Both are approved by the FDA but which is better? Each has its own benefits and advantages. Each has its own potential liabilities and disadvantages. Neither is perfect. But both have their good points. After a physical examination, a detailed consultation and a thorough review of all the various pro’s and con’s with your plastic surgeon, an informed choice can be made. But there really is no wrong answer or better implant – the implant that represents the best overall choice for you is the right one. Let’s take a look at some of the key points you should be considering in your decision making process.
The saline (physiological salt water) which is used to fill saline breast implants comes directly from an IV saline bag. Instead of going into your circulatory system though an IV, the saline goes through the sterile tubing right into the implant. No one is doing research on the safety of sterile IV saline; millions of people receive IV saline every day all over the world. If it is safe enough to go directly into your veins, does it stand to reason that it would be just as safe to fill a breast implant with? This is an absolutely 100% safe fluid which is completely identical to one’s natural body fluid. The silicone gel inside silicone implants has been studied exhaustively. The FDA concluded that approval as a safe and effective device was warranted, granting such status in 2006. But studies are still ongoing and further long term evaluation and research mandated by the FDA is still pending. So silicone safety information is not quite the “slam dunk” it is for saline. Please see our associated article, “Are Silicone Implants Safe?” for more information on this subject.
2. FDA Minimum Age Requirement
As per FDA stipulations, patients must be age 22 or older to receive silicone gel implants. There is no age stipulation for saline implants.
When ordered for you and your procedure by your plastic surgeon’s office, silicone implants are roughly double the cost of saline implants.
Rippling is a phenomenon which occurs very commonly with saline implants but is extremely uncommon with silicone implants. Rippling is characterized by small longitudinal ridges, like the ripples on a pond, that might be felt along the bottom or the outer side of the breast where the tissues are usually their thinnest. In extreme cases, the ripples may even be visible. However, most of the time when rippling does occur it is of a very minimal nature. Patients with very low body fat, a petite body frame, thin skin and/or stretch marks on the breasts, and minimal breast tissue are at higher risk for significant rippling. But rippling can occur in anyone. Choosing a silicone implant lowers this risk substantially.
5. Adjustability for Asymmetry
For patients looking for better symmetry because of any degree of size difference between the sides, the fine tuning adjustability that can be best realized only with saline implants is an important asset. Silicone implants are not adjustable.
6. Incision Size and Placement
The inframammary (under the breast) crease incision is the most commonly used and preferred incision by most plastic surgeons. The natural shadow and crease under the breast tends to additionally hide the typically thin, hard to see final scar quite well. This incision can be utilized for either type of implant. The incision size is typically about one inch or less for saline implants, which are inserted empty, then filled and adjusted once properly situated inside the pocket which was created for them. The incision must be made bigger (about two inches) to allow the insertion of the pre-filled, fixed total volume of the silicone implant.
7. Leak/Rupture Rates
Saline implants have a ~ 1% – 2% per year leak rate; silicone implants have somewhat lower rate with a less than a 1% per year leak rate. The risk for leak/rupture with both types of implants generally increases with the age of the implant. Leak/rupture rates are also higher for implants used in revision or reconstruction procedures.
8. Rupture/Leak Detectability
If a saline implant leaks, the saline is harmlessly absorbed by the body and the breast will eventually begin to shrink. It becomes very obvious very quickly which is the side that leaked! No x-rays or special tests are needed. But silicone is not absorbed by the body and, therefore, it can be harder to detect a leak or a rupture without an x-ray study. The breast might look and feel completely fine – 30% or more of silicone gel implant leaks are not obvious, and not detectable by physical examination or appearance. An MRI is the best study for answering any question of a gel leak, and the FDA recommends routine MRI screening for women with silicone gel implants. Interestingly, the obviousness of a leaking saline implant is perceived by some to actually be a disadvantage. The removal/replacement of a ruptured saline breast implant is not a true medical emergency although it may be a pressing social emergency! The days in between diagnosis and treatment might fall on a vacation getaway or during bathing suit weather. Not so pleasant when one side has deflated! But here’s where the “hidden” nature of the ruptured silicone gel implant could be an advantage – until its replacement it will probably still look virtually identical to the non-ruptured side!
Extra, special views are needed for women with breast implants of any kind when having regular, routinely scheduled x-ray studies like mammograms. All women with implants should have their studies performed at a qualified institution with certified staff well versed in these special techniques. For women with saline implants, no additional or special mammography follow-up is recommended other than what would be recommended for women without implants. But for women with silicone gel implants, special additional MRI evaluation every two years is highly recommended because more than 30% of silicone gel rupture/leaks can be unapparent. Insurance carriers have been classically resistant and unlikely to cover the costs of routine breast MRI’s even though they are recommended by the FDA and plastic surgeons for those with silicone gel implants. An MRI of the breasts has a cost range of $500 – $1000.
10. Capsular Contracture (Scar Tissue/Implant Stiffness)
Stiff scar tissue (the “capsule”) forming around the implant can make for a stiff, hard feel to the implant and breast. This occurs at a rate of ~ 2 -3% per year for saline, ~9 -10% per year with silicone. Capsular contracture rates are higher still (10 – 15% per year) for implants used in revision or reconstruction procedures.
Infection risk is extremely low overall, and comparable for saline and silicone implants. Infection rates are higher for both implant types when used in revision or reconstruction procedures.
12. Re-Op/Revision Rates
Revision rates are comparable for saline and silicone implants at ~ 5% per year. Revision rates are higher (~10% per year) for either breast implant type when used in revision or reconstruction procedures.
13. Explantation (Implant Removal) Rates
Implant removal rates are comparable at ~3% per year for both implant types. Explantation rates are higher for either type of implant when used in revision or reconstruction procedures. The reasons for removal can vary – but replacement with a new implant (for one which has leaked, for example) is much more common than simple removal alone. The technical demands during surgery for saline implant removal are typically fairly simple and straightforward. Silicone implant removal can be potentially difficult and complex depending on the age and type of implant.
Saline implants weigh ~ 1.0 g/cc. Silicone is slightly lighter at ~0.97 g/cc. From a patient perspective, this difference is undetectable and the weight of an implant for any given size will feel the same whether saline or silicone.
15. Use In Reconstruction
All the follow-up statistics and data seem to favor silicone as the preferred long term choice for breast reconstruction procedures.
16. History of Use Following FDA Approval
Saline implants received their formal FDA approval in 2000 – they’ve had ~15 years of post-approval use. Silicone gel implants received their FDA approval in 2006 – they’ve had ~9 years of post-approval use. Some patients view this as an independent factor favoring saline implants as a preferred choice.
17. Skin Stretch/Deformational Force
Less of the stretching, potentially long term deforming forces from the presence, weight and size of the implant are generated by silicone implants compared to saline, creating a theoretical basis favoring silicone as an implant choice when considering long term effects such as droopiness or stretch mark exaggeration.
18. Overall Patient Satisfaction
For softness, shape, contours, size enhancement, naturalness of look, naturalness of movement/bounciness, sensation (to the touch and as by being touched) and overall look, the satisfaction rate for breast augmentation procedures is quite high. The overall long term satisfaction rates are also comparable for patients who have either silicone gel or saline implants.