Saline vs. Silicone Breast Implants

While you may recall an era where silicone breast implants were controversial and even unsafe, in November of 2006, silicone implants were re-approved by the FDA and have become increasingly popular for Denver breast augmentation patients. In February 2013, the newest generation of cohesive silicone gel implants, Natrelle 410, was approved by the FDA.

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Comparison of Saline and Silicone Breast Implant Options

There is a wide range of plastic surgeons’ opinions on whether saline or silicone breast implants are preferred. Many surgeons feel that silicone implants give a better result; others feel that is definitely not true. Here’s what is true:

  • Under clothes, there is very little difference in appearance; we get great results with both silicone and saline breast implants.
  • With your clothes off, often there is a difference in appearance. Saline implants look less natural when naked because in certain positions the implant shape is visible, such as when leaning over or being viewed from the side. Also, to the touch, silicone breast implants feel more like natural breast tissue.

If you have thin skin, and/or are thin or petite with very little skin to sufficiently cover the breast implant, silicone gel implants are less likely to cause visible rippling or wrinkling than saline breast implants. Rippling or wrinkling, when present, are seen generally on the side and bottom of the breast (for example while leaning forward with your clothes off).

Also for thin people with little breast tissue or skin covering, saline implants can feel like there’s a water bag under the breast. In general, patients with thinner tissues and less native breast tissue are more likely to appreciate the benefits of silicone gel implants. In addition, women who have thinner skin and little existing breast tissue may desire a moderate size increase with a more natural shape. These women are an excellent candidate for the Natrelle 410, an anatomical (teardropped) shaped, silicone gel implant.

By contrast, for Denver breast augmentation patients with thick enough skin, and plenty of breast tissue for coverage, saline implants have less of these issues and are an excellent option.

While some plastic surgeons feel that silicone delivers a more natural shape, Dr. Slenkovich feels that in a large majority of women the shape results are equal. At Colorado Plastic Surgery Center, he has used both silicone and saline breast implants in about equal numbers for breast augmentation and gets great results with both.

Despite the type of implant you choose, the breast implant is most commonly inserted under the pectoralis muscle for the safest and most natural result. This positioning allows Dr. Slenkovich a greater control of the positioning of the breast implant pocket and has been shown to further minimize the probability of capsular contracture along with other surgical protocols.

Mammograms are different with a silicone or saline implant in place, and a “diagnostic” mammogram (which takes pictures from more angles) is done to best visualize the breast tissue. Sensation in the breast and nipple, and success at breast feeding are the same with all of the breast implants, with problems with either of these areas very uncommon.

Pros and Cons of Silicone Breast Implants

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Silicone delivers a great result for breast surgery patients including a natural shape and natural feel.

The biggest drawback to silicone breast implants, whether the round silicone gel or the anatomical Natrelle 410, is that if there is a problem, it is likely to be a “silent” rupture. Saline, unlike silicone, is absorbed by the body and therefore a saline rupture is very noticeable. While older silicone implants were in liquid form with a weaker casing, both of today’s silicone implants have silicone in the form of a “cohesive gel” and the implant shell is very durable and safe. With these cohesive silicone gel implants, migration of silicone into the breast tissue is very rare.

Silicone breast implants also require more “homework’ both before and after surgery. As part of the re-approval of silicone implants in 2006, the FDA has made several recommendations that we ask patients to learn about and consider. After surgery the most significant FDA recommendation is that patients get an MRI of the breast three years after surgery, and every other year moving forward. Despite this recommendation many surgeons – including Dr. Slenkovich who was a researcher on the 5-year study assessing the safety of silicone gel breast implants and whether or not to approve them for future use – question the usefulness of obtaining MRIs this frequently. Dr. Slenkovich recommends following the ASAPS MRI recommendation standard of an initial MRI and 10 years and every five years thereafter. Of course, if there is a change in the breast or a clinical question arises about the status of the implants, an MRI is recommended.

Many Denver breast augmentation patients who had silicone breast implants 15 years ago still have absolutely beautiful, natural appearing, soft breasts and have never had a problem. Today’s silicone implants are even safer and better than the earlier versions.

Dr. Nick’s position on silicone gel breast implants is as follows:

“I think that the silicone gel is a great implant. However, if a patient has reservations about silicone, then typically saline is still a great option that in most patients gives an equivalent shape. I recommend that my breast implants Denver patients read the FDA recommendations forms, and that they don’t just blindly sign it, but I personally, do not have reservations about silicone. Indeed, the 1992 FDA statement that silicone implants were being pulled off the market because of safety concerns, but that if a patient had an implant, they did not recommend that it be removed, was very confusing to many. Either silicone was unsafe or it wasn’t, and since they weren’t recommending removal, one had to wonder. Further, numerous reviews of all of the silicone implant studies have concluded that there is no scientifically identifiable association between silicone implants and auto-immune diseases (lupus, arthritis, MS). I feel that those claims are unsupportable and I am completely comfortable with silicone. I would use silicone for family and on my staff (some of whom have silicone implants). I think most medical professionals would agree that silicone is great. However, the choice between silicone or saline implants is ultimately the patient’s choice.”

Pros and Cons of Saline Implants

The saline used in a saline breast implant exactly matches the salinity of the human body, so if there is a leak or rupture, there is no health danger. Depending on how you look at it, this fact that your body will absorb the saline from a ruptured implant is either an advantage or a disadvantage. It is an advantage in that you generally don’t need an MRI to detect a leak as the breast would simply go flat as the saline is absorbed. It is perhaps a disadvantage in that a rupture and rapid deflation leave little opportunity for conveniently choosing a time for any needed breast surgery to replace the implant.

The disadvantages include a less natural feel since water feels less like breast tissue than silicone gel; rippling or wrinkling of the skin; and visibility of the implant from certain angles when naked (such as leaning over or when viewed from the side). These drawbacks are significantly minimized when there is sufficient skin and breast tissue to completely cover the implant (only an examination can make this determination) and when the implant is inserted beneath rather than on top of the muscle, which is now standard procedure for saline breast implants.

If you are considering a breast augmentation surgery and would like to learn more about implant options, please contact our plastic surgery office today to schedule a breast augmentation consultation.