Saline Implants vs. Silicone Implants
— Los Angeles Health News, October 2005
It is well known that one of the most common cosmetic procedures performed in the Unites States is breast augmentation. The most common reasons women desire breast augmentation are the changes that occur to the female breasts after child birth (post-partum atrophy), changes that occur with weight loss, wanting to be more proportionate and fit better in their clothes, women with asymmetries and post mastectomy reconstruction.
What is a breast implant?
Breast augmentation is a procedure that has been performed for over a hundred years. Multiple substances have been injected in to the breast to try and improve the shape and volume of the breast. Since the 1960’s breast augmentation has been performed with an insertion of an implant. The implant is a bag made of a silicone rubber shell and is filled with saline or silicone gel.
Saline filled implants are filled with salt water. The human body is essentially 60% salt water. Therefore, if the saline implant leaks, the salt water solution is absorbed without difficulty. The only problem is that it leads to an embarrassment and an obvious asymmetry, since it usually occurs on one side. This can be corrected with a replacement surgery.
These implants are inserted empty in to the breast pocket and then filled with the sterile saline. The surgeon therefore can adjust the final implant volume to correct for minor asymmetries that exist in almost everyone. Since the implants are inserted empty they can also be placed through distant incisions such as the armpit or belly button that leave no scars on the breasts.
The FDA approved the saline implants as safe devices in June of 2000. The implant manufacturers’ clinical testing, to determine the most common risks and complications associated with the implants, showed that devices are not devoid of problems such as deflation or leakage, which was approximately 1% per year.
They also reported risk rates of developing capsular contracture (hardening of the scar tissue around the implant), infection, bleeding, pain, numbness and/or loss of nipple sensation and rippling or wrinkling. Despite the fact that the companies also reported a 20% re-operation rate within three to five years the satisfaction rate remained fairly high at 96-98%.
The main disadvantage is that saline implants are more palpable (patient may feel their implants more readily) and they may lead to more rippling or wrinkling especially in thin women. Currently, more than 95% of implants placed in the US are saline filled prosthesis.
For those who are too young to remember, in 1992, the FDA restricted the use of silicone filled implants due concern that there may be a link between these implants and connective tissue disorders (Lupus, scleroderma, rheumatoid arthritis) and even cancer.
After 15 years of studies by both implant manufacturers, the FDA has approved the use of Silicone Gel breast implants for women 22 years and older. None of the studies performed showed any direct link between the silicone implants and connective tissue disorders or cancer.
The current recommendation by the FDA and the manufacturers for follow up and detection of leakage is an MRI three years after the augmentation and every two years thereafter. MRI is a much more accurate diagnostic tool in detecting implant rupture and other abnormalities than mammograms (89% versus 65%).
Silicones are manufactured in variety of forms, including oils, gels and solids and have many medical uses. Since the consistency of silicone is closer to the female breast, the silicone gel filled implants tend to fill more natural, especially in thin women. If the silicone implant ruptures and the silicone gel leaks outside the pocket it cannot be absorbed. This may lead to nodules that are called granulomas, which are usually asymptomatic.
The manufacturers have now developed better gel filled implants with thicker shells as well as more cohesive silicone gels which have reduced the incidence of leakage and rupture significantly. Cohesive gels, to which some people refer to as the "gummy bear" implant, are less likely to lead to formation of granulomas or foreign body reactions if the implant shell ruptures since the gel remains cohesive within the pocket.
Numerous studies have been performed regarding the safety of the silicone gel filled implants. In most of these studies large groups of women that received silicone breast implants were compared to a control group that did not have breast augmentation. The short term and long-term studies confirmed repeatedly that there was no association between silicone breast implants and breast cancer. In regards to the connective tissue diseases, those studies also found no association between silicone breast implants and connective tissue diseases. Evidence suggests that such diseases are no more common in women with breast implants than women without them.
Now that the FDA has approved the use of silicone filled implants the women in the United States like the women in the rest of the world will be able to choose which type of implant they would like to have in consultation with their surgeon. For millions of women who have undergone breast augmentation, the procedure has resulted in an aesthetic appearance that has improved their self image and quality of life.
Choosing a Surgeon
When choosing a surgeon who is experienced with breast augmentation, you should know the answers to the following questions:
- How many breast augmentation procedures does he/she perform per year?
- What is the most common complication he/she encounters with breast augmentation?
- What is the rate of infection, capsular contracture and leakage with breast augmentation in their practice?
- What is his/her re-operation rate with breast augmentation and what is the most common type of re-operation he/she performs?
Familiarize yourself with the options in breast implant surgery and be prepared to discuss with your surgeon any questions you may have regarding implant shape and size, implant placement, incision site, surgical setting, anesthesia and post-operative care.
— Los Angeles Health News October 2005, Dr. Haiavy
Contact Rancho Cucamonga Cosmetic Surgeon Dr. Jacob Haiavy, MD for more information and schedule a consultation today.