Breast Implants: Silicone or Saline?

Serving Chattanooga, Tennessee

ow that the FDA has approved silicone breast implants for use in the general population, the specifics of their selection need to be defined. We must compare silicone breast implants to the known safety and efficacy record that we have for saline breast implants.

We know that we cannot use our past experience with silicone implants since many practicing plastic surgeons were not practicing before the ban on silicone implants in the early 1990's. Add to that the fact that our current silicone breast implants are so vastly improved over their early counterparts that comparison is useless.

What we do know for certain is that saline breast implants for augmentation have enjoyed a 95% satisfaction rate. That's a record that's hard to beat. The typical risks of saline implants which can lead to disappointment are deflation, contracture, rippling, and contour deformity. The definition of deflation is obvious. Current saline implants carry a 0.4% risk of deflation per year for ten years. Deflation rates after ten years vary, but the implants are not permanent and will deflate in time. Contracture is a hardening in the natural scarring around the implant. This can deform the implant and change its cosmetic appearance. Saline implants have a very acceptable contracture rate. Personal experience leads me to believe that this is around 3%. Rippling is a function of the physics of the implant or its manufacturing process. All saline implants ripple. This can be accentuated by under or overfilling the implant beyond the manufacturer's limits. The ripple can be unnatural appearing, and is the principle reason why saline implants should be placed beneath the pectoralis muscle. Contour deformity constitutes a cosmetic problem with the appearance of the breasts after surgery. These are typically patient and surgeon technique dependent issues and have little to do with the implant per se.

The most significant problem a silicone implant can help with is rippling. Although a silicone implant is not ripple free, it can produce a much more natural result especially with women who have very little or no breast tissue. Whereas silicone implants do not deflate, the monitoring process recommended with MRI is costly and not covered by health insurance policies. If the implant is ruptured, the breast shape will not deflate like with a saline implant, but replacement is required. Silicone implants require a larger incision for placement to avoid damaging the devise. Contracture rates in the cosmetic population have not been well established for silicone implants. Many surgeons will continue to recommend placement of the implants beneath the pectoralis muscle as this approach has historically produced the lowest contracture rates. Submuscular placement also permits the greatest visualization of breast tissue with a mammogram.

Then there's the issue of cost. Size for size, silicone implants have more than twice the cost of saline implants. Of course, they are more complex devises. But for many, they perform the same function.

So in summary, saline implants have served the cosmetic breast surgery population well. They are by no means outmoded, though we do anticipate an upsurge in the use of silicone implants. So far, it appears that silicone implants have their greatest advantage in the reconstruction population. They are also particularly helpful in thin patients with very little breast tissue, and in patients who have failed other implants. For more information, see the American Society of Plastics Surgeon's Website (ASPS).