Breast augmentation is one of the most popular aesthetic procedures done in the United States, with 300,000 women undergoing the procedure just last year. So why is it so popular and what’s all the buzz in the media about? Are saline implants safer than silicone gel implants or vice versa? How does a patient find out the straight scoop?
First let’s discuss Implant History 101. The original silicone gel implants were introduced in 1963, followed by saline implants in 1964. Before that, starting in the late 1800s, surgeons used paraffin, ivory (yikes!), glass balls (ouch!), sponges, and injected silicone. Since the 1960s the basic concept of a solid shell filled with a liquid or a gel has not changed.
Saline implants are filled with sterile salt water during surgery. Silicone gel implants are prefilled and factory-sealed. (Some implants are a combination of the two.) The newest gels have a thick shell filled with a thick, cohesive gel designed to “cohere” or stick together to minimize the risk of the gel leakage. There are plenty of videos on Youtube.com attesting to how the gel stays put even when the implant is cut in half!
Lately the media has focused on a recent FDA report about silicone gel implants. There is a lot of good news reported on the FDA website, including:
- High satisfaction with body image after silicone gel breast augmentation
- High satisfaction with the shape and feel of silicone implants
- No apparent association between connective tissue disease and implants
- No association with increased risk of breast cancer
- No evidence of untoward effects of implants on pregnancy or fertility.
- No association between mothers with implants and difficulty breast feeding or adverse effects in their children
However, the media reports focused on the FDA’s mention of studies with up to a 40% reoperation rate within 10 years of a silicone gel breast augmentation and 20% of patients in those studies needing their implants removed within 10 years of implantation. These numbers are high and concerning, and they deserve discussion. The statistics are based on Core Studies involving many different surgeons. For that reason it is very important to find out the experience of the specific plastic surgeon you might be considering. For example, in our practice we have been putting in silicone gel implants for 11 years. (We participated in two Core Studies beginning in 1998.) To date in our own silicone breast augmentation patients, we have not replaced any gel implants for leakage. Our reoperation rate for silicone gel implants is very low, much less than the media-quoted 40%, and is lower than our saline implant reoperation rate, which is also low.
There are many factors that can result in reoperation, including:
- Type of implant and size of incision (We have removed broken, textured silicone implants placed by other surgeons through small incisions. Initial insertion may have weakened the implants.)
- Surgical technique
- Postoperative instructions
- Patient compliance with instructions
- Postoperative care by the surgeon
- The surgical facility used (Yes, this matters.)
- Type of anesthesia
- Nicotine/cocaine use
So which implant is better? Well, there is no perfect implant, and each has advantages, so it’s smart to know about both. In our next post we’ll compare saline implants with silicone gel implants.