If you are one of thousands of women considering breast augmentation, then you probably realize that literally millions of pages of information about breast implants and augmentation may be found on the web. Unfortunately, some sites provide information that is either misleading or completely wrong. In an unpublished study, I found that up to 93% of websites contain at least one factual error regarding breast implants or breast augmentation. This finding has been corroborated by multiple other studies and for this reason, I want to give you some basic information that may help you through the process. In my consultations, one of the most basic questions that patients ask is, “Which implants are right for me: silicone or saline?” Both silicone gel and saline implants are FDA-approved for breast augmentation and each consists of a silicone elastomer shell filled with either silicone gel or saline. However, there are significant differences between the two types of implants.
The silicone in a silicone gel implant is derived from silica, or silicon dioxide. Beach sand, quartz and crystals are all composed of silica. In fact, silica is the most common substance on earth. However, it is only through extensive processing of the silica that it is converted into a long chemical chain, or polymer, called silicone. This silicone polymer can be a liquid, a gel, or even a rubbery substance depending upon the degree of cross linking. The silicone derived from this process is found in silicone rubber, lubricants and oils as well as in many common household items such as suntan and hand lotion, antiperspirants, soaps, processed foods and chewing gum.
The FDA has also approved many other medical devices made of silicone such as replacement heart valves.Despite the commonplace usage of silicone, a significant controversy regarding silicone gel implants erupted in the early 1990's. Reports surfaced that suggested that silicone breast implants were responsible for connective tissue diseases in some women. As a result, silicone gel implants were temporarily taken off the market for primary breast augmentation. However, after a comprehensive evaluation of the evidence for the association of silicone breast implants with human health conditions, the FDA concluded that there was "no definitive evidence linking breast implants to cancer, neurological diseases, neurological problems or other systemic diseases." Silicone breast implants were therefore released back onto the market for general usage on November 17, 2006.
Saline:
While silicone implants were unavailable, manufacturers chose saline as an alternative implant filler. Saline implants still have a silicone outer shell but contain salt water instead of silicone gel.
Advantages and Disadvantages of Silicone vs. Saline:
Saline implants carry many of the same risks as silicone gel implants, including capsular contracture, infection, etc. However, both types of implants do have certain advantages and disadvantages in comparison with the other.- First, all implants carry a risk of rupture. However, if a saline implant leaks or breaks, the salt water is simply absorbed into the tissues. The implnat deflates and the results are seen almost immediately. When a silicone implant ruptures, the breast often looks and feels the same because the silicone gel only leaks into the surrounding scar capsule that forms around both saline and silicone implants. Thus, a visible difference is not always apparent. As a result, the FDA currently recommends that patients with silicone implants have a follow up MRI at 3 years after surgery and then every 2 years after that. This increases the likelihood of detecting a leak in a silicone implant.
- Secondly, since a woman's breasts are never identical, size differences must be considered in the preoperative planning. The size of a saline implant can be altered, depending on the aesthetic or physical needs of the patient. This allows the surgeon to account for any asymmetry in size between the patient's breasts. In contrast, a silicone gel implant is filled with a fixed amount of silicone gel and is thus not adjustable. Though the implant manufacturers have developed numerous implant sizes, silicone gel implants may not fully account for very small differences between the breasts.
- Also, may surgeons and patients with breast implants have the opinion that silicone implants have a more natural look and feel than saline implants due to the fact that silicone gel has a texture similar to breast tissue. In addition, the possibility of visible wrinkling or rippling is significantly greater with saline implants than with silicone gel implants (21% vs. < 1% over the first 3 years).
- Finally, due to the expense of processing the silica into silicone, the cost associated with silicone gel implants is generally higher than for saline implants.
