MODERN BREAST IMPLANTS
SILICONE OR SALINE: THE GREAT DEBATE
For years, the conversation concerning breast implants has circled around one aspect: what’s inside of them. Prior to breast augmentation surgery, a series of choices need to be made, and choosing the shape and type of implant that’s right for you can be daunting. Considering that 290,000 breast augmentation procedures were performed in 2013 alone, according to the American Society of Plastic Surgeons (ASPS), many women have been faced with these decisions.
“There are many choices available to patients nowadays in selecting an implant,” said Dr. Jon Perlman, a plastic surgeon in Beverly Hills, California. “In large part, the patient should consider the doctor’s personal recommendation, which will be based upon his or her experience and preferences.”
In terms of shape, patients may choose between round or teardrop-shaped implants. Dr. Perlman said round-shaped implants (same shape all over) are either smooth or have a textured shell surrounding them, and teardrop-shaped implants (fuller at the bottom and tapered toward the top) require a textured shell in order to reduce the chances of rotation or malposition. With regards to filler material, patients can choose between saline and silicone gel.
Saline implants are inserted empty, then filled with sterile saltwater during the procedure to achieve the desired size. According to the ASPS, if a saline implant ruptures, it will deflate and the body will absorb the saline solution and naturally expel it. Surgery is usually required to remove the implant shell, according to the Mayo Clinic. One disadvantage to saline implants is that they sometimes ripple (as a result of thin breast tissue), whereas silicone normally does not, noted the Canadian Society for Aesthetic Plastic Surgery.
“Anyone who has seen a patient’s breasts that are rippled or wavy understands the weakness of saline implants,” continued Dr. Perlman.
Silicone implants have undergone significant changes in the last decade. During the 1990s, there was concern surrounding their safety, namely whether they could be associated with connective tissue disease and cancer. Today’s modern silicone implants are filled with a cohesive silicone gel—a soft, sticky substance closely resembling the feel of human fat, making them feel closer to natural breast tissue. According to the Canadian Society of Plastic Surgeons, the cohesive silicone gel does not “seep, run or shift.”
“Since the scare regarding the safety of silicone gel implants is largely behind us, the pendulum has swung far back toward a preference for cohesive silicone gel due to its natural feel and good safety record,” said Dr. Perlman.
“The current generation of cohesive silicone gel implants remain soft and natural but will not allow its silicone to flow out of the implant if it breaks,” said Dr. Perlman. According to the ASPS, the gel will remain within the implant shell or leak into the pocket of the implant.
“The majority of my consultations come in convinced that they wish to have silicone and not saline. I usually do not disagree,” said Dr. Perlman. The main determinant in Dr. Perlman’s decision is whether a woman has good breast tissue thickness and skin elasticity.
“For the former [good tissue thickness], the option of saline is a reasonably good one, but if the patient has had pregnancies and has thinning of her breast tissue, my preference is strongly toward the use of silicone gel implants,” said Dr. Perlman.
The incision can be made in the armpit (transaxillary), around the nipple (periareolar), or below the breast fold (inframammary).
“My personal preference remains to perform breast enlargement through an incision that becomes very well hidden and minimally visible within the perimeter of the areola,” said Dr. Perlman, who explained that this type of incision is very suitable for smooth or textured implants, whereas teardrop implants require a much larger incision made under the breast.
According to the ASPS, side effects of breast augmentation surgery include infection, breast pain, implant leakage or rupture, temporary changes in nipple sensation and capsular contracture—when scar tissue that has developed around the implant starts to harden, squeezing and tightening the implant, causing it to become firm.
In order to avoid capsular contracture and injury to the muscle during the healing process, Dr. Perlman recommends not lifting anything heavier than a towel or pillow, and avoiding driving and forceful use of the upper extremities.
“I commence a specific massage exercise regimen in the first week and have patients continue that for a period of six weeks,” Dr. Perlman added.
Patients can expect to take a week off work and resume regular activities with their upper body after six weeks. Dr. Perlman said patients can also protect their new breasts by wearing supportive bras and avoiding both sunburns to the chest area and major weight gain or loss. The ASPS says weight loss can affect the appearance of breast implants and it states that implants are not intended to last forever. Dr. Perlman echoed this sentiment with specific regard to saline implants.
“After pregnancy, weight changes and aging, the more obvious feel of a saline implant and the risk of palpable rippling or visible waviness can increase greatly.” But if there are no early leaks or ruptures, especially after trauma, Dr. Perlman says they can last for many years.
“With the previous generation of silicone implants, it has been my experience that they begin to deteriorate between 20 and 25 years after placement (with rare exception).”
As for today’s silicone implants?
“Whether the new cohesive gel implants last much longer remains to be determined, though I am hopeful that that will prove to be the case.”