Breast Implants are utilized in both cosmetic and reconstructive surgery. The two basic types of implants are saline and silicone filled. Until recently, women seeking plastic surgery for breast enlargement were limited to saline unless a breast lift (mastopexy) was being performed at the same time. In that case, they could qualify for use of silicone implants but only as part of a clinical study. As one of the study investigators, I was one of the few cosmetic plastic surgeons in the Tampa and Palm Harbor, Florida area able to use silicone implants at that time. In November of 2006, the FDA announced that silicone breast implants would once again become available for cosmetic plastic surgery patients over the age of 22. Since that time silicone has become my customary choice.
Saline breast implants are similar to silicone filled implants and are made from a silicone shell. However, the implant is filled with saline (salt water) rather than silicone. This quality gives us the advantage of adjusting the size of the implant to accommodate your desires for breast enlargement. Also, it allows us the luxury of slightly overfilling to try to minimize the rippling or wrinkling effect sometimes seen. Another advantage of saline breast implants is that they are easier to detect a rupture or leak. The disadvantage of saline in my opinion is that they do not usually feel as natural, and they are more prone to visible wrinkling than silicone breast implants. Those two reasons are predominantly why I advise most patients to choose silicone.
As I mentioned above, the silicone filled gel breast implants that I use were recently re-approved by the FDA for cosmetic breast enlargement. In the early 1990’s Concerns were raised about the safety of silicone filled gel implants and their likelihood of contributing or causing various autoimmune diseases like lupus, scleroderma, and rheumatoid arthritis. At that time, they were taken off of the market for use in most cosmetic plastic surgery cases except as part of a clinical trial like the one mentioned above. They were also still eligible for use in breast reconstruction. After 14 years of reviewing data and clinical studies evaluating silicone filled gel breast implants and the autoimmune diseases showed that there was no conclusive evidence that silicone implants caused major health problems. Therefore, the FDA re-approved their use for breast enlargement in women over the age of 22. Despite their re-approval, the FDA has asked that both of the major manufacturers of silicone breast implants (Allergan and Mentor) continue with a post-approval study for ten years.
What is different now than in the past? Mostly the difference is that there is no solid evidence that silicone implants cause any of the autoimmune diseases. Also, the silicone gel implants created in the past were more of a liquefied gel that could ooze out of a leaking implant. Modern silicone breast implants are more of a cohesive gel; it has consistency is more like a Gummy Bear than like a jelly donut.