Breast Procedures

Saline vs Silicone Information

Types of Breast Implants – Saline and Silicone-Gel Filled Implants, “Gummy-Bear” or Form-Stable gel implants

Gel or “silicone gel” filled implants have become the frequent choice of women considering breast augmentation since the FDA released them for all women over the age of 22. This is because they are soft, feel very natural, and much less likely to be visible through the skin. Unlike saline implants, they do not have that “ripply” feeling at the bottom or side of the breast in women who have little soft tissue of their own to cover them. They are an ideal implant in terms of feel, for thin women, for this reason.

The form-stable, or “gummy bear” implants made by Sientra and marketed worldwide received FDA approval for sale in the US in 2012.  Mentor and Allergan have also received approval since then. These implants hold their shape and are made in round and anatomic tear drop shapes. Their profile is more like the natural breast with more projection in the lower part.  The come in round, oval and tear-drop, with varying sizes and projections. Women can have a customized look depending on their goals and anatomy. When cut the gel stays in place and does not distribute around the pocket. View the Sientra video to observe this.

Because form-stable implants must be oriented vertically, their surfaces are textured to grab and integrate with adjacent tissue. They are currently the most expensive choice in gel implants.

There is some maintenance or upkeep associated with gel implants. The FDA recommends that women get an MRI (magnetic resonance imaging) test at 3 years after implantation to check for “silent rupture”. It is called “silent” because when a gel implant leaks you cannot tell. The silicone gel stays in the pocket, so the breast stays the same size. A woman may be unable to tell that there is a leak in the implant unless there is some change in shape or feel. With a saline implant, when the implant begins to deflate as the saline is absorbed, it is clear that there is a deflation problem.

If a leak in a gel implant is not detected, over a period of time, a gradually increasing number of women may get some gel into tissues adjacent to the pocket, and when this happens, the body will wall off the gel. This may cause a lump or some area of discomfort and will have to be investigated, like any lump in the breast, to make sure it is not cancer. With an MRI or ultrasound, this should not be a problem, but it is better to detect the leak before it gets outside the pocket, hence the recommendation for periodic MRI’s. Longer-term studies are in progress to see if the recommended interval for MRI’s could be longer than every 2 years after the initial one. Recent studies have compared highly-specific ultrasound very favorably with MRI, so that may be an alternative in the future. Other studies that are becoming available include 3-D mammograms and highly specific ultrasound.

There has been a steady evolution and improvement in implant manufacturing and design such that the gel-filled and saline breast implants available today are greatly improved over previous generations. They are more durable, available in more shapes for specific augmentation needs, and have either smooth or textured surfaces.

The Food and Drug Administration (FDA) allows silicone gel-filled breast implants as well as saline-filled  breast implants for cosmetic augmentation. In addition to the information being provided here the FDA has Information for Women Considering Saline-filled or Silicone Gel Breast Implants at their website.

It is in the nature of medical technology to gradually evolve. New implant filler materials and implant designs are being actively researched. We can expect these to gradually become available and widen our choices. This does not mean that today’s breast implants will be obsolete. With currently available gel and saline implant technology, it is possible to achieve better results, with a much more natural-appearing breast than ever before.

Nevertheless, it is in the nature of breast implants that a woman might someday either want or need to have another procedure. The reasons for doing so include the following:

  • Simply a desire for a larger size. Since the size of the implant that can be initially placed in a woman with a tight skin envelope is limited, a larger size may be possible after the skin envelope has had time to expand.
  • Capsular contracture, or hardening of the breast that can occur due to thickening of the fibrous capsule around the implant. Should this occur, removal of the capsule is recommended whenever the capsule is firm enough to distort breast shape or position.
  • New implant development that offers a substantial gain in desired characteristics of durability, feel, or appearance.
  • Deflation of a saline-filled implant.

Shell Surfaces and Silicone Gel Implants

There are two types of shell surface available in breast implants, smooth and textured. Textured shell breast implants do not have any advantages, in my experience over smooth implants.  The  textured surface is necessary, however, for asymmetrical implants, e.g. form-stable implants, so they will not rotate, but stick in their proper orientation. It has been claimed that there may be a smaller incidence of capsular contracture with textured implants. I have not seen any such difference. The risk of capsular contracture using the saline implants has been exceedingly low in my practice. There were no known contractures in my patients during the four year period from February, 2003, to early 2007. And the overall incidence as of June, 20124was under 1.5 percent.

Silicone Gel breast implant savailable since December, 2006, for first-time breast augmentation patients, seem to have even a lower risk of capsular contracture in my practice.  The implants used in the 1980′s were not the same as the very low gel bleed implants available today. They allowed more gel to migrate through the shell. Theoretically, this was a factor in triggering capsular contracture.  Since the incidence of capsular contracture remains so low in my prractice, textured implants are only used for special situations. For example, women who come to our breast implant revision practice who have pre-existing contractures are candidates for textured implants.

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