sonny Boy, about her Alzheimer-stricken father.

But Soleil was best known for her four-year run as a bright, adorable 12-year-old on Punky Brewster.

As the five-foot-one Soleil matured and grew into a woman, she developed a 38DD bust line which presented a whole host of problems. For one, she could not run for exercise.

If she tried to jog, boys would taunt: “Hey, Punky Boobster!” There were also practical considerations, with Soleil once admitting it was even hard to give somebody a hug.

The medical complications were all too real however; the huge weight caused back problems and made her bra straps painfully dig into her shoulders.

And young love was a problem, too, because no matter how much a teen lad cared for her, the main attraction became…..well, hey, you’ve got the picture by now.

If she moved too much or too fast in a film, her condition showed a massive chest heaving up and down.

It’s a long video, but the first few seconds show Soleil running with a massive bosom, that rises and falls like huge ocean waves.

Back then, Soleil told People Magazine: “People started to think of me as a bimbo.”

Shortly before her 16th birthday, Soleil went under the knife for breast reduction surgery, an operation that was performed on 88,732 women and teens in 2008, the most current year for which statistics exist.  (17,902 men also had the procedure in ‘08.)

According to the record books, the problem has been with us for quite a while and was first described by doctors in 1648; the largest recorded weight was 67 pounds per breast.

The only known medical treatment is plastic surgery.

To qualify for the procedure these days, each of the patient’s breasts must tip the scales at a weight of at least 3.5 pounds.

Read more about breast reduction.

If you didn’t already know, nurses are in high demand worldwide.

In America, a Registered Nurse with some experience can command a five-figure sign-on bonus that can turn a Wall Street tycoon green with envy.

But in Europe, one employer has found the way to attract the crème de la crème of nursing staff: Ask them to work for breast implants!

The  ISCARE LIGHTHOUSE Clinic Centre in Prague, Czech Republic, has - like many health facilities worldwide — suffered from a lack of top tier talent - that is, until they hit on the unusual sign-on bonus.

Not only are free breast implants offered, staff can also choose liposuction or tummy tucks!

After all, much of the stock-in-trade at The Iscare Clinic is plastic surgery procedures.
(View the Czech plastic surgery clinic website.)

For many potential plastic surgery patients in Germany, Great Britain and France, the Czech Republic is attractive because it offers popular rejuvenation surgical procedures at a much lower cost of plastic surgery than typically found in their native lands.

According to RussiaToday.com, the cost of a breast augmentation at the clinic is $3500; the same procedure would cost twice to three times that much in, say, England.

The clinic can charge so little because overall costs in the Czech Republic are much lower.

So the average Czech nurse making a typical salary of $900 a month - about the same as a bus driver there — would be hard-pressed to ever afford breast enlargement.

Said one 31-year-old Czech nurse who signed on for breast enhancement: “I would rather have plastic surgery than a free car. We were always taught that if a nurse is nice, bright, loves her work and looks attractive, patients recover faster.”

Consequently, many trained, credential nurses have left the Czech Republic for Germany, the United Kingdom and other west European countries where wages are higher. Reportedly, the Czech Republic has about a 6,000-nurse shortage.

Nurses, physicians and other staff who sign on for three years can have the no-charge plastic surgery after they have served the three years.

So far, ten of 50 nurses at the clinic have taken the plastic surgery option when renewing their contracts while one male physician is thinking about having liposuction.

What do breast surgery patients want? Short answer: Satisfaction!

With over half a million U.S. women undergoing some form of breast surgery yearly, according to the American Society of Plastic Surgeons (ASPS),  plastic surgeons and others want to know exactly what makes breast surgery patients happy at the end of the day.

So five researchers from Canada, the United States and England interviewed 48 breast surgery patients, who had:

• 15 breast reductions
• 12 breast augmentations
• 21 breast reconstructions

The patients were chosen at random from the practices of four plastic surgery practices in Vancouver, Canada.

The basic task was for each patient to describe the condition of her breasts and how the subsequent surgery impacted their lives.

Results: Six themes came out of all the interviews, including:

• Satisfaction with breasts: Women who were happy with breast size, shape, symmetry, cleavage, scars, positioning, how natural the breasts look and feel and how the breasts fit the rest of the body were key concerns.
• Satisfaction with the overall outcome
• Psychosocial well-being: Patients rating high levels of well-being were pleased because, after surgery, they felt less embarrassed, more confident in social settings, more self-assured and more feminine and attractive.
• Sexual well-being: The subjects said they felt more sexually attractive when clothed and unclothed. They were more confident sexually and more satisfied with their intimate lives. Said one breast augmentation patient: “What I find now is that I am sensual, which I did not feel before.”
• Physical well-being
• Satisfaction with the process of care: Attention plastic surgeons and office staff: According to the study, breast surgery patients mainly look for the amount and quality of information they get before surgery; the actual care provided by the surgeon along with the office staff care. Responded one patient: “And once I came home, the home care…the nurses would come round and they were just excellent..”

A newly released video, Breast Men, is loosely based on the history of the first woman to have silicone breast implants, back in 1962.

(The movie’s ad tag: “Never before has one invention given America such a lift!)

The video paints one of the surgeons as a get-rich-quick-artist who spots a surgeon friend’s invention - the silicone implants - as a way to fame, fortunate and a burgeoning 401k account.

What actually happened back in the ’60s was that the two surgeons  — one was a professor of plastic surgery — first tried injecting silicone into the breasts. But after seeing the terrible results on 11volunteer patients, they gave it up.

With the first implant in hand, the doctors came across 26-year-old Timmie Jean Lindsey, a mom who had four children in nine years. That left Timmie Jean with sagging breasts.

She also had a small tattoo on each breast and went to see one of the plastic surgeons for dermabrasion removal of the tats. The surgeon said he had developed  a new breast rejuvenation procedure for women who had many children. But Timmie turned him down, saying what she really wanted was an otoplasty to pin her large ears back.

Eventually, the surgeon agreed to do the otoplasty for no charge if Timmie would have the breast implants. She agreed, increasing her breast size to B from a C, and became the world’s first cosmetic breast augmentation via implant patient in 1962.

Recently, Timmie told the Daily Mail in London, England, that after the procedure, she suddenly got tremendous attention from men and soon married again. (Read the breast implant story.)

The condition of Timmie's breast are shown, extreme left, before surgery; middle, two months after the procedure and two years later.

But after ten years, her breasts became hard - probably due to capsular contracture, a type of internal scarring and the most common complication in breast augmentation.

(See our previous post on typical breast enlargement complications and how to deal with them.)

Timmie, now in her eighth decade, still has problems with her 45-year-old implants but does not want to risk surgery due to her age.

And the surgeons? They sold their invention to Dow Corning in return for royalties.

Although Dow Corning no longer makes breast implants, two other medical manufacturers picked up the slack.

Now, the most current plastic surgery statistics available reveal that breast augmentation is the U.S.’s leading invasive cosmetic plastic surgery, with about 307,000 patients counted in 2008.

You’ve often read on our blogs that plastic surgeons have years of training beyond medical school and will often add a year of fellowship, working at the side of an older and more experienced surgeon to learn a particular skill.

One such area is microsurgery, operating on very tiny structures of the body through a microscope.

When women lose one or both breasts to cancer, a plastic surgeon often works with the cancer surgeon afterwards to rebuild the breasts.

Many physicians like the idea of a woman waking up from surgery and not seeing her breasts gone, with scars on her chests where her bosom used to be.

So the plastic surgeon often steps up to the table right after the mastectomy surgery.

The DIEP method takes extra flesh, fatty tissue - along with their blood supply vessels — from the woman’s stomach for use in building soft, warm, living breasts. The method is usually best for patients that need a small amount of tissue to reconstruct the breast mound or those who need both breasts reconstructed.

To get donor tissue, the surgeon uses the same incision across the binki line from hip to hip as he would in the tummy tuck procedure. Then, another curved incision is made in an arc from one side to another above the first incision.

The resulting flap — shaped like a large eye - is then moved to where the new breast will be. The long scars in the tummy area fade over time.

However, the vertical stomach muscles that create a “six-pack tummy” the rectus abdominis, are not touched.

Working at the location of the breast, the surgeon then painstakingly uses microsurgery to reconnect the blood supply to the new breast.

Then, the nipples are reconstructed from flesh on the new breast. Areolas are often created with tattoo ink. The procedure can take three to four hours.

Many patients say the DIEP (”Deep Inferior Epigastric Perforator” flap) breast is often
firmer and has a more youthful look than the natural breasts.

One 43-year-old DIEP patient wrote to her surgeon: “Not only am I cancer free, but I look much better than when I first came to you.”

Another patient wrote her surgeon after having DIEP reconstruction that, after 14 years after a divorce, she had her femininity back, had met a wonderful man and was getting married again.

Yet another option for breast enlargement is brewing in Europe and headed for U.S. shores.

Plastic surgeons there are using a thick, gel-like substance, Macrolane, made of the same chemical compound as the familiar Juvederm.

It’s made by the same Swedish firm that makes Restylane.

Injected deep into the breasts, Macrolane breast enhancement really is an augmentation without the knife. Of course, this procedure has its plus and minus features, too.

Upsides include:

• Recovery is nil

Walk in, have a one to two hour procedure, walk out

• It looks good

Macrolane is said to provide substantial volume and provide a smooth appearance to the breasts without lumps or bumps

• Few risks

The risks of general anesthesia and surgery (infection, scarring, broken implants) are gone.

The downsides are:

• Not approved yet for U.S. use
• Effects only last one to two years (British doctors include yearly “top-offs” to maintain the look.)
• Not for those allergic to hyaluronic acid
• Women who have the procedure are monitored

Many women now in their 40s and 50s who had breast augmentation while younger no longer want large bosoms and often have surgery for smaller implants.

If those women can afford to go back every two years for Macrolane, they would not have to worry about explants surgery later on.

Explore Plastic Surgery, the most excellent blog of Indiana board-certified plastic surgeon Barry Eppley, M.D., says injecting Macrolane is “very much like injecting jello.”

Dr. Eppley compared breast augmentation before and after pictures of both implants and Macrolane. His opinion?  “Macrolane fares poorly compared to breast implants.”

For a preview of coming attractions, here’s a British You Tube segment, below.

The segment starts with a low cringe factor as the surgeon uses a tiny syringe to inject what is probably a pain killer.

That thicker, foot long instrument he puts into the patient’s breasts is not a needle but a blunt end canula, a thick, hollow tube that injects the Macrolane jell deep into the breasts. (Watch the Macrolane breast augmentation.)

Dr. Eppley says Macrolane will probably be used in the United States soon.

But the real danger he sees: the stuff is so easy to use, more untrained hands may take advantage of “quick and cheap” factors to produce shoddier breast augmentations.