Decision Point for Saline vs. Silicone Implants

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 U.S. women access to the same implants women in more than 75 countries have long had as an option. The website Breast Implant Safety 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 Dr. Romano will match the correct implant to your anatomy, expectations and lifestyle.

The most common reasons for exchanging saline to silicone implants are to decrease wrinkles (and 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 a decision. Dr. Romano will guide you through this process.

Breast Augmentation before and after artistically performed by Dr. Romano

Saline Vs. Silicone

Feel:

Silicone implants feel better than saline and have a texture more similar to breast tissue.

The main reason to consider exchanging saline for silicone implants is if you already have very soft breasts but feel the edges and wrinkles and want a more natural breast feel.

Deflation:

Saline implant deflations are more common, but if they occur they are immediately noticeable.

Wrinkles and Folds:

Wrinkles and folds are more common and more easily felt in 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 these in silicone, but much less.

Natural appearance:

Depends on the original anatomy or your breast but is often better especially in smaller breasts with a saline implant since it has a greater tendency to round out the lower part of the breast.

Incision:

Saline implants can be inserted deflated and can utilize a smaller incision.

Leakage/Rupture:

Saline implants have a fill valve and can potentially leak through this.

Silicone implant ruptures are harder to detect. MRI is best to detect ruptures.

Silicone implants are now made with a cohesive gel (new formulation) that retains its shape even after rupture. Here cross linking of silicone molecules forms a gel that is so thick it cannot leak out. Cohesive gel means less folds, less weakness, less leaking.

Silicone implants have some degree of “gel bleed” where the molecules can leak into the tissues. It is believed this contributes to the higher contraction rate.

Silicone implant cut in half to demonstrate the non-liquid cohesive material of the implant.

Mammogram:

Accuracy of mammography is decreased with both saline and silicone implants with little difference between the two.

Size:

Because saline implants can be filled and have a fill “range” of volumes, they appropriate size can be filled to virtually any volume. In this sense they are “adjustable”.

Silicone implants come pre-filled and there is a difference of 25 to 50cc between most sizes.

Both saline and silicone implant sizes come in a wide range of profiles and projections. Silicone implants have a greater tendency to be true to these dimensions after implantation.

Breast Cancer:

There is no established link with any type of breast implant to breast cancer.

Stretching:

The pocket created for saline implants tends to stretch and enlarge over time more than occurs with silicone implants.

Texture:

The smooth and textured (fuzzy) surfaces of saline and silicone implants are similar. Textured surfaces make both more palpable, but texturing makes saline implants more likely to deflate.

Capsular:

Silicone implants have a much higher rate of capsular contracture than saline implants.

Silicone implants have a higher contraction rate (20- 30 %) compared with saline (5%). This is for the older silicone gel. Now the newer silicone is better, more “form stable” and called cohesive. It is like jello, not gummy bears. It is called cohesive gel.

Silicone cohesive gel implants have a less of a contracture rate less 10% 2 years, versus the older silicone gel rate of 15-20% in 2 years.

FDA

FDA recommends MRI 3 years after placement of silicone implants

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