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“Silicone or Saline: Which is the best choice for me?”
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Now that the FDA has approved the availability of silicone implants for cosmetic breast augmentation, many women are asking: “Which implants are best for me: silicone or saline?” Here is some essential information that I share with my patients in consultation when they ask about cosmetic breast augmentation: In 1992, questions about the safety of breast implants led to restrictions on the use of silicone gel filled breast implants. After many years of research, the prestigious Institute of Medicine released its report that there was no evidence that women were becoming ill from silicone implants. In January 2007, the FDA released silicone gel filled implants for wider use in cosmetic breast surgery. Since the increased availability of silicone implants in January, more than half of my augmentation patients have chosen silicone. What is so remarkable about silicone implants is that they feel just like the breast. The results of breast augmentation with silicone implants can be so natural that the implant can be indistinguishable from the breast. So why doesn’t everyone want silicone? The newer implants have a silicone gel that is cohesive (sticks to itself) so the gel stays in place, and is much easier to remove, if the implant envelope develops a leak. With silicone gel implants, you won’t see any change in the size of your breast, so you would not know there is a leak. With saline implants, a leak is obvious: because the salt water is absorbed by the body, the breast “deflates” within a few days. For this reason, some doctors recommend replacing silicone gel implants every ten years and the FDA recommends scans every couple of years to check the integrity of the silicone implants. Either approach makes the choice of silicone implants more expensive and “higher maintenance” than saline implants. To date, it appears that the vast majority of women with gel implants have not monitored with scans nor replaced their implants, presumably because they are not having problems or are satisfied with their results. The incidence of a leak is about one percent per year for saline implants: of 100 women who have saline implants this year, one will have a deflation by this time next year. By ten years from now, we expect that about ten of those women will have had to replace a deflated implant. With silicone gel implants, the incidence of leaks has been reported as much less, but some think silicone gel implants are under-reported because they are not detected. Because saline implants are filled at the time they are inserted, we can make a smaller incision (ľ of an inch); the prefilled silicone implants require a larger incision, 1-1/4 – 1-1/2 inches. Capsule contracture or tightening of the space around the implant is less likely with saline implants. Capsule contracture makes the breast feel unnaturally firm and can distort the shape of the breast. Other factors can influence the choice of saline or silicone implants, including the size and shape of your chest and breast, as well as your personal aesthetic preferences. The choice is a uniquely personal one that should be based on good information and a thorough discussion of the tradeoffs. The best way to decide is in consultation with an experienced plastic surgeon. The good news is that women have better options for breast augmentation than ever before. The improvements in both implant technology and breast augmentation surgical techniques mean better results for more women. ________________________________________ Dr. Paul Zwiebel is a Board Certified Plastic Surgeon specializing in cosmetic surgery, and has been in practice for 23 years. He performs over 125 breast augmentations a year in his private practice in Littleton, Colorado. Call the Zwiebel Center at 303-470-3400.
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