Saline Vs. Silicone:

Part 2 of 3: The pros and cons of Silicone Breast Implants

September 29, 2009

This is Part 2 of a 3-part blog centered on the issue of deciding whether you want saline breast implants or silicone breast implants. Before reading Part 2, please read Part 1 of this blog which focuses on saline breast implants. Part 2 will focus on silicone breast implants. And Part 3 will tie it all together (along with some advice from me) and help you figure our which is best for you.

The advantages of Silicone Breast Implants are…..

• Silicone implants simply look and feel more natural than saline (provided that they do not get a capsular contracture – in which case, they will probably look and feel worse). The degree of difference between silicone and saline depends to a very large extent on the amount of breast tissue you begin with and the firmness of your breast tissue (explained in Part 1). In general, the larger and firmer your breasts, the less of an advantage silicone will offer in terms of natural look and feel over saline breast implants, because saline implants can feel pretty natural in some women with generous breast tissue. Conversely, the smaller your breasts, the greater the difference there will be between saline and silicone implants.  (Speaking of which, size and firmness are not related, as some women with small breasts have firm beasts, and some women with large breasts have flaccid floppy breasts – and vice versa.)
• Large silicone implants are less likely to displace downward due to gravity than the same-sized saline implants. This is because silicone weighs less than saline. As downward displacement can sometimes be difficult to fix, this is not a minor consideration in those who choose larger implants. See Part 1 of this blog for more details on this issue.

The disadvantages of silicone breast implants are …

• Silicone breast implants have a greater risk of capsular contracture than saline. The difference may be as small as 1% per implant per year, but it is a difference.
• Silicone implants cost more by about $1000 per pair.  
• Silicone implants often require a longer scar  - unless they are small implants, in which case, they can often be placed through a shorter incision.  
• Silicone implants may rupture silently. This means that they may rupture, but you may not know it. If a silicone implant ruptures, it will either trigger a capsular contracture, or it wont. If it does not trigger a capsular contracture, you may not know that it has ruptured – this is called a silent rupture. In order to monitor women for silent ruptures with silicone breast implants, the FDA has recommended that women get MRI scans of their breasts every other  year beginning after the implants have been in place for 3 years. There are a few problems with this recommendation: 1) cost and 2) false positive MRI results. The cost of and MRI scan can range from about $2000-3000, and insurance may decline coverage for such scans if related to previous implant surgery. A False Positive is a medical test which indicates you have a problem or condition when in fact you do not have it. So, a False Positive MRI scan may show a ruptured implant when in fact the implant was intact. This can create unnecessary surgery and distress. As a result of these issues, many plastic surgeons (including myself) do not recommend routine MRI scans unless the patient is having problems or unless the patient requests an MRI scan.

Aside and apart from these issues, one issue to think a bout is whether you are comfortable with the concept of silent ruptures. Many plastic surgeons feel that ruptured silicone implants do not impose any actual or potential general medical problems and that the main drawback of a ruptured implant is potential capsular contracture. Most women are in turn comfor6table with the possibility of silent ruptures. However, there are some women who are not comfortable with the concept of silent ruptures and who would be distressed over this possibility. I do not recommend that these women have silicone implants, as the purpose of implants is to make your life better  – not more stressful.

Sorry for the delay in getting Part 2 posted. Hopefully it was worth the wait! Please stay tuned for Part 3 in which I will tie everything together and tell you what I tell my patients.

Breast Wishes!

Jean M. Loftus, MD