The Two Types of Implants Available in the United States
Saline Vs Silicone
This is a big decision in breast augmentation – one of the most important. After educating yourself on some of the basics on this page, be sure to visit Dr. Loftus’ Breast Blog, which covers in detail the advantages and disadvantages of saline implants and the advantages and disadvantages of silicone implants, and Dr. Loftus’ advice on which way you should go.
Implant Contents and Shells
Implants are named according to what fills them. In other words, saline implants are filled with saline (sterile saltwater), and silicone implants are filled with liquid silicone gel, which has the consistency of molasses.
Regardless of what breast implants are filled with, they all have a solid silicone shell.
Solid silicone, or silastic, has been implanted in millions of people in pacemakers, artificial joints, heart valves, penile implants, and artificial lenses for the eye. Solid silicone is a very different substance than silicone gel, which fills silicone gel implants.
It might be helpful to think of breast implants as being similar to balloons. A balloon may be filled with water, helium, or air, but has the same pliable plastic outer layer regardless of what is placed inside.
History of Saline and Silicone Gel Implants
Both saline and silicone implants have been used since the 1960s. From 1968 (when silicone gel implants were introduced) to 1992 (when silicone gel implants were temporarily banned by the FDA), they were the overwhelmingly most popular type of implant due to their extraordinarily natural look and feel in most women. In 1992, the FDA issued a moratorium on silicone gel implants based on concern that they might cause auto-immune diseases such as lupus and rheumatoid arthritis. From 1992 to 2006, saline filled implants with solid silicone shells, also known as saline implants, were the only option available to women in the United States seeking breast augmentation. Throughout that time, silicone gel remained the implant of choice for women in Europe, South America, and Canada. In 2006, the FDA lifted the restriction on silicone gel breast implants after it was presented with substantial evidence that silicone gel implants did not cause such diseases. It was determined that a woman’s risk of developing auto-immune diseases was the same whether she had silicone gel implants or no implants.
Silicone Gel Implants: Pros and Cons
The advantage of silicone gel implants is primarily aesthetic: they look and feel so soft and natural that they typically cannot be distinguished from breasts without implants provided they do not develop a capsular contracture. They also have a lower rate of rippling and wrinkling. Hence, thin women with modest breast tissue may choose the option of having them placed over the muscle without sacrificing aesthetics (see below). If the same women chose saline implants, they would most likely be advised to have them placed in the subpectoral plane to reduce the risk of rippling. Also, because silicone is lighter than saline, the risk of downward displacement due to gravity is lower. There are disadvantages of silicone gel breast implants. They impose a higher cost (by about $900- $1000) and a longer scar. The longer scar is necessary as silicone gel implants are pre-filled by the manufacturer, so they must be able to fit through the incision. In general, larger implants require longer scars. Also, the risk of capsular contracture may be slightly higher with silicone. This is because silicone implants might incur a late capsular contracture due to implant rupture whereas saline implants do not generally form capsular contractures in response to rupture or deflation. Finally, silicone gel implants might rupture “silently”, such that there is no outward evidence that a rupture has occurred. Physical exam by your plastic surgeon will identify only 30% of ruptures, whereas MRI will identify about 90% of ruptures, so women with silicone gel breast implants may consider MRI scans. The FDA recommends routine MRIs for women with silicone breast implants, but find out why Dr. Loftus do not necessarily recommend this by reading their Breast Blog.
Gummy Bear Implants
One of the two main silicone gel implant manufacturers (Mentor) touts that its silicone gel breast implants are made with cohesive silicone gel. Being cohesive, the gel supposedly has a tendency to stay together rather than disband in the event of a rupture. They have been likened to Gummy Bears, the soft candy that feels as though it is filled with liquid, but which has contents that do not run out if cut open. The other large implant manufacturer (McGhan/Allergan/Natrelle) argues that all silicone gel implants (including their own) are cohesive in nature and that Mentor uses the term “cohesive” as a marketing ploy.
There are varying degrees of cohesiveness. Type I are the least cohesive and are used to make round silicone gel implants. Type I are not considered to be Gummy Bear implants. Types II and III are more cohesive, such that they hold the shape into which they were molded. As such, they are used to make teardrop implants. Currently, only Type I is widely available for use in the United States. Both Type II and III are considered to be Gummy Bear implants. Types II and III are currently restricted by the FDA with no prediction of if and when they will be widely available.
Saline Implants: Pros and Cons
Saline implants have different advantages than silicone. Saline implants have a presumed (studies currently are underway) lower rate of revision surgery than silicone gel, as saline implants tend to get early capsular contractures, if any, rather than both early and late. Hence, the overall rate of capsular contracture is lower for saline than silicone. Further, the scar is shorter, as saline implants can be filled after they are placed, allowing a smaller incision. Finally, the cost is lower (by about $900-$1000 per pair of implants), and there is no need for MRI, as silent rupture is not a concern. If a saline implant shell ruptures, the saline generally leaks out and is absorbed by the body within a day or so, resulting in an obviously smaller breast.
The primary disadvantage of saline implants is that they tend to look round and feel stiff and unnatural, particularly in thin women with modest breast tissue. Further, large saline implants have a higher rate of downward displacement than silicone, as they are simply heavier than their silicone counterparts.
Remember – see the Breast Blog for more details.
Other Options for Breast Augmentation
Efforts to find other options for breast implant materials have been met with disappointment. Oil-filled implants have turned rancid, leading to unpleasant body odors. Fat injections (from hips or thighs) cause calcifications, which can confound the detection of breast cancer. Plastic surgeons continue to seek other options, but there are no promising alternatives on the immediate horizon.
The best way to decide whether to have silicone or saline implants is to first decide which issue or issues are most important to you. For example, if it is most important to look and feel natural, then choose silicone. If you instead most want lower cost, shorter scar, lower rate of capsular contracture, and no need for MRI, then choose saline. No, you can’t have it all.
In general, thin women with a modest amount of breast tissue tend to select silicone gel implants, as the cosmetic advantages are substantial and easily offset the known disadvantages for many women.
In general, heavy women and those with a more generous amount of breast tissue will enjoy less of an aesthetic advantage with silicone, as both silicone and saline tend to feel soft and natural in women with more breast tissue. Hence, the disadvantages of silicone implants are not warranted, and saline is often selected. An exception here is with larger implants. If a large implant is selected, silicone offers the advantage of a lower rate of downward displacement.
Women with an intermediate amount of breast tissue will find themselves caught in the middle of this decision. For these women, Dr. Loftus recommend they decide which is most important: optimal cosmetic result (silicone) or lower rate of capsular contracture, lower cost, shorter scar, and no need for MRI (saline). Once they make this decision, the choice is clear.
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