Saline implantshave been around forever, but became widely used after 1990 when the FDA began questioning the use of silicone implants. They have an identical shell as silicone implants, but the difference lies in the filling. As the name suggests they are filled with sterile IV solution (saline). The water in the solution has less viscosity (like water is less thick than motor oil), so it is more likely to show rippling or dimpling of the shell in women who are very slender and have little breast tissue or body fat to hide it. The consistency of the implant is a little firmer and a little stiffer than that of silicone. These two properties make the implant more palpable (you can detect the edges of the implant more easily with careful palpation at the lower outer edge of the breast where there is no muscle coverage.) That’s why saline implants are always placed behind the muscle, and if you want your implant in front of the muscle you should choose silicone. So why would anyone ever choose saline over silicone ? The answer comes with maintanence considerations. Saline implants are basic place it and forget it implants. If anything ever goes wrong with them (such as deflation or leakage) the saline is simply and harmlessly absorbed by your body and goes out through your kidneys. At that point, the implant will become flat and you will obviously know what has happened. (no expensive tests). Replacement is almost always a simple inexpensive office procedure and is unlikely to involve any serious recovery time. Most implants have a life time warranty and the replacement implant is usually free. The cost to replace a deflated implant varies in our office by who put them in.. I give a VERY significant discount to my patients, some discount to those put in by my former partners, but even at full price it is way cheaper than when your implants were put in initially. At the time of replacement surgery you can choose to have both implants replaced, change sizes, or even correct some of the features you didn’t like about the previous or ruptured implant(s).
Silicone implants have also had a long history but were unavailable for cosmetic use from about 1990 until 2006.They are filled with a silicone elastomer and recently there have been some implants introduced with even thicker elastomers (gummy bear implants). For the most part you don’t need to dwell on the thickness (or G factor) of the elastomer, just know that for shaped implants the gel needs be more cohesive to prevent shape change and undue rippling. The typical round smooth implants are softer, less detectable, and are actually less likely to leak or deflate than their saline counterparts. So where’s the catch? The silicone elastomer will be trapped inside the body’s scar capsule if there’s any leakage outside its shell. And that’s a good thing. If we knew that it would stay there forever, there wouldn’t be any harm in that. BUT, the gel won’t stay inside the capsule if ANY damage happens to your bodies scar tissue. Simple bumping into furniture, exercise equipment, or falls to the ground can disrupt a fragile scar capsule. Even if the capsule remains intact, gel bleed can make subsequent capsule contracture problems. Suffice it to say that if the silicone gets out of its shell, the whole implant (and usually the accompanying scar capsule) needs to be removed. Generally this is done in a surgery center under general anesthesia which makes it a bigger deal than simple office replacement of a saline implant. Just to complicate matters more, it’s not obvious when leakage occurs. To find this silent leakage requires an MRI scan (mammogram and ultrasound are notoriously unreliable) which can be expensive. The current manufacturers recommend an MRI three years after implantation and every other year thereafter. You may argue with their guideline on an epidemiologic basis, but bottom line is that you will need some sort of regular surveillance program FOR LIFE.
The analogy I give my patients during our consultation is generally like that of choosing a car. If you want the reliability and convenience of standard auto makers with an oil change at Jiffy Lube without an appointment, you want SALINE implants. If you want to take corners at 60mph and don’t mind making an appointment with the dealer a month in advance to have your high performance auto serviced, then you’ll probably want SILICONE implants.
There are lots of nuances to this discussion, so if you have more questions leave a comment for me, or better yet come in to our office for a private , personal consultation with Dr Zickler to have your individual specific questions discussed.