Saline Implants VS Silicone Implants

Some of the earliest traceable breast implants date back as far as the 1880s and were made of materials such as ivory, glass, and rubber, and later petroleum jellies and paraffin. Because these methods understandably resulted in a number of complications, silicone implants were considered revolutionary when they debuted in the early 60s. After undergoing several “generations” of technological enhancements, modern silicone implants are considered relatively safe, and are preferred by many surgeons for their ability to approximate the “natural” texture of the female breasts.

Silicone implants are composed of a pliable but durable tri-layered silicone shell and filled with a viscous silicone gel. Some of the newest implants, sometimes called “gummy bear” implants, contain a cohesive gel which holds its shape when the shell is ruptured, potentially reducing the risks associated with in vitro silicone implant rupture. Because silicone implants have thicker shells than saline implants, the undesirable “rippling” effect evident with saline implants is virtually eliminated. One disadvantage of silicone implants is that they come pre-filled from the manufacturer, and therefore require larger incisions, and are almost always inserted via inframammary incisions, at the fold underneath the breast. Another disadvantage is that their rupture is usually less apparent and more gradual than in saline implants, which show a pronounced deflation after rupturing. Patients are therefore asked to monitor their implants on a regular basis for signs of “silent rupture” and to report to the clinic immediately should any pain, tenderness, or hard knots in the breasts (known as nodules) develop. Cohesive gel implants greatly reduce the risks associated with rupture compared with traditional silicone implants, as they hold their shape and do not leak fluid into the breast cavity.

In 1992, the American Food and Drug Administration (FDA) restricted the use of silicone implants. In 2006, many of the restrictions were lifted, provided that certain conditions were met, including that women be informed that silicone implants are not designed to last a lifetime. Women are now advised that the lifespan of any implant is generally 10-15 years, after which the risks of complications, such as capsular contracture, greatly increase. Furthermore, all manufacturers are required to submit a yearly report detailing research findings, and Health Canada continues to monitor the safety and effectiveness of silicone implants, which are now deemed acceptable for use in cosmetic surgery applications.

Some downsides of saline implants include their tendency to rupture more easily, due to their thinner shell. However, the rupture of a saline implant generally causes less serious complications than the rupture of a silicone implant. Despite their relative safety compared with silicone implants, many surgeons find saline implants aesthetically undesirable, as they may ripple or wrinkle under the skin because of their thinner shell. Furthermore, many patients describe the sensation that their breasts are filled with liquid, and may be able to feel the saline solution as it moves around inside the implant. Many women report that saline implants are more readily apparent to the eye and touch. The occurrence of these aesthetic problems is more likely in women with less breast tissue (e.g. smaller breasted women or women who have undergone mastectomies), and silicone implants may be recommended in these cases. For women with ample breast tissue, saline implants can usually provide visual results similar to those achievable through silicone implants. Saline implants are also more prone to deflation over time, and are often overfilled in order to compensate.

Patients must also choose between smooth or textured implants. Smooth implants have a shiny, polished surface whereas textured implants are made with a rough surface, which can be finer or coarser, designed to help the implant better adhere to the surrounding breast tissue. Texturing the implant can prevent it from rotating in its cavity, which is vital with anatomically shaped implants. For this reason, cohesive gel implants are almost always textured. Textured implants may also guard against the risk of capsular contracture, as they encourage an inflammatory response and discourage hardening of collagen fibres, although this is may only be a short-term benefit, and there is little evidence linking textured implants with reduced risk of capsular contracture over the long term. One main drawback of textured implants is that rippling or wrinkling is more pronounced in textured than in smooth implants. Larger-grained textured implants may also show “traction wrinkles,” which are unique to textured implants. Because of the increased potential for wrinkling, it is crucial that textured implants be filled to their maximum capacity. Another slight drawback of textured implants is that when replacements are necessary, removal can be more difficult, although still possible