What is the difference?
When discussing breast augmentation with a perspective patient, I am commonly asked whether I prefer Saline or Silicone breast implants.
My initial answer is that I don’t have a preference except in a few circumstances.
In general I feel that Silicone implants are an advantage in breast
reconstruction and in women, who are thin, possibly never had children, and
have little or none of their own breast tissue. Saline on the other hand is
an advantage in women who have asymmetry in size ( uneven breast size) as
Saline implants can be adjusted at the time of surgery giving me a greater
ability to create a more symmetric appearance( a more even look) to the
breasts.
What is a Saline Implant?
Saline implants are come as empty silicone shells. Saline (salt water) is
used to fill the implant at the time of the surgery. Saline implants are
generally felt to give a firmer, slightly less natural feel compared to
silicone implants. They also have a high incidence of palpable rippling;
wrinkling that can be felt after the procedure. Should the implants leak the
saline is absorbed by the body and is of no danger to the patient. The
patient notices a difference in size and should make an appointment to be
evaluated for replacement of the implant.
Silicone Implants
There is a long history behind silicone breast implants. Silicone breast
implants were introduced in 1963 and have gone through many changes in
shape, shell, shell texture and chemical make-up of the gel.
The first generation of silicone breast implants were made as a two piece
device glued together to form the implant shape. It came in three sizes,
small, medium and large and had a patch on the back of the implant to
encourage tissue in-growth to prevent unwanted movement of the implant.
These patches were problematic, occasionally causing tearing of the implant
and were subsequently discontinued.
The next changes in silicone breast implants came in the mid 70’s. The
changes included making the shells thinner and the silicone gel thinner to
give a more natural feel. The biggest problem was that the thinner shells
were more fragile and had a high incidence of leak or rupture as they aged.
To combat these problems the implant shell was made stronger by adding a
coat of diphenyl silicone and the gel was made thicker and more cohesive
decreasing the amount of silicone bleed (the diffusion of silicone molecules
back and forth through interaction with the silicone shell). It has been
postulated that the greater the “bleed” of the silicone the greater the
incidence of capsular contracture.
In 2006 the FDA again approved silicone breast implants for cosmetic use
after an almost 15 year absence. There are only two companies approved to
produce these implants in the United States, Mentor and Allergen. The shell
is still made of two layers (dimethyl siloxane and amorphous silica) and the
gel more cohesive with greater cross linking to decrease gel bleed.
When it comes to safety silicone may be one of the most studied materials
today. There are over 35 studies from both the United States and around the
world documenting the safety of silicone gel. It has been accepted that the
silicone implants do not cause an increased risk of disease. It is well
accepted that the problems associated with breast implants, such as
infection, bleeding, asymmetry, capsule formation are related to the
surgical procedure or the patient’s biologic processes.
Replacing Breast Implants
The most commonly discussed risks related to the placement of breast
implants include breast pain, changes or loss of nipple sensation,
infection, bleeding, scar tissue causing the breast to feel hard (capsular
contracture), asymmetry, leakage or rupture, and the need for additional
surgery. It is important to realize that all surgical procedures have risk
but that these risks can be decreased by going to a board certified plastic
surgeon and following all of your doctor’s instructions.
To find out more about Breast Augmentation and other types of breast surgery
call our office to schedule your complimentary consultation.
Peter Klainer, M.D., F.A.C.S.
Chrysalis Plastic Surgery, Inc.
46396 Benedict Drive, Suite 330,
Sterling, VA 20164
703.421.6000
