Which Breast Implants Should I Have? – Silicone or Saline? 

Are you considering a breast augmentation with implants? Dr. Kalus sheds some light on the safety of saline versus silicone.

Breast implants have been available for around 50 years and did you know that the very first breast implant was a silicone shell filled with saline solution! But these implants had a problem:- leakage of the saline fluid because the valve was of poor design! Therefore when implants filled with silicone rubber gel were introduced they were initially very popular. But it was soon found that the silicone gel would leak directly through the wall of the implant and sometimes spread to other parts of the body. This, together with other concerns about having large volumes of silicone gel inside your body, led to all silicone implants being banned from the market right through the 1990’s.

At about this time the manufacturers of saline implants improved the design of the valves so that they no longer leaked.  So throughout the 1990’s surgeons in both the USA and Australia used saline filled implants. Those surgeons that were inserting a lot of implants (sometimes 100’s a year) learned that they could obtain excellent results so long as the implant was placed behind the muscle. In fact, in this location, in most cases, it became almost impossible to distinguish the feel of a saline implant from a silicone implant. The overwhelming majority of patients were delighted with the results and even now, 25 years later, most of these implants are still intact – a record for any type of breast implant!

At about the year 2000, the manufacturers of silicone gel breast implants made a series of submissions to the FDA (the organisation in the USA that licenses medical devices) claiming that the new generation of silicone gel implants with their thicker shells and thicker, firmer silicone gel were a lot safer than the old silicone gel implants and should be licensed for use.

Click here to read more about the regulatory history of Silicone Implants.

The FDA found that the silicone breast implant manufacturers had not proven that their silicone gel implants were safe but nevertheless agreed to approve their use for women aged 22 or older and for breast reconstruction. The FDA further recommended that if you have silicone gel filled breast implants, then you should have an MRI screening procedure 3 years after receiving your implant and every 2 years after that.

Click here to read more about Silicone Implants.

Specifically and importantly, although no apparent association was found between silicone gel filled breast implants and connective tissue diseases etc., the FDA stated that, in order to definitively rule out these and other rare complications, much larger studies would need to be conducted.

This decision by the FDA led to extensive marketing of silicone gel filled breast implants and the development of numerous styles including smooth-walled, textured walled, round, anatomical etc.

But do these give better results? The answer is “No” as at a recent meeting of the American Society of Aesthetic Plastic Surgeons in San Francisco, the 2000 plastic surgeons in the audience were unable to tell which type of implant any particular woman had when multiple images were projected on the screen!

More recently, a French company, manufacturing the so-called PIP breast implants, was found to have filled the implants with industrial grade silicone rather than medical grade silicone. The chemicals in the silicone resulted in the implant shell being dissolved within 1-2 years and the free silicone forming lumps or silicone granulomata all over the chest around the implants. As a result of this, the Australian Chief Medical Officer made the statement that:

“All silicone gel filled breast implants are high risk medical devices”. Read More

Saline implants, on the other hand, have had none of the regularity problems associated with silicone gel filled implants. In fact, the FDA has approved saline filled breast implants for breast augmentation in women aged 18 or older and for breast reconstruction in women of any age.

So there is no doubt that saline implants are safer than silicone gel filled implants. This alone prompts many women to choose saline over silicone. But are the results as good? The answer is that it depends on who does the surgery. Saline filled implants require considerably more expertise than silicone filled implants in regards to implant placement, implant selection and implant fill – all of which are decided by the surgeon.

For example some surgeons say that saline filled implants cause “medial rippling”! This is why, surgeons experienced in the use of saline implants will always place the implant under the pectoral muscles. The muscle lies on top of the implant so it is not possible for any rippling to be visible.

Some surgeons say that saline filled implants are not as “soft” as silicone gel filled implants. Yet many of the current generation of high cohesive gel silicone implants are actually quite hard. A surgeon experienced in the use of saline implants can adjust the amount of fill of the implant not only regarding the volume but also regarding the softness.

In addition, the way a breast implant feels is primarily determined by the thickness of the scar tissue capsule that the body forms around the implant. A surgeon experienced in the insertion of saline implants will know how to minimise the thickness of this capsule.

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Some surgeon say that saline implants feel cold after a swim or hot after lying in the sun. This is true of silicone implants as well because all implants have different thermal properties from breast tissue and there is no blood circulating through them. But their temperature readjusts quickly and it is not usually noticeable.

There is no doubt that silicone gel implants are easier to insert. They come pre-filled in a box and for some surgeons, it’s just a matter of making a pocket under the breast and inserting the implant! This is how they are able to offer cut price surgery. The use of saline implants will always involve more time and expertise and therefore you should expect to pay a little more. However, when you consider that most saline implants last well over 20 years, that you don’t have to have an MRI every 2 years, that you have complete peace of mind, never having to worry about whether or not your implant is leaking and that even plastic surgeons are unable to tell the difference between the various types of implant, then the case for having saline implants is compelling.