After a few years when almost no patients asked about saline breast implants we have had a few requests for more information about them. Right after silicone breast implants were approved again by the FDA in 2006, women would come in with significant biases for or against one type of implant. When asked about the basis of their preferences, they sometimes quote information that is not quite true or is blatantly mythical. Now when patients are asking about saline implants I am seeing the same bias. In this article, I will explain which implants I like and the science behind my preferences when it comes to breast implants as well as discuss breast implant maintenance issues that are tossed around on the internet.
It is easy to read on the internet about the “silicone breast implant crisis” of the 1990s. Unfortunately, much of what was published and is still out there was untrue, and this disinformation created near hysteria in many patients who had silicone implants. What was true was that older generation silicone implants were neither as durable as we would have liked, nor were produced with all the best practices and technology that we have now. Subsequently, many women who had silicone breast implants prior to 1990 had implant ruptures. Often this rupture was contained in the scar or capsule for the breast implant and there was no problem other than a higher than normal potential for capsule contracture. Sometimes, however, there was leakage of the silicone gel into the surrounding breast tissue. This leakage occasionally led to breast lumps, scar tissue and a need to remove or exchange the implants. It did not lead to an increase in auto-immune deficiency or other diseases that some women felt they developed because of their silicone breast implants. In very large-scale studies, women with leaking silicone implants were found not to have any higher rate of any diseases as compared to women that had never had breast implants of any kind.
While the FDA, charged with monitoring these medical devices for patient safety, was looking at the data concerning silicone gel filled breast implants, they briefly took silicone breast implants off the market. It took a long time to figure it all out and get past the various interest groups that had a stake in the issue. (Yes, politics play a role in FDA decision.)
What Happened to Implants Over the 10 Years of the Silicone Breast Implant Moratorium?
When the breast implant safety data was finally sorted out 10 years later, silicone gel breast implants were found to be safe and the FDA allowed them back on the market.
During the 10-year hiatus that silicone breast implants were not available 2 things happened:
- Saline implants were exclusively used. Patients became used to this new standard and physicians got used to using them.
- The breast implant manufactures changed their silicone breast implants based on new technology and silicone chemistry information. The goal was to make silicone breast implants safer and more durable.
The New Silicone Breast Implants
We now have 5th generation silicone gel breast implants available and these are what I use now. They are called cohesive gel implants or gummy bear breast implants. The shells are thicker and more durable, and the gel inside is now so thick, that even if a hole or tear develops in the shell, the gel cannot ooze or leak out into surrounding tissue. In fact, these implants are called gummy bear breast implants because if they are cut in half and squeezed the silicone gel comes out, and then when you let go the gel goes right back; just like a gummy bear candy when it is cut. These implants are so strong that they should last your lifetime.
What About Having to Change Breast Implants Every 10 Years?
Most older generation silicone implants were found to be leaking ten years after placement. This is how the misbelief was started that all silicone implants should be replaced at ten years. With cohesive gel implants, a study in which the implants were removed at 10 years post-implantation only a small percent showed signs of wear at all. Consequently, older silicone implants probably should be exchanged if they are more than 10 years old, but new generation cohesive gel implants are intact and perfectly fine at that 10-year anniversary.
Silicone Breast Implants and MRI Studies
The FDA originally strongly recommended, but did not mandate, that women have MRIs every two to three years following silicone breast implant placement. The FDA has now softened their position on MRI follow up for silicone breast implants. You should be aware that no medically implantable device is permanent. We now have performance data for highly cohesive silicone gel breast implants going back 15 years and the while safety of these implants continues to be monitored, silicone gel breast implants continue to stand up to the scrutiny.
Are Silicone Gel Implant Toxic in Any Way?
Many patients worry that silicone may be toxic or foreign to their system and cite this as their reason for preferring saline implants. The shell on both saline and silicone implants is made of the same silicone elastomer, so both types of implants contain silicone. We have silicone in our toothpaste and baby-bottle nipples are also made of silicone. In general, it is an inert substance and is quite safe.
How Good Are the Silicone Gel Breast Implants Today?
Having put breast implants in for over 30 years now, I have used a lot of breast implants and seen their outcomes. The new textured gummy bear silicone implants simply look and feel more natural than saline implants and they look and feel much better than the older generation smooth silicone gel breast implants. Here is why:
- Rippling: While any type of implant can exhibit rippling of the overlying skin, saline implants have a much greater incidence of doing so. The textured silicone breast implants have the least rippling and those made by Sientra have been shown scientifically to have the least rippling (over or under the muscle).
- Capsule Contracture: Current-day silicone implants also have the lowest rate of developing scar tissue around them, which is called capsular contracture. Again, the implants made by Sientra have been shown to have the lowest breast implant capsule contracture rate.
- Rupture rate: Highly cohesive silicone gel breast implants have the lowest rupture rate of all breast implants. Sientra breast implants have been shown to have the strongest shell of all breast implants.
Saline Implants and Rupture
Proponents of saline implants claim that if a saline breast implant ruptures, it is just saline that will leak and it will do no harm. This is true but saline breast implants have a very high rupture rate and thus many patients who have had saline breast implants in place must have a second operation to have their saline breast implants replaced. Second surgeries are expensive and are not without risk. Is that more safe? I have had patients who had both and they always like their new Sientra implants better.
One advantage to saline is that they are adjustable by filling the implant with varying amounts of saline. Some surgeons feel they can obtain better symmetry with this option. Saline implants do not need to be replaced until or unless they deflate.
One problem with saline implants is that to reduce the rippling that many patients complain of, surgeons will over fill or over inflate saline breast implants just like one can over fill a balloon. This tends to make the implant firmer and more round than is desirable.
Saline vs Silicone Breast Implants During the Moratorium
During the “silicone implant crisis,” many women who had silicone implants came in for consultation for exchange of their silicone implants to saline implants. They were driven to do this by the fear induced by the misinformation they read in the lay press. Many of these patients had their breast implants exchanged. I have spoken with many patients who will unequivocally tell you that they are unhappy with their saline implants as compared to their silicone breast implants usually because of firmness and rippling. These same patients returned when silicone implants became available again to switch back to silicone implants.
Saline vs Silicone Breast Implants Today
Studies have shown that the overall satisfaction with silicone breast implants is much higher especially with today’s breast implants.
These days we also see women who are taking good care of themselves and thus are very thin and have exceedingly little breast tissue. This lack of breast tissue can even be worse after large weight loss or pregnancy and these women generally are poor candidates for saline implants because the rippling and firmness of saline breast implants are more even more pronounced for them.
What About Woman Who Are Under 22?
The FDA has not approved placement of silicone implants in women under the age of 22. Their rationale for this as stated in the FDA literature is that women under 22 years of age may be unable to make a good decision about long-term effects. Really?? I personally feel that a well-informed 22-year-old is capable of such a decision, so with a signed waiver, I am willing to offer silicone implants to patients under 22. The waiver states they are aware of the FDA’s position on this issue, but they have been fully informed about the benefits and risks and desire to proceed.
In Conclusion on Saline vs Silicone Breast Implants
At the end of the day it is a very personal decision as to what type of breast implant you may want, when you come if you come into see me, I will discuss the pros and cons of each device. Ultimately, I allow the you to decide which implant suits you the best. I can tell you that after our discussion of saline breast implants versus silicone gel filled breast implants no one in the last 4 years has chosen to have saline breast implants.
Implant technology has continued to improve dramatically. The new Sientra textured gummy bear breast implants are, as far as all the studies have shown to date, among the safest medical implant devices we have available. Furthermore, they are the most natural feeling and natural looking breast implants have available on the US market. To be sure, improvements will be made in the future but they are the best breast implants that I have seen or worked with during my career.