“Breast Implants: Saline or Silicone – That’s the Question” by Dr. Galumbeck
by Dr. Matthew Galumbeck
Breast augmentation is the most popular cosmetic plastic surgery procedure performed today. Many options exist for women to individualize their appearance after breast implant surgery. The selection of saline or silicone implants is one of the most important if not one of the most controversial choices for breast implant surgery.
Implants for breast augmentation were approved in the United States in 1962. In 1992 silicone implants were removed from the U.S. market by the FDA for health concerns. From then until 2006 only saline breast implants were available. Silicone implants were reformulated by the implant manufacturers and approved for use in the United States by the FDA in 2006. Currently, women 22 years of age or older may select either silicone or saline breast implants for cosmetic breast augmentation. Both saline and silicone implants are manufactured with an outer silicone shell. Saline implants are filled during surgery with sterile salt water. Silicone implants are pre-filled with a cohesive silicone gel when they are produced. In the following discussion, I will review the the differences between the two types of implants.
Rippling is a term that describes an abnormal scalloping appearance, usually seen on the side of the breast. The consistency of the cohesive silicone gel is more like that of human fat, giving these implants a more natural feel. Since silicone gel is thicker than saline, the implant shell is less like to ripple when filled with silicone gel. While rippling can occur in both saline and silicone implants, it is more common in saline implants.
All implants when introduced into the body are surrounded by scar tissue. The scar tissue may thicken and tighten around the implant. This tightening is called a capsular contracture. Capsular contractures can cause breast distortion and pain. In studies released by the FDA, capsular contractures occur in silicone implants at a rate of approximately 20%. Capsular contractures in saline implants occur less often, at a rate of about 9%.
Over the life of the implant, the outer shell can lose integrity and the fill of the implant can leak. Ruptures of silicone implants occur in about 13% of women, while saline implants rupture in approximately 3% of women. When a leak occurs in saline implants, the salt water is absorbed by the body. The implant deflates and is immediately noticeable. Silicone implants use a cohesive gel that is not absorbed by the body. In many instances breast pain or breast deformity may occur; however, silent ruptures can occur. A silent rupture is when the implant ruptures but no signs or symptoms are noticeable. Approximately 35% of silicone implant ruptures are silent ruptures. Because of the risk of silent ruptures with silicone implants, the FDA recommends women with silicone implants get a screening MRI 3 years after initial breast implant surgery and every 2 years after that.
Mammograms can be safely performed in women with both saline and silicone breast implants. Because silicone implants are filled with a denser material than saline implants, mammograms can be more difficult to interpret.
These are many of the differences between saline and silicone implants used in breast augmentation surgery. One type of implant is not better than the other. When considering a breast augmentation, a woman and her plastic surgeon should discuss these issues to help each patient choose the best option for her.