By Elana Pruitt © 2006-2009
PlasticSurgery.com Editor
The common desire for breast surgery patients is to look as natural as possible. After all, no woman wants to look as though they just had surgery to enhance their bust size. So when it comes to choosing between saline implants, a solution composed primarily of saltwater, or silicone implants, a plastic gel-like substance, keep in mind the health implications of both.
July 2005 marked a turn in policy as Mentor Corporation, one of the leading suppliers of medical products in the United States and internationally, when it received an "approvable with conditions letter" from the Food and Drug Administration (FDA) for its MemoryGel™ silicone gel-filled breast implants. About two months later, its competing manufacturer INAMED Aesthetics (formerly McGhan Medical) also got the so-called "green light" on its path to selling silicone in the United States. Both companies already sell these implants overseas, and now, U.S. patients seeking breast augmentation will have more options to choose from -- but not without rules and regulations.
As you consider breast augmentation for aesthetic enhancement or for reconstructive purposes, keep in mind that it's not as black-and-white as silicone "bad" or saline "good," rather there are benefits and risks to both. For purely an aesthetic enhancement, saline continues to be the dominant implant used for breast augmentation performed in the United States and generally considered the "safer" of the two.
Silicone Breast Implants
"Silicone implants are very good for women who do not have a lot of soft tissue coverage," says Ben Lee, M.D., a board certified plastic surgeon of Englewood, Colorado, who specializes in breast augmentation. According to Dr. Lee, implants made with silicone have a more "natural-looking and natural-feeling quality." But that alone does not guarantee successful results for patients seeking.
It's not as black-and-white as silicone "bad" or saline "good."
In fact, controversy with silicone implants originally stirred over its usage since its development over 25 years ago, because women began to claim connective tissue disorders and other related illnesses. If ruptured, gel leakage is a major concern with these breast implants. Despite saline implants being made of silicone rubber, the salt water solution, if leaked, is generally considered non-toxic and less dangerous than silicone. Therefore, even without clear-cut evidence of illnesses directly linked to silicone, the FDA posed a restriction on the general public for breast augmentation in 1992.
According to the FDA, "Silicone-gel implants can only be used in controlled clinical studies for the purposes of reconstruction after mastectomy, correction of congenital deformities, or replacement of ruptured silicone-gel implants that were used for augmentation." Because getting silicone implants is still an investigational process, a patient would need to participate in either an adjunct study or an investigational device exemptions (IDE) study, in which she would be monitored or followed for at least five years.
Saline Breast Implants
So saline it is? Cosmetically speaking -- yes. "Saline has a very good track record," says Dr. Lee, admitting that while it lacks a realistic feel to most women, there are still benefits to its placement. As compared to silicone implants, saline implants can be inserted through four different ways -- the armpit, the belly button, under the breast, or the outside of the areola. Silicone implants are typically placed under the breast already filled with gel, which is why surgeons must create large incisions for its insertion. Saline implants, on the other hand are inserted using smaller incisions because the shell is initially empty before inserted, and then filled once inside the patient.
"Women frequently compare the feel of saline implants to that of a water balloon, while silicone implants more mimic a woman's natural breast tissue. In countries where silicone is available, patients will choose it 90 percent of the time. In all cases, patient safety and informed decision making should be primary considerations in selecting a particular type of implant," reports the American Society of Plastic Surgeons (ASPS).
Most recently, Mentor and INAMED are seeking approvable letters for what is considered a "fourth generation" implant called the "Gummy Bear," which is made of cohesive, silicone-gel pieces, designed to prevent leakage and keep solid form.
A newer saline-filled implant gaining U.S. popularity is the "adjustable implant." According to Dr. Lee, "adjustables" are great for patients who are "waffling on sizes," and "very good in situations like a breast lift and breast augmentation," yet admitting that he only uses them about 10 percent of the time. The majority of his patients are still undergoing breast enhancement using traditional saline implants.
Breast Implants Risks & Side Effects
All plastic surgery carries risks and uncertainties, and breast augmentation is no exception. Because of the "balloon-like" feel to saline, they usually possess a firmer quality, and are prone to wrinkling and rippling, says Dr. Lee. Yet, if ruptured, saline implants are usually noticed right away due to the breast's deflated look. Silicone, on the other hand, may not be noticed right away because a scar capsule may already be formed around the implant, with the silicone getting trapped in that capsule. According to the ASPS, if the gel has migrated outside the capsule, additional surgery will be required to remove it, as well as the implant. In this case, additional costs prevail, and insurance will not cover the removal of the implant nor the replacement.
When deciding on breast augmentation for reconstruction purposes or cosmetic reasons, brush up on your knowledge about the benefits and risks to saline and silicone implants. Whether you recently had breast cancer surgery and desire reconstruction, or simply want a sexier bust appearance, the best thing you can do for yourself is to learn about the safety regulation of each one. And with more options to choose from, some would argue that female patients can enjoy the power of having a choice.