I am often asked what type of breast augmentation implants I recommend. While each type of implant has its advantages, it is up to the individual patient to decide which advantages she desires and which inconveniences she is willing to accept. There is no right or wrong answer; there is simply the answer that is most right for you, the patient.
Saline implants are made with a solid plastic (silicone plastic) bag or “shell” on the outside. This implant is placed into position and inflated during surgery with saline solution. Saline is simply salt water that has the same concentration of salt to water as you’ll find in your own body. Because saline implants are inflated once they are in position, a slightly smaller incision can be used (typically 4.5 cm instead of 5.5 cm in length) than are used when placing a pre-filled silicone gel implant into position. In addition, the fill volume of the implant can be varied to adjust for natural asymmetry that the patient may have prior to surgery. By adjusting the saline implant fill volume, we can reduce natural asymmetry as much as possible.
Silicone gel implants have a very similar shell, but are filled with a silicone gel material. This material is a very thick gel that is a lot thicker than was present in 1st, 2nd and 3rd generation gel implants from many years ago. This gel, however, is still softer than solid silicone would be, but not as liquid-like as water.
The strength of the shell of different breast augmentation implants are very similar and the leakage rates are very similar as well. What differs is how the material that the shell is filled with behaves. Saline will have a firmer quality when used for breast augmentation. Gel, which feels a lot like natural breast tissue, will have a more natural, softer feel. Because saline is simply water, there is a tendency for saline implants to feel somewhat like a balloon of water. This means that under many circumstances, some rippling or scalloping around the edges of the implant can be felt. Typically, if the implants are placed below the chest muscle, rippling/scalloping is not visible. There is a “feelable” difference when the plastic shell is felt. In contrast, if there is gel within the implant shell there is a much less noticeable ability to feel the implant. This is particularly true in the lower part of the breasts just above the fold. Silicone gel will have much less of a tendency to have rippling and scalloping “feelable” and consequently it will be even more unlikely to have those changes visible. During your consultation you will have the opportunity to feel both types of implants and be able to better understand the differences.
The main advantage of saline implants is that when they do break (remember, all things break eventually), you will know it in a day or two as the water is absorbed by your body and your breast becomes flat. With silicone gel, however, the gel remains within the scar tissue pocket and you will not see any difference whatsoever. With silicone gel implants, if you want to know whether the implants are intact, a breast MRI is necessary. With saline implants, you just have to look at your breasts to know if they are intact. For that reason, it is recommended that women who have silicone gel implants consider periodic breast MRI imaging to check the status of the implants. I recommend you consider having this monitoring at eight years post-op and then every three years thereafter. We can refer you to a facility that offers a deeply discounted rate for an MRI for breast implant surveillance.
I am frequently asked if silicone gel breast implants are safe. They are as safe as saline implants in my opinion as they have no known generalized illnesses associated with them should they leak. In fact, what typically happens is that when they do leak, you will not notice any change at all. Countless studies have shown that silicone gel-filled breast implants do not have any higher rate of general illness associated with them (whether they are intact or broken) when compared to patients who have saline implants or have no implants at all.
The only other difference is that silicone gel-filled implants are a bit more expensive than saline-filled implants. On the grand scheme of the cost of breast augmentation, however, the cost of the implants should not be how you make the decision as to which type of implant you want.
So, in general, decide what results you want, saline or gel, and then decide whether you are willing to accept the maintenance necessary for each type of implant. If you are willing to undergo MRI monitoring to check whether the implants are still intact, then silicone gel will be a great choice as it will certainly give you a more natural-feeling result. If you are unwilling to consider the MRI monitoring of your implants for leakage, however, then saline implants might be right for you. Remember, however, you would have to accept that they might be more “feelable” and there might be rippling around the edges of the implant.
Remember, no matter what you decide, the decision will not be made until after you have had a chance to talk to me during your consultation and have any other remaining questions answered. Your care will be customized to your goals and desires.