Breast Augmentation: A Comprehensive Guide to Selecting the Right Implant
Women often have many questions when researching breast augmentation. Some questions are more personal, like “how will I look in a bikini” or will I have too much cleavage and look un-natural?” Other questions are more specific to surgery like “how large an implant should I select” or “what type of implant is best for me?” Dr. Richard de Ramon is able to answer all of these questions and more during a consultation for breast augmentation. During the consultation, one of the topics discussed will be the difference, advantages and disadvantages of saline versus silicone implants.
The Revolution! Breast Implants Arrive!
The first breast augmentation surgery was performed in 1962 – almost 60 years ago – using an implant developed by Dow Corning Corporation. The recipient was a mother of 6 from Texas. The first implants placed were silicone, although both silicone and saline implants have been available since the early 1960s, and both are safe and effective devices. Initially, implants came in just a few sizes, (think small, medium and large), but now there are over 400 sizes available for women.
It is not surprising that silicone implants have gone through modifications and improvements over the years. Surgeons are currently using the seventh-generation silicone implant introduced in the mid-2000s. This is a highly cohesive silicone gel device that is no longer truly a liquid. The implant can be cut in half, and it will retain its shape. It will not run like a fluid. The term “gummy bear implant” was coined to try to convey what a silicone implant is like although, happily, they are not as stiff as gummy bear candy.
Saline implants became popular in the 1990s and 2000s when patients became interested in implants that were filled with a “natural” substance – sterile IV solution. Some patients are more comfortable with the idea that in the unlikely event of a rupture, the saline solution is absorbed into the body.
Get the Sensation – the Feel of Silicone and Saline Implants
There are pros and cons to how each of these two implant types feels to a patient, and it is important to understand the difference for a woman to make a truly informed decision about which implant she would like. Patients who are thin and have very thin soft tissue coverage on the breast may be able to feel the difference and may prefer the feel of a silicone implant. Silicone implants may have an advantage with reduced wrinkling or in-folding and possibly reduced visibility or palpability of wrinkles. Silicone implants may also feel softer than saline in some patients.
In some cases, silicone implants will also offer a more natural feel. There are many patients, however, who find it is impossible to tell which type of implant they have on physical exam.
The Risks Associated with Breast Implants
The human body naturally makes a thin capsule around any foreign body. A breast implant, whether saline or silicone, will cause a capsule to form in the breast. In most cases, there is a low risk for these capsules to cause any problems. However, when a patient has higher grades of capsular contracture, this capsule progressively thickens and tightens around the implant. It can cause implant/breast hardness, visual distortion or pain. Capsular contracture is a risk with both silicone and saline implants.
The current rate of capsular contracture for both implants is low and is equal between saline and silicone. Capsular contracture rates vary in the literature from 1% to 30% at ten years depending on the surgeon, the position of the implant and the surface of the implant. The severity of capsular contracture is rated using a grading system:
- Grade 1: Grade one capsular contracture is asymptomatic (producing or showing no symptoms). The formation of scar tissue around the implant does not interfere with the size, shape or texture of the breasts. The breasts look natural and remain soft to the touch.
- Grade 2: Grade two capsular contracture usually presents itself with only minor cosmetic symptoms. The breasts will usually appear normal in shape but feel somewhat firm to the touch.
- Grade 3: Grade three capsular contracture presents itself with obvious cosmetic symptoms. The breasts will be firm to the touch and appear abnormal, e.g., they will be overly round, hard-looking and the nipples may be misshapen. However, this grade of capsular contraction often doesn’t cause much (if any) pain.
- Grade 4: Like grade three capsular contracture, grade four capsular contracture causes the breasts to become hard and misshapen. Patients with grade four capsular contracture also experience breast soreness; their breasts will often be tender and painful to the touch.
Another risk of both saline and silicone implants are leaks and deflations. In some cases, leaks occur during a surgical procedure. In other cases, leaks or deflations can be caused by the age of the implants, needle biopsies or even a car accident. Studies show that the deflation rate or the leak rate of implants is slightly lower with silicone than with saline. Many people feel that a silicone implant will, therefore, result in a lower rate of re-operation. While these implants have never been compared in a head-to-head study, both implants have a very low deflation rate.
Saline implants are filled with sterile intravenous fluid. If they leak, it is not dangerous, and your body absorbs the saltwater solution. Because of that, it is very obvious to a woman if the implant ever leaks because the breast will significantly diminish in size. Because of that fact, imaging of the breasts to monitor the integrity of the implant is not required for saline implants.
On the other hand, silicone implants often display no outward signs if a leak develops. For that reason, the FDA recommends interval imaging with MRI for women who have silicone implants. The current recommendation is the first screening MRI is performed three years after implantation and then once every two years after that. As further study is being done into the risks of silicone implants and the need for surveillance, Dr. de Ramon recommends to patients that they have annual exams with him for monitoring and a discussion of current FDA expectations.
While the rupture rate is very low and most people have no symptoms, it is recommended to replace implants that are known to leak. The rupture rate for saline implants is under 4% at seven years. The rupture rate for silicone implants (specifically Sientra) is under 2% at five years.
How Long Do Breast Implants Last?
When women undergo breast augmentation, a consideration may be the lifespan of their breast implants. Both saline and silicone breast implants are not lifetime devices however, they are considered to be long-lasting and safe. In addition, both types of implants carry a lifetime warranty from the manufacturer. If the implants ever deflate, the manufacturer will provide a new implant at no charge. Most manufacturers will provide two implants if the patient desires to replace both implants and will also allow the patient to change size if they desire. Implants that deflate due to needle puncture are not covered under warranties.
According to the American Society of Plastic Surgeon, after a decade, there is a 90 percent chance the implant will still be fully intact. Women who choose to have a breast augmentation should be prepared to keep up with regular annual check-ups and perform self-checks to ensure their devices are still intact.
Some women may experience an early deflation and require surgery for implant replacement, yet other women may have their implants for decades without the need for replacement. Whether to replace implants at a specific amount of time from the original surgery is something to ask your doctor as surgeons’ views on this vary.
What Are My Choices for an Incision Site?
Another difference between saline and silicone implants is that saline implants are filled during surgery once the empty implant is in position. A saline implant is rolled, place through the incision site and then filled once in place. Incision sites, usually at the breast crease (inframammary fold) are therefore smaller. The incision may be as small as two inches.
A potential advantage of saline implants is that the volume can be adjusted at surgery to compensate for small asymmetries. Correcting breast asymmetries during a breast augmentation can also be accomplished by using different size implants. Most women do not require this, but for those who do saline can offer this advantage.
Silicone implants are prefilled at the factory requiring a slightly larger incision also placed at the breast crease. Because there is an increased risk of implant pocket contamination during their placement, Dr. de Ramón feels it is important to place the implant in such a way that the implant does not contact the skin during surgery. This is accomplished by using a disposable funnel system called the Keller Funnel. The Keller Funnel resembles a pastry bag used in cake decorating. The silicone implant is placed into the funnel and then the funnel is squeezed to insert the implant into the breast without contact with the skin.
Some patients ask about the axillary incision (under the armpit). This is a surgical technique that sometimes requires the use of an endoscope to visualize the implant pocket. So although it may result in a less obvious scar, the risk of asymmetry is greater because the surgeon is working on the area from farther away from the breast than if an inframammary fold incision is used.
Final Thoughts
Over the last 20 years, Dr. de Ramón has observed that women, who rate the feel of the implant as most important, tend to choose silicone while women who are most concerned with detecting leaking from their implant and are concerned with the MRI recommendations, tend to choose saline implants.
Both saline and silicone implants have a proven track record of safety and efficacy, and both are FDA approved. The decision to choose one over the other is a personal decision made by weighing the pros and cons of each of them and having a candid discussion with your surgeon. At de Ramon Plastic Surgery Institute, Dr. de Ramon takes special care to discuss implant options with the patient’s input for the best results. During your consultation, you will see and feel both implant types and try different size implants to be sure you get the best results for your figure. You will also see pre and post-op photos of other patients with similar body types and desired implant sizes.
Contact de Ramón Plastic Surgery for a Personalized Consultation
To receive your personalized consultation with Dr. Richard de Ramón, please complete our brief online form or give us a call at 717-791-2880. We look forward to helping you look and feel your best.
