SILICONE VS SALINE
With the announcement by the FDA in November of 2006 regarding silicone gel breast implants, there are a number of things to consider when comparing the two types of implants. First, it is important to realize that the silicone gel breast implant was never completely gone from use. Many people are under the impression that from 1992 to 2006, the silicone gel implant was not available for use in the United States. That is not the case. They have been widely used during that time period by surgeons in the U.S. in four groups of patients:
- 1) Patients who were undergoing reconstruction from cancer could get a gel implant
- 2) Patients that had silicone gel previously and needed replacement
- 3) Patients who had marked asymmetry or in need of a breast lift could get them
- 4) Patients who presented with a complication from their previously placed saline implants, such as hardening or capsular contracture, could get them as well
What the announcement did in November of 2006 was to open the availability of the silicone gel implant up to a fifth group of women; the patient who did not fit in any of the above categories and simply wanted breast augmentation. So while it may sound like silicone gel implants are a brand new product which has never been used before, that is not the case.
But there are some advantages and disadvantages to each implant and it is important that each patient understands what those might be in her particular case.
COST
Silicone gel implants at the present time are close to double the price of their saline counterpart. This does not mean the entire cost of the procedure is double, simply the cost of the implants themselves.
INCISION SIZE
Silicone gel implants usually require a larger incisions size due to the fact that they come from the manufacturer pre-filled. Saline implants do not, and that allows the saline implant to be rolled tight and placed into the body through a much smaller incision and then filled once inside the patient.
DETECTION OF IMPLANT RUPTURE
As with almost all medical devices, Breast Implants, saline or silicone, do not last forever. At some point almost all patients will want or need them to be replaced and that means re-operation. But how would a patient detect that a crack has developed in her implant? The ability to detect rupture is where the two implants are very different. With a saline implant, it is usually very simple. The breast begins to deflate in size and within a day or two, it becomes very obvious. Many patients like the fact that with saline, they will know very soon after that something has happened. Then again, the downside is that it may happen at the most inopportune time, like the first day of a ten day Bahama vacation! With silicone you may not know at all that there has been a rupture. It is very silent and in most cases, unnoticed. You may go for a long period of time and still not know. This rupture may be found on a general health exam such as mammogram or more likely, MRI, which is routinely recommended at present by the FDA. Some women are uneasy with the idea of not being able to know when that rupture occurs. Other women like the fact that they do not have to worry about the “Bahama problem” as described above.
FEEL AND APPEARANCE
For most women of normal stature and build, both implants can give a very natural look and feel. In most women, again of normal body type with a small to moderate size implant, no one would be able to tell thatthe woman has had breast augmentation, let alone whether her implants are silicone gel or saline. Where the difference becomes evident and where we begin to see one implant at a distinct advantage over the other, is in the case of a woman of very slender build. This would be a woman who has very thin skin on her chest, who has very minimal breast tissue, whose ribs can be easily seen along the side of her chest and even in the middle between her breasts. In these women, silicone gel gains the advantage. In these very lean women, silicone does seem to look and feel more natural and less like a water balloon. But remember, in women of normal tissue thickness, those differences disappear and saline as well can give a very soft, natural and normal looking breast.
This same rule applies to “rippling” that can be more evident with a saline filled implant in very thin women. In those individuals of very slender frame, ripples can be seen more readily in saline implants than with the silicone gel.
ADJUSTABILITY
Many women have uneven breasts and have a size difference that is noticeable. This can be a bit easier to correct at the time of surgery with the saline implant. Because the saline implant is filled at the time of surgery, more fluid, in varying amounts can be added to try and make the breasts more even in size. This can be more of a challenge with the silicone implant since it is pre-filled from the factory and is packaged and sealed in amounts of varying increments.
SHAPE AND PROFILE
Both saline and silicone implants are available in different shapes, profiles and textures.
SAFETY
The FDA has pronounced both of these implants as safe to a woman’s health. This does not mean however that, complications cannot occur. As with any medical procedure, these can occur but there does not seem to be any inherent risk to a woman’s health from the substances themselves, silicone gel or saline.
There is much more information available to consumers and this list only mentions some of the differences but women do have a choice and ultimately it takes communication and the development of a relationship between doctor and patient to decide which implant best suits her needs.