Silicone Implant Update

Silicone vs Saline Implants: Are Silicone Implants Right for You

by James J. Romano, MD

Silicone breast implants are once again available in the United States as of 2007, ending a restriction dating back to 1993. This landmark decision by the Food and Drug Administration gives American women access to the same implants women in more than 75 countries have long had as an option. The website www.breastimplantsafety.org is a good resource to answer questions about implants.

There is no absolutely better or worse implant to use in all situations. There are advantages and disadvantages to both and the correct choice MOSTLY depends on how I will match the correct implant to your anatomy, expectations and lifestyle.

The most common reasons for exchanging saline implants to silicone implants are to decrease wrinkles, rippling, and to have a more natural feel, especially in women with thin skin.

The following summary of information about saline and silicone implants is presented to help you make and informed decision. I will also help you through this process.

• Silicone implants feel better than saline and have a texture similar to breast tissue.
• The main reason to consider exchanging saline implants for silicone implants is if you already have very soft breast but feel the edges and wrinkles and want a more natural breast feel.
• Saline implant deflations are more common, but if they occur they are immediately noticeable.
• Wrinkles and folds are more common and more easily felt with saline implants, usually in the lower and outer edges of the breast and especially in women that are thin and have little breast tissue. You will still feel some of the edges on silicone implants, but much less.
• Natural appearance depends on the original anatomy of your breast but is often better especially in smaller breast with a saline implant since it has a greater tendency to round out the lower part of the breast.
• Saline implants are inserted deflated which allows then to utilize a smaller incision.
• Saline implants have a fill valve where the saline may potentially leak through.
• Accuracy of mammography is decreased with both saline implants and silicone implants with little difference between the two.
• Because saline implants can be filled and have a fill "range" of volumes, the appropriate size can be filled to virtually any volume. In a sense they are "adjustable". Silicone implants come pre-filled and there is a difference of 25 to 50cc between most sizes.
• There is no established link with any type of breast implant to breast cancer.
• Silicone implants are at least twice the cost of saline implants.
• The pocket created for saline implants tends to stretch and enlarge over time more so than with silicone implants.
• • Both saline and silicone implants come in a wide range of sizes and projections. Silicone implants have a greater tendency to be true to these dimensions after implantation.
• • The smooth and textured (fuzzy) surfaces of saline implants and silicone implants are similar. Textured surfaces make both more palpable, but the textured implants are more likely to deflate.
• Silicone implant ruptures are harder to detect. An MRI is best to detect ruptures.
• Silicone implants have a much higher rate of capsular contracture than saline implants with a rate of 20 to 30% for silicone compared to a 5% rate with saline.
• Silicone implants are now made with a cohesive gel that retains its shape even after a rupture. Cross linking of silicone molecules for a gel that is so thick it cannot leak.
• Silicone implants have some degree of "gel bleed" where the molecules can leak into the tissues. It is believed this contributes to the higher contracture rate.