The Return of Silicone
Breast Implants

Serving Chattanooga, Tennessee

o issue in the field of plastic surgery has had as much press as the controversy over the use of silicone breast implants. Last month, after years of research, the USA FDA has approved specific silicone breast implants for use in general cosmetic surgery patients over 22 years of age.

For those of us who have been involved in silicone breast implant research, the news was welcomed. The current largest manufacturers in the US, MENTOR and INAMED (now ALLERGAN) have been participating with plastic surgeons across our country and world to determine if silicone implants are safe and reliable. The short answer to this question is---Yes, they are. Research will be ongoing, and those physicians and patients who opt to use silicone implants will find that implant use will be closely monitored. New researchers will receive mandatory education prior to receiving any implants, and patients will also need to review a lengthy pre-operative document and agree to appropriate follow-up. This includes future MRI exams which, no doubt, will not be covered by their medical insurance.

So, how did these medical devices become so controversial? I think the easiest explanation is poor education regarding patient and surgeon expectations from a less than adequate device. That is to say that, in the seventies and eighties when the former generation implants were being used, the design and our scientific knowledge about silicone chemistry was really at entry level. Manufacturers made inappropriate promises which physicians passed along to their patients regarding implant permanence and the risks associated with implant use. When the implants started to fail and complications arose from their use, finger-pointing erupted on a grand scale. Junk science and greed hopped aboard until finally--- the FDA had enough. The dysfunctional silicone implants were pulled off the market in the US.

Some may say that they threw out the baby with the bath water, but research continued both here and in Europe. Thoughtful science and evaluation replaced emotional courtroom drama during the late 1990’s and this has led to the approval of the advanced silicone implants we have today. What we have learned since the seventies and eighties is a lot about silicone chemistry and how to control the shape and consistency of the gel within the implant.

The former generation of silicone implants required the use of an oily, runny gel contained in a silicone rubber shell. This type of gel easily escaped if the elastic shell ruptured. This led to a high rate of contracture which is essentially hard, cosmetically lacking, and possibly painful breasts. Today’s silicone gel is cohesive—like JELLO, so it is far less apt to leave the confines of its shell even if the shell is damaged. We’ve also learned that the silicone which escaped the shells of the old implants could cause local inflammation or be transported to lymph nodes. No scientific study to date (and the subject has been intensely reviewed) has identified silicone as being the cause of any disease.

So, we have grown much more knowledgeable about silicone breast implants in the last decade. Research is continuing in the use of varyingly shaped implants, silicone gels of different texture, and their use in cosmetic and reconstructive breast surgery patients. Our goal as plastic surgeons is to provide the safest and most appropriate implant device tailored to the needs of each patient and clinical situation. For more information regarding silicone breast implants visit the American Society of Plastic Surgeons website (ASPS).