Silicone Vs. Saline Implants
Saline and silicone gel are very different filler materials with different properties. Saline is called a non-coherent filler. A non-coherent filler does not resist a change in shape, whereas a coherent filler like silicone gel does resist a change in shape. In other words, if saline is placed into a round container and suddenly that container changes shape to square, the saline will quickly flow and assume the square shape. Not so with silicone. It will stay round, at least for a while, until it slowly moves to take the new shape of the square container.
Implants are silicone shells filled with either saline (salt water) or silicone gel (approved by the FDA November, 2006). There are two primary types of fillers used in breast implants: saline filled and silicone gel filled implants. Saline implants have a silicone shell filled with sterile saline (salt water) liquid. Silicone gel implants have a silicone shell filled with a viscous (cohesive) silicone gel. Saline implants are firmer than silicone gel implants. Silicone gel implants better resemble the texture and feel of natural breast tissue. There are also silicone gel highly cohesive “Gummy Bear” implants that provide a more long lasting natural shape to the breast. Not every woman is a candidate for this type of implant. Both implant types are very safe, and each offers its own specific advantages. I will help you decide which kind is right for you. For additional information on silicone breast implants, please see:
An advantage of saline breast implants is that, if ruptured, the saline (salt solution) is absorbed by the body. A disadvantage is that saline breast implants are firmer than silicone gel implants and natural breast tissue, and are subject to many times the amount of rippling and wrinkling as seen with a silicone gel implant. Also, saline implants have a valve used to fill them during surgery (they arrive deflated from the manufacturer), which is another potential point of failure (leakage) not found in silicone gel implants, which arrive pre-filled from the manufacturer.
Silicone gel-filled implants provide a much more natural feel to the breast, and are the implant choice for the vast majority of my patients. In November 2006, after fifteen years of intensive study by many researchers, the U.S. Food and Drug Administration (FDA) had re-approved silicone breast implants for breast augmentation surgery. I am proud to offer patients the option of silicone gel-filled breast implants, since they yield a much softer and more natural feeling breast than when saline-filled breast implants are chosen.
A silicone implant feels much closer to human breast tissue, whereas a saline implant is firmer than breast tissue. Due to the cohesive nature of silicone gel, such an implant has far less rippling and wrinkling than does a saline implant. This is especially important for women with thin tissue, as irregularities in the implant contour will be painfully obvious with respect to the look and feel of the augmented breast. Remember this important concept for later: the more tissue you can put in front of an implant, the less visible and palpable the implant will be.
A Word About Silicone and Safety
In 1991, due to unfounded concerns that silicone breast implants were responsible for certain autoimmune diseases such as rheumatoid arthritis, lupus and scleroderma, the FDA director, David Kessler, MD (a pediatrician), created a moratorium on silicone breast implants pending further study. What this meant was that silicone gel filled breast implants would not be available in the United States for general use in women except under special organized multicenter investigational studies. The use of these implants did continue, however, in other parts of the world. In November, 2006, the FDA gave clearance to the use of silicone gel filled implants. Silicone breast implants became the most studied medical devices in history. The results of these studies concluded that silicone breast implants are safe and are not related to breast cancer or connective tissue disorders.
The best information regarding the safety of breast implants is obtained from epidemiological studies between two groups of women who have and do not have implants. With this type of study, one can then draw an accurate conclusion as to whether certain disease processes occur more frequently in those women with (or without) implants. These studies are much more scientifically meaningful in terms of drawing an accurate conclusion than case reports of individual or small groups of women.
The best summary of these studies that I am aware of can be found in Appendix 2 and Appendix 3 of The Best Breast 2, written by John and Terrye Tebbetts, where the key epidemiological studies are individually summarized by Dr. Tebbetts. (Dr. Tebbetts is my mentor who in 1994 taught me the principles and technique of performing a breast augmentation with a 24 hour recovery). I encourage you to read his book and familiarize with the concepts presented – this way we will be “on the same page” at consultation time. These epidemiological studies conclude the following:
- There is no connection between breast implants and breast cancer.
- Women with breast implants who do get breast cancer are not delayed in their diagnosis of breast cancer and are not diagnosed at a further stage of breast cancer than women without implants.
- There is no connection between breast implants and connective tissue disorders such as lupus and scleroderma.
For more information regarding the safety of breast implants I recommend that you visit www.breastimplantsafety.org.