Silicone Breast Implants
Reviewed by Walter Erhardt, MD
Considering breast augmentation surgery with implants?
There are currently two main options silicone breast implants and saline (salt water) breast implants. Both have their own set of advantages and disadvantages.
In general, silicone gel-filled implants are smoother and softer than their saline-filled counterparts. Silicone implants feel like a semisolid gel, while saline implants are often likened to water balloons. Many women prefer the softer, more natural feel of silicone implants to saline breast implants. This is especially true of women with little breast tissue, including those undergoing breast reconstruction following breast cancer. Silicone-gel implants are also less likely to ripple than saline breast implants.
Anatomy of a Breast Implant
A breast implant can be filled with saline or silicone gel. Both silicone and saline implants have an outer shell made of silicone-rubber material.
Breast implants come in a variety of sizes, shapes and profiles.
Another important variable is texture. Implants can be smooth or textured.
Other varieties of implant are being studied, including gummy bear breast implants. These are also made of cohesive silicone gel, but the gel has the consistency of a gummy bear, meaning if you cut it in half, it will not leak. These implants are only available to women who enroll in a clinical trial.
Silicone Breast Implants: A Brief History
The Food and Drug Administration (FDA) removed silicone-filled breast implants from the market in 1992 after lawsuits alleged these implants increased a woman's risk of autoimmune and connective tissue diseases. This legislative move left only saline-filled implants available in the United States.
From 1992 to 2005, the only surgeons allowed to use silicone breast implants were those involved in clinical studies evaluating the use of silicone implants for breast reconstruction and revision breast augmentation. After a thorough investigation, the FDA could not find any link between silicone breast implants and connective tissue or autoimmune disease. As a result, they re-approved silicone-gel filled implants in 2006. Now, silicone breast implants are approved for women of all ages who need breast reconstruction and for women age 22 and older for breast augmentation.
In 2011, five years after the re-approval of silicone breast implants, the FDA stated that these breast implants remain relatively safe, but are not meant to be permanent fixtures. The agency plans to continue tracking safety information on silicone breast implants.
Silicone Breast Implants: Weighing the Pros and Cons
Both saline and silicone breast implant fillers have pros and cons that must be weighed when making your decision.
An advantage of saline breast implants is that, if the shell ruptures, the saline (salt solution) is absorbed by the body. In contrast, silicone gel may stay inside the implant shell or leak outside of the shell if it ruptures. If a saline breast implant ruptures, it is noticeable because the implant deflates. This is not necessarily the case with silicone breast implants. Sometimes there are no obvious symptoms when a silicone-gel implant ruptures. This problem, referred to as "silent rupture," was one of the concerns expressed by the FDA.
As a result, the FDA recommends that women with silicone-gel filled implants undergo magnetic resonance imaging (MRI) three years postoperatively, then every two years to check for ruptures. Silicone implants must be removed if they rupture.
Other differences involve how the breast implants are filled. Saline implants are filled after they're implanted, which means that they require a smaller incision than prefilled silicone breast implants. Also, many saline implants can be adjusted after surgery. The doctor can use a syringe to add or remove liquid. The size of standard prefilled silicone implants cannot be changed.
Today's silicone gel-filled implants can be placed in any of the various implant placement positions, including:
- subglandular (over the muscle)
- partial submuscular (the top 2/3 is covered by the muscle)
- complete submuscular (under the muscle)
Saline implants, due to their greater tendency for rippling and wrinkling, most frequently are placed in the submuscular position.
Silicone Breast Implant Cost
Breast augmentation with silicone gel-filled breast implants costs about $1,000 more than breast augmentation with saline-filled implants. There are many reasons for the discrepancy, including the cost of the implant-filling material.
Discuss the Benefits and Risks of Silicone Implants with a Surgeon
When deciding which type of implant is best for you, discuss your options with a board-certified plastic surgeon. Because of the former FDA restrictions on silicone implants, which were in place for more than 14 years, many surgeons have little or no experience with silicone implants. You should consult a plastic surgeon who has extensive breast implant experience with the various types of breast implants.
Experienced breast augmentation surgeons can explain the benefits and risks for certain implant types depending on your personal anatomy, implant placement, and type of implant incision. Start your search for a local surgeon now.
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