Silicone Breast Implants
Breast Augmentation with Silicone Gel Implants
Silicone breast implants (also known as silicone gel breast implants) offer several advantages over saline breast implants. They also have some disadvantages, so you and your surgeon should carefully weigh the pros and cons, if you are considering this option.
The Good News:
Advantages of Silicone Breast Implants
The major benefits of silicone breast implants are in the realm of a more natural look and feel.
Silicone breast implants are filled with silicone gel, which is softer and more natural (in the way it feels to the touch) than saline breast implants. They feel so soft and natural, that it is often impossible to discern them from natural breast tissue.
Rippling (see risks of breast augmentation) is far less likely to occur in women with silicone implants than in women with saline implants. This is because silicone gel is far more viscous (thicker) than saline, so it does not move or slosh, as saline can. Silicone implants can be placed over the muscle in women with little body fat or little breast tissue without the aesthetic concerns (rippling) associated with placing saline implants over the muscle in these women.
The Not-So-Good News:
Disadvantages of Silicone Breast Implants
Silicone implants may rupture. If they do so, liquid silicone may leak out of the implant shell. It is important to note that silicone implant ruptures and leakage have never been shown to cause systemic problems (such as lupus-like diseases, see below). Yet, in response to silicone implant rupture (with or without leakage), your body may develop a thick scar around the implant, called capsular contracture (see risks of breast augmentation).
Ruptures, if they occur, tend to occur in implants that have been in place for years (as opposed to recently placed implants). Thus, so do capsular contractures.
The overall rate of capsular contractures among women with silicone implants is higher than in women with saline implants. A new type of silicone breast implant has been developed to hopefully reduce the risk of rupture, leakage, and capsular contracture. It is the cohesive gel implant (see below). Studies regarding the rate of rupture, leakage, and capsular contracture for these implants are currently underway, so the rate of these problems is not yet known.
Silicone implants are all pre-filled by the manufacturer. This means a longer incision (6-8 cm) is required to place the implant. This is in contrast to saline implants, which are empty (hence smaller) prior to their insertion. As such, saline implants may be placed through a shorter incision (3-5 cm).
The cost of silicone breast implants is about $1000-$1500 higher than saline. This is due to higher production costs (compared to saline) by the manufacturer. Your surgeon may also charge a higher surgeon's fee for placement of silicone implants because of greater follow-up time and paperwork for his/her office staff. Be sure to ask about this.
Additional potential issues with silicone implants exist and can be found here: Informed Consent for Silicone Breast Implants.
Putting it Together: Are Silicone Breast Implants Right for Me?
The advantage of having silicone breast implants with a softer and more natural feel is more important for women who have the least amount of natural breast tissue and women who have little body fat. In these women, saline implants can often be seen or felt through the skin. Although this does not bother many women, it does bother some.
Women who are starting out with a more generous amount of natural breast tissue will have more "padding" between their skin and the implants. So, in these women, the difference between saline and silicone is less evident, and sometimes there is no difference. In other words, in women who have enough breast tissue, neither implant can be felt through the skin, so the advantages of silicone breast implants are less important, but the potential disadvantages remain the same.
If silicone implants came with no risks, no worries, no extra follow-up, and no extra expense, then everyone would want to have them. But, because they come with all of these things, they are probably best suited to women who have nominal breast tissue and are willing to accept the aforementioned disadvantages. They are also very appropriate for lean women and body builders, because they can be placed over the muscle with a low risk of rippling.
Options in Silicone Breast Implant placement:
When planning your operation with your plastic surgeon, you will need to decide important issues such as whether the implant will be placed under or over the pectoral muscle; whether the implant will be textured or smooth; whether the implant will be round or anatomic; and the size of the implant. Each of these issues is addressed through the breast augmentation main page.
Another issue to decide is whether your implants will be cohesive gel or non-cohesive gel. Cohesive gel implants can be thought of as similar to gummy bears. They are soft and pliable, but do not leak out when they are cut open. Therein lies an important advantage of cohesive gel implants.
If you choose cohesive gel, then the next decision is whether you will choose Type I, II, or III.
Type I are the most pliable and are the most appropriate for the majority of women seeking silicone breast augmentation. They are smooth and round and have a lower incidence of mal-rotation and displacement than Type II or III.
Type II is textured, teardrop shaped, and more firm than Type I. It is best for women who have an extreme paucity of subcutaneous soft tissue, such as body builders. The advantage of Type II is that they have a lower likelihood of rippling than the Type I. (Note that Type I silicone cohesive gel implants are less likely to ripple than saline, but the Type II are even less so). The disadvantage of Type II is that they are more likely to rotate or displace into an unnatural position.
Type III are very stiff and cannot ripple, but these are not currently available, even under a study protocol.
How to Proceed if you Want Silicone Breast Implants for Cosmetic Breast Augmentation
If you wish to get silicone breast implants, then you must:
1. Find a plastic surgeon who is involved in one of the studies and can offer you silicone breast implants;
2.
Be considered an appropriate candidate for silicone breast implants (see below);
3. Carefully consider risks by discussing them with your surgeon and reviewing the consent form; and
4. Commit to follow-up appointments 1, 3, and 5 years after breast implant surgery.
Criteria for Qualifying for Silicone Breast Implants
In order to be considered a candidate for silicone breast implants, you must fit one or more of the following criteria:
1. Have tissue or skin which is too thin to support a saline implant, such that saline implants are unsuitable;
2. Have a pre-existing implant (saline or silicone) which causes severe wrinkling or another deformity;
3. Have had a mastectomy and now seek reconstruction with silicone implant;
4. Have congenital chest deformities such as pectus excavatum, Pectus Carinatum, or severe asymmetry; or
5. Have a history of traumatic injury to the breast.
If you fit any of the following descriptions, you will be automatically excluded from the study and are not considered a candidate:
1. Have an active infection at the time of surgery;
2. Are pregnant or nursing;
3. Have lupus or other connective tissue disease;
4. Have uncontrolled diabetes;
5. Have such poor tissue quality such that any implant is contra-indicated.
Study Protocol
The study requirements involve filling out some extra paperwork and questionnaires prior to surgery. In addition to this, you and your plastic surgeon would fill out more paperwork 1 year, 3 years, and 5 years after your surgery. Each time this paperwork is completed, it will require about 15 extra minutes of your time.
How We got Here:
History of Silicone Breast Implant Controversy
From 1960-1990, silicone breast implants were the most popular type of implant placed for breast augmentation. In 1991, unfounded news reports emerged that silicone gel breast implants were responsible for causing connective tissue diseases (CTD's) in some women. (The key word here is unfounded). CTD's are lupus-like diseases that can include arthritis and can be disabling, affecting the entire body. Whereas it was true that a few women with silicone implants developed CTD's, so did women without implants. It has been shown through multiple studies that silicone implants did not cause the CTD's. Simply put: women with silicone implants and women without silicone implants have the same risk of developing CTD's. The presence of silicone implants does not increase the likelihood of developing a CTD.
Because preliminary studies have supported that silicone implants are safe in this regard, silicone gel breast implants have been under wider study for return to the market in the USA. In April 2005, an FDA advisory panel recommended to the FDA that silicone gel breast implants be returned to the market. The key word here is recommended. Advisory panels review the information and make recommendations, but they do not have the authority to act. So, it is up to the FDA decision-makers to determine when and how these implants will once again be widely available, outside of a study protocol. In the meantime, they are still available to those women who qualify as candidates and are willing to become part of the study.
More Information on the Status of the FDA's Approval of Silicone Breast Implants:
http://www.fda.gov/cdrh/breastimplants/
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