Breast Implants: What’s new, what’s true, what’s not?
Nearly every one is familiar with the concerns that were raised in the early 1990’s about the safety of silicone gel filled implants. This prompted the FDA to issue a voluntary moratorium asking plastic surgeons to desist in their use for cosmetic patients until important questions were answered regarding their medical safety, particularly their alleged link to autoimmune and connective tissue disorders. (Their use was never interrupted for reconstructive purposes following mastectomy). In December 2006, the FDA lifted the 14 year old ban on their use for cosmetic breast augmentation after literally hundreds of studies in multiple medical centers around the world failed to demonstrate any relationship between silicone implants and medical illness of any kind. The only restriction that remains today (without any scientific justification) is that their use is limited to women who are at least 22 years old.
Today’s “4th generation” implants have thicker shells and far less likelihood of leak or rupture, and while still not perfect, the manufacturers have worked hard at ensuring that the implants are both safe and durable. (The two main manufacturers of breast implants are Mentor Corporation and Allergan whose implant line is known as Natrelle). The gel used in implants today is much more cohesive, with a consistency more like Jell-O than pancake syrup or honey. This means that it cannot “leak” if the implant shell was to tear or rupture, and is therefore virtually incapable of disseminating throughout the breast or body. The actual risk of deflation or leakage of either a saline or a silicone gel filled implant is quite comparable, and about 0.5% per year. I tell my patients to think of a breast implant like a long lasting tire; it might last the life of the car, but it might not. If it does need to be replaced at some point in time, the surgery is usually pretty straightforward and not particularly complicated. The implant manufacturers provide a lifetime warranty for their breast implants.
Silicone versus Saline: What’s right for you?
While the variety of implant choices today can be quite confusing, i.e. silicone gel or saline filled, smooth versus textured surface, low, mid-range, or high projection, and soon to be FDA approved, anatomical or “shaped” implants instead of simply round, one of the most important choices for a woman is whether her implant should be filled with silicone gel versus saline. While there are no obvious advantages as far as the aesthetic appearance that can be expected, the main difference will be in the way the augmented breast feels. A silicone gel implant will result in a softer and more natural feeling breast, while a saline filled implant, especially one that is slightly over-filled, can be a bit firmer. Rippling is also a concern, with saline filled implants generally considered more prone to show ripples. When it comes to deflation or rupture, it is generally easier to detect a saline rupture because it tends to be “all or none” with an unmistakable (often rather sudden) change in the size of the breast. This is more of a psychological “emergency” rather than a medical one, since the body simply absorbs the saline. If a silicone gel containing implant were to tear or rupture, this may be more difficult to detect by physical examination alone, but MRI is considered the gold standard for determining the status of a gel filled implant. Your plastic surgeon will help you decide if this is indicated.
The Bottom Line:
Breast implants provide a wonderful option for women desiring breast reconstruction after mastectomy, or for women who want to feel more confident and feminine and might be considering a cosmetic breast augmentation, regardless of whether they were always small breasted, or perhaps got that way after nursing children and losing some of their pre-pregnancy breast size. Both saline filled and silicone gel filled implants have their own distinct advantages. To find out which might be best for you it is best to consult with your plastic surgeon. For more information, contact Dr. Ram Kalus at Plastic Surgery of the Carolinas at 843-881-3881.
