Breast Augmentation – Should You Get Silicone or Saline Implants?
Women often have many questions when trying to decide whether to use saline or silicone implants. Both implants have been available since the early 1960s, and both are safe and effective devices. Silicone implants have gone through some modifications and improvements over the years.
We are currently using the fifth-generation silicone implant. This is a highly cohesive silicone gel device which 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 they are not as stiff as the gummy bear candy.
The Differences between Silicone and Saline Implants
There are pros and cons to each of these two implant types, and it is important to understand the difference for a woman to make a truly informed decision about which implant she would like. Capsular contracture is a risk with both implants. While the human body normally makes a thin capsule around any foreign body, in capsular contracture this capsule progressively thickens and tightens around the implant. It can cause implant/breast hardness, visual distortion or pain.
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. Both saline and silicone implants are available in smooth or textured surfaces. We will discuss the pros and cons of implant surfaces in a future blog.
Leaks and Deflations
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. 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.
Depending on the soft tissue qualities and the size of the breast which will cover the implant, many patients cannot tell the difference between a saline and silicone implant once in place. Patients with very thin soft tissue coverage 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 infolding and possibly reduced visibility or palpability of wrinkles. Silicone implants may also feel softer than saline in some patients.
Silicone implants in some case will also offer a more natural feel. There are many patients, however, where it is impossible to tell which type of implant they have on physical exam.
Which Type of Implant has a Better Lifespan?
Both 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. Most manufacturers will also allow the patient to change size if they desire. Implants that deflate due to needle puncture are not covered under warranties.
Many women want to know the lifespan of implants. This is a question that has not been answered. 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.
Another difference between saline and silicone implants is that saline implants are filled during surgery once the empty implant is in position. Silicone implants are prefilled at the factory requiring a slightly larger incision and possibly increasing the 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 its placement. This is accomplished by using a disposable funnel system. Saline implants do not require this.
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.
In summary, 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.
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. At de Ramon Plastic Surgery Institute, we take special care to discuss implant options with the patient’s input for the best results.
Contact de Ramón Plastic Surgery for a Personalized Consultation
To receive your personalized consultation with Dr. Richard de Ramón, MD, 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. 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.
