In the 1990s, silicone implants were vilified and eventually pulled off the market because of fears of a link to silicone implants and autoimmune disease. But after years of studies, no link was established between silicone implants and an increased instance of any systemic disease. In 2006, silicone breast implants were once again approved by the FDA for use in cosmetic breast augmentation, and they are now available to the general public.
Of course, this does not mean that silicone implants are automatically the best choice for everyone. There are differences between silicone and saline implants that lend each its own distinct advantages and disadvantages in a variety of situations. Each patient should sit down with her surgeon after a thorough examination and discuss which option makes the most sense for her body and goals for surgical outcome.
The Facts About Saline Breast Implants
Saline Implants and “Feel”
Saline implants tend to feel firmer than silicone implants, which means the feel is not as close to that of natural breast tissue. In addition, some patients complain of being able to manually detect the outer edge of the implant and/or the fill valve.
But How Do They Look?
In most cases, there is little to no discernible difference between the appearance of breasts augmented with saline versus silicone-enhanced breasts, except in that there is a slightly greater chance of visible rippling or wrinkling with saline implants. This is less likely to be apparent when the implants are placed under the pectoral muscle. It is also less likely to be noticeable in women with sufficient natural breast tissue to cover the implant. For this reason, silicone implants tend to be preferred for augmentation in very thin women.
Another distinct difference between saline and silicone implants is that saline implants are placed inside the body as an empty shell and filled once in place. This means that a smaller incision is needed than with silicone implants, which come pre-filled from the manufacturer. Smaller incisions mean smaller scars, which is a very attractive benefit to some women.
This characteristic allows the surgeon to roll the empty implant shell up like a cigar and tunnel it under the skin for placement as in the transumbilical or belly button approach (TUBA), or to place the implants via a peri-areolar (along the edge of the areola) -- even in women with very small areolas. In addition, filling the implants after they are in place allows the surgeon to make adjustments to volume during surgery to compensate for existing asymmetries.
What if My Saline Implant Ruptures or Leaks?
If your implant ruptures, deflation happens within a few minutes or hours. While this is obviously not desirable from an aesthetic point of view, it is actually a benefit.
Breast implants are not lifetime devices, and most definitely will rupture or leak at some point. Experts agree that a ruptured implant should always be removed, regardless of the type. With saline implants, you will undoubtedly know if your implant has ruptured. On the other hand, there can be a gradual loss of volume over time due to microscopic leakage that can occur even through an intact shell.
If rupture does occur, many patients are comforted by the knowledge that saline is simply salt water, a substance of which 70% of your body is composed. Therefore, if a saline implant leaks, the saline is simply harmlessly absorbed by the body.
The Facts About Silicone Breast Implants
Silicone Implants and “Feel”
Silicone implants have a softer feel that is closer to that of natural breast tissue than saline implants.
But How Do They Look?
There is less chance of visible rippling or wrinkling with silicone implants. Many doctors believe this makes silicone a better choice for over-the-muscle implant placement, for very thin women, or for post-mastectomy breast reconstruction (where there is little or no natural breast tissue to provide coverage over the implant).
What If My Silicone Implant Ruptures or Leaks?
If your implant ruptures, it will not "deflate." Though this may seem desirable from a cosmetic standpoint, it creates a situation known as a “silent” rupture, in which your implant has ruptured, but you are not aware.
In some cases of rupture, the silicone gel stays put inside the capsule. In other cases, there is some silicone migration (movement to other parts of the body). In addition, some microscopic silicone gel bleed is possible even through an intact shell. It is believed that the risks of migration is lessened with the newer, highly cohesive “gummy bear” implants (which are still in clinical trials and therefore not available to the general public in the United States).
Although studies have shown no link between silicone implants and systemic disease, silicone migration has been known to cause the formation of granulomas, and is also believed to contribute to an increased incidence of pneumonitis.
FDA Approves Silicone Gel-Filled Breast Implants After In-Depth Evaluation, FDA News Release, November, 2006
Saline-Filled Breast Implant Surgery: Making An Informed Decision, Mentor Corporation (information provided by the U.S. Food and Drug Administration)