Beverly Hills Breast Implants

Breast Implants: Silicone or Saline?

As I was reading the latest issue of the Journal of Plastic and Reconstructive Surgery, I came across the following article compiled by a colleague from Texas in the form a letter to the editor. I found it very informative and now I recommend it to all of my patients who are interested in breast augmentation.

  1. Why did the FDA ban silicone breast implants in the first place? The ban occurred for a number of reasons. Pressure from the media, trial lawyers, and various activist groups was intense after the Connie Chung show in 1990. There was fear that they were not safe. They were never approved by the FDA to begin with. They were "grandfathered" in 1976 when the FDA began the process of approval as a formal process. Even though there was a large amount of research including animal data and human data on the safety of these devices, the FDA elected to take implants off the market entirely at first and then allowed their use in reconstruction only.
  2. Silicon (no "e") is an element which exists nearly everywhere in nature. Silicone is a generic name for a family of silicon-carbon based polymers. Depending on the length or complexity of these polymers, silicone can be liquid, gel, or solid rubber. Silicone does not exist naturally but must be compounded in the chemical laboratory. Saline is a simple solution of salt (NaCl) and water. Normal saline has a concentration of human extracellular fluid.
  3. The difference between silicone and saline implants is simply what is contained within the envelope of the implant. All breast implants have the same outer shell which is made from silicone rubber. Most implants are smooth while some are textured. These days it seems most plastic surgeons prefer the smooth implants for a variety of reasons. The silicone implant contains silicone gel and is pre-filled at the factory with a specified amount. The sizes vary in increments of 25-30 cc (roughly 1 ounce) depending on the manufacturer. The saline implant contains normal saline and the implant is filled to it's designed volume in the operating room. The sizes vary in increments of 25-30 cc, but because they are filled in surgery, some additional adjustment can be done at the discretion of the surgeon for various reasons.
  4. As of November 17, 2006 the FDA lifted the ban on the use of silicone implants for breast augmentation surgery. That means that women desiring breast augmentation surgery have the option of choosing a silicone gel filled implant for her augmentation. This choice will have a number of requirements imposed by the FDA. The FDA is requiring, or at least strongly suggesting, MRI examinations after the first three years and every two years following that. Also the patient must be a minimum of 22 years of age (18 years of age minimum for saline implants).
  5. For more information, check out the FDA website: Labeling for Approved Breast Implants. This website has a wealth of information regarding breast implants and is helpful to women trying to make a rational choice regarding breast augmentation surgery. It also spells out the new requirements for long-term follow-up of silicone gel filled implants.
  6. There are potential complications and inherent risks with either saline or silicone breast implants. Among the potential complications and risks are: bleeding, hematoma formation, infection, capsule contracture formation, chronic pain, implant deflation or leakage, implant rupture, changes or loss of sensation, asymmetry, possible interference with breast feeding, possible difficulties with mammography, stretch marks (extremely rare) and the possible causation of other disease(none known at this time). Because of the above, it is possible(probable) that a woman undergoing breast augmentation will need additional surgery at sometime in the future. This would be more likely it would seem, the younger the patient is at the time of the original surgery.
Saline Filled Silicone Gel
rippling-palpable /visible possible natural feeling/min. rippling
less natural feel possible more natural feel
natural substance foreign substance
adjustable not adjustable
small incision larger incision
leaks easily detectable leak detection requires MRI
initial expense = less initial expense = much more

  1. Thoughts on choosing between Saline VS. Silicone: For women choosing breast augmentation who already have a modest amount of normal breast tissue and subcutaneous fatty tissue, either type of implant will normally be very satisfactory and often almost undistinguishable. This also applies to women desiring a very minimal augmentation.

For women choosing breast augmentation who are relatively thin or have relatively little breast tissue, sub muscular placement can greatly minimize the undesirable properties of the saline implant. This is why sub muscular placement is virtually always used in patients who have had mastectomies undergoing reconstruction even with silicone gel filled implants.

For women choosing breast augmentation who are extremely thin and with minimal breast tissue the silicone gel filled implant has a number of advantages particularly when it comes to the issues of rippling and "natural feel". These implants may be placed sub muscular or under the breast tissue at the discretion of the surgeon.

An editorial in the "PLASTIC AND RECONSTRUCTIVE SURGERY" journal February 2008 gave the following summary:

  1. Saline implants have overall decreased capsular contracture and rupture rates compared with silicone breast implants.
  2. Saline implants require a smaller incision for placement than silicone implants.
  3. Rupture detection for silicone implants depends on MRI scanning which the FDA recommends and is not likely to be reimbursed by insurance.
  4. Primary breast augmentation surgery is not an isolated (lifetime) operation and implants will (or may) need to be replaced for a variety of reasons sometime in the future. Revision surgery is often easier with saline than with silicone implants.
  5. Patient satisfaction is high with both types of implants.
  6. Saline implants have less of an effect on mammography detection of breast cancer.
  7. The cost of saline implants is roughly one half that of silicone gel implants.
  8. Both implant types require additional views to adequately image the breasts.

Summary: I personally prefer saline filled implants (usually sub muscular) for the majority of my patients seeking breast augmentation for the following reasons: minimal incision, easily adjustable, natural substance, easy leak detection, and minimal expense. I prefer silicone gel filled implants for the extremely thin patient with minimal breast tissue because they are likely to have less visibility of the implant edges and less visible rippling with the silicone filled implant compared to the saline filled implant. I recommend that you read this article several times. Please feel free to ask any questions you may have regarding the differences between these implants at the time of the consultation or anytime thereafter. Thank you.

Ivan Thomas, M.D., F.A.C.S.

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