| Breast implants are used in both cosmetic and reconstructive breast surgery. The 2 basic types of implants are saline and silicone filled. Until recently, women seeking plastic surgery for breast enlargement were limited to saline unless a breast lift (mastopexy) was being performed at the same time. If that was the case they could qualify for use of silicone implants but only as part of a clinical study. As one of the study investigators, I was one of the few cosmetic plastic surgeons in the Tampa and Palm Harbor, Florida area able to use silicone implants at that time. In November of 2006, the FDA announced that silicone breast implants would once again become available for cosmetic plastic surgery patients over the age of 22. Since that time silicone breast implants have become my usual choice for breast augmentation.
Saline Breast Implants
Saline breast implants are similar to silicone filled implants in that they are also made from a solid silicone shell. However, the implant is filled with saline (salt water) rather than silicone. This quality gives us the advantage of adjusting the size of the implant to accurately suit your desires for breast enlargement. Also, it allows us the luxury of slightly over filling the implant to try to minimize the rippling or wrinkling effect sometimes seen in breast enlargement surgery with saline implants. Another advantage of saline breast implants is that they are easier to detect a rupture or leak than silicone implants. The disadvantage of saline in my opinion is that they do not usually feel as natural as silicone and they are more prone to visible wrinkling than silicone breast implants. These 2 reasons are predominantly why I advise most patients to choose silicone over saline.
Silicone Breast Implants
As I mentioned above, the silicone filled gel breast implants that I use were recently re-approved by the FDA for cosmetic breast enlargement. In the early 1990’s Concerns were raised about the safety of silicone filled gel implants and their likelihood of contributing or causing various autoimmune diseases like lupus, scleroderma, and rheumatoid arthritis. At that time they were taken off of the market for use in most cosmetic plastic surgery cases except as part of a clinical trial like the one I mentioned above. They were also still eligible for use in breast reconstruction. After 14 years of reviewing data and clinical studies evaluating silicone filled gel breast implants and the autoimmune diseases showed that there was no conclusive evidence that silicone implants caused major health problems. Therefore, the FDA reapproved their use for breast enlargement in women over the age of 22. Despite their reapproval, the FDA has asked that both of the major manufacturers of silicone breast implants (Allergan and Mentor) continue with a post approval study for 10 years.
What is different now than in the past? Mostly the difference is that there is no solid evidence that silicone implants cause any of the autoimmune diseases. Also, the silicone gel implants created in the past were more of a liquefied gel that could ooze out of a leaking implant. Today’s silicone breast implants are more of a cohesive gel. This means that the consistency is more like a Gummy Bear than like a jelly donut.
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