Silicone breast implants: pros and cons

A very common question during augmentation consultations is about the various advantages and disadvantages of silicone breast implants and saline breast implants.

In this chapter of PSB- the Plastic Surgery Blog, we’ll talk about silicone breast implants. The next installment will discuss saline breast implants.

Currently, about 80% of our patients select the silicone gel implants.

Safety data:

The FDA thoroughly looked at the scientific data, prior to allowing silicone breast implants back on the market for general cosmetic uses in 2006. The “blue-ribbon” panel of experts from multiple different fields of medicine agreed that, based on current scientific studies:

a) there is no increase in the risk of breast cancer due to the use of silicone breast implants, and

b) there is no increase in the rate of developing “auto-immune” or connective-tissue diseases like scleroderma, lupus or rheumatoid arthritis due to the use of silicone breast implants.

That being said, no implant is perfect.

Just like any man-made device, the implant, whether it is saline-filled or silicone gel filled, will eventually get old, become brittle, develop a small crack in the flexible outer shell, and leak. Implants don’t last forever. At some point, a second surgery will be required to swap out the implants for a new pair.

Also, implants (both saline and silicone) do get in the way of seeing tissue clearly with a mammogram, as the implant hides some of the breast tissue. This problem is worse when the implants are above the muscle, and somewhat better when they are behind the pectoral muscle.

Lastly, an implant can become firmer than desired, due to the development of capsular contracture. This may require more surgery to fix, and currently, it’s impossible to predict ahead of time whether this problem will happen for a particular patient, or not.

Advantages of silicone breast implants:

1. “the feel” – Most of my patients like the way the silicone breast implants feel. Simply put, they feel very similar to real breast tissue, and do not have the “water balloon” feel that the saline implants have. This, for most patients, is the deciding factor.

2. Less chance of ripples & wrinkles – Particularly in slender women, one of the main drawbacks of saline implants is that any wrinkling in the implant may show through the skin, causing visible ripples, particularly with leaning forward. This can happen even with the implants behind the muscle, and even if the implants are filled to the correct volume. Studies show that rippling occurs in about 10% of patients with saline implants, but only about 1% of silicone breast implants. Patients who are thin enough to feel their ribcage on the side of their chest are particularly prone to rippling problems. Switching to silicone implants often fixes the problem for patients with ripples in their saline implant (unless you are super-skinny!)

3. Works better for women with rib cage irregularities – Silicone gel implants seem to drape more smoothly over rib cage asymmetries due to scoliosis or pectus excavatum (sunken chest).

4. Less tissue stretch – Over time, the saline implants seem to have a slightly higher rate of stretching out the skin and soft tissues of the breast, compared to gel implants. This can result in pocket expansion, bottoming out, or ptosis (droop) of the breast.

Disadvantages of silicone breast implants:

1. More expensive than salines.

2. FDA recommendations for follow-up MRI’s – As we discussed in an earlier blog chapter, MRI’s are recommended at years 3, 5, 7 and so on. This can get expensive.

3. Trickier to tell if you have a deflation – Unlike saline implants in which a deflation is very obvious in a few days, it’s more difficult to tell if there s a leak in a gel implant by simply looking at the breast. Usually, some sort of scan – like a breast ultrasound or MRI – is needed in order to make the diagnosis.

4. In the event of a leak, additional surgery is needed – Current recommendations call for a capsulectomy to be performed for most patients with a leaking gel implant. While this is a routine operation for most plastic surgeons, it does represent more surgery than the simple “switch-out” procedure that would be performed for a deflation in a saline implant.

5. May need a somewhat longer incision that the saline implant. Saline implants can be rolled up while still deflated, and placed into the breast through a small incision, and inflated after positioning. This drawback will become even more significant when the new generation “form-stable” or ‘Gummy Bear” silicone implants are introduced to the U.S. market, as these require a 5-6 cm. incision.

Overall, patients are very satisfied with breast augmentation, regardless of whether saline or silicone breast implants are used. They recommend it to their friends, co-workers and family. It’s the #1 most popular surgical procedure both in our practice, and nationwide. While you can usually get a good result with both kinds of implants, certain individual situations may make the choice of a particular type of implant better than the other.

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