When considering breast augmentation surgery, there are several choices and decisions that women will want to make to ensure they are well informed and pleased with their surgical results. These options include incision placement, implant placement (above or below the pectoralis muscle), ultimate breast size and implant type (saline vs. silicone).

Until recently, women seeking breast augmentation were limited to saline-filled breast implants. In November 2006 the FDA released its previous restrictions on silicone gel implants and now all women over 22 years of age have the option to choose between saline and silicone implants for cosmetic surgery. From 1992 until November 2006 silicone implants were available, but with significant restriction imposed by the FDA. Silicone breast implants were allowed for women undergoing breast reconstruction or revisional breast surgery if they already had silicone gel implants. During this period of time, studies were ongoing about the safety of silicone breast implants. This period of time also allowed surgeons to become more experienced with saline filled implants and to evaluate the satisfaction of women undergoing breast augmentation with saline filled breast implants.

Both saline and silicone implants have solid silicone outer shells. Saline implants are filled with a sterile salt water solution during the operative procedure to reach the desired size. Silicone implants are pre-filled with a gelatinous cohesive gel silicone. Many women feel that silicone implants feel softer, and may more closely resemble the texture of natural breast tissue. Saline implants do not have this same gel-like consistency and there is a greater potential for palpable or possibly visible rippling of the implant.

There is more information to consider when choosing a breast implant. Both implants have the potential for rupture. Although statistics vary, women can assume a 10% rate of rupture in 10 years, and approximately a 30-40% rate of rupture in 15 years. The ability to detect a rupture varies between the two styles of implants. When a saline implant leaks, your body absorbs the salt water fluid, and you will notice a decrease in breast size over a period of hours or days. Diagnosing a ruptured saline implant does not require a radiologic examination, and the deflated implant can be easily removed and replaced with a simple operative procedure.

A rupture silicone implant is more difficult to detect. The shape and feel of a ruptured silicone implant may be the same to both the patient and physician because the silicone gel tends to remain cohesive in the implant pocket. It may even be difficult for a routine mammogram to diagnose a ruptured silicone implant. For this reason, the current recommendations by the FDA are that you undergo an MRI breast evaluation every 2-3 years following surgery to detect a ruptured silicone implant. Although not a dangerous exam, the cost of repetitive MRI examinations can add up over the years. When a ruptured silicone implant is diagnosed, the gel implant is not as easy to remove as the removal of a ruptured saline implant. Therefore, women need to be aware that there may be a more extensive surgical procedure with a longer recovery time associated with revisional silicone implant surgery.

The incidence of capsular contracture also varies between saline and silicone gel implants. All women form some type of scar around their breast implants. A capsular contracture is abnormal constrictive scar tissue that develops around an implant that may distort the shape of a woman’s breast and can make the breast feel unnaturally firm. We do not know for sure what causes capsular contracture, but it appears to be more common with silicone breast implants, particularly those placed above the chest wall muscle (sub-glandular placement). Silicone bleed (gel leakage from a silicone implant) has been implicated as a cause for the increased risk of capsular contracture, and well as the possibility of a sub-clinical infection.

The development of a capsular contracture does not mean a woman needs to have secondary surgery, however if the scar tissue is distorting the shape of her breast or creating breast discomfort, she might be considering revisional surgery. The surgical procedure to remove constrictive scar tissue is more extensive with silicone implants, and therefore women again need to be prepared for a more extensive operative procedure with a longer recovery time.

Saline and silicone implants can be placed via the traditional breast implant incisions: transaxillary, periareolar and inframammary fold. Since saline implants are filled during the operative procedure once they have been placed in the pocket, they can be placed through smaller incisions. Silicone implants come prefilled, therefore the incision has to be large enough to acodomate the size implant being used. Typically these incisions are at least twice as long as the incisions needed for saline implant placement.

The choice between saline and silicone implants may not seem so obvious when one considers not only the feel or texture of the implant, but also the maintenance and revisional surgery requirements with breast augmentation surgery. The women that may notice the most difference between the feel and look of saline versus silicone implants are those with significant skin relaxation from prior pregnancy or weight loss, and those women with minimal breast tissue prior to surgery. It is important to have a good understanding between the two types of breast implants prior to consenting to any breast surgery procedure that involves the use of implants.

At The Women’s Center, we will discuss these options in detail. Recent studies show that the satisfaction rate with saline filled implants is above 93%. With silicone implants now an option for women 22 years of age and older, it is important for you to have a good understand of the advantages and disadvantages of each implant to make an informed decision. Every patient is unique and has individual concerns and goals for surgery. We will thoroughly discuss your options so you can make an informed decision on the surgery that will meet your specific needs and lifestyle.

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