Breast Augmentation: Is One Implant Better Than Another?

Breast Augmentation: Is One Implant Better Than Another?I am still asked the simple sounding question, “which breast implant is better, saline or silicone?” Patients want an opinion.

Often they will get several opinions before deciding, and this is always a good idea.

Saline is a saltwater solution imitating natural body fluid and is a standard solution in intravenous fluids and other medical uses. Silicone Gel, Memory Gel and Cohesive Gel are silicone, which is neither liquid nor solid but in between. When cut (or when a leak develops), it doesn’t flow or break up. All silicone filled implants are like this today.

It takes me quite a while to give an answer. Like many questions in medicine, the answer is, “that depends”. There are advantages and disadvantages of each, and to complicate matters, there may be an alternative in the not too distant future.

It depends many things. Some patients are most interested in the most natural, most undetectable implants possible. For these, today, silicone gel filled implants offer the most lifelike feel. But the difference between saline and silicone isn’t as obvious once they are inside the body compared to when you hold the implants. And the more natural breast tissue and body fat you have, the less difference it makes. If you have generous breasts which have drooped and you are having a lift with a modest implant to give additional fullness, saline may be just as good as silicone, because the implant will make up only a part of the total.

Saline has some advantages. First, though it isn’t usually a deciding factor, they are less costly (about $750). Second is the matter of detecting leaks, and the consequences of leaking implants. When saline implants leak, the body, which is about 70 per cent saline to begin with, absorbs the saline. This is harmless. With the implant volume reduced, there is an obvious loss of breast volume. You know immediately if there is a leak: The breast looks and feels smaller.

When a silicone gel implant shell develops a leak, the contents don’t go anywhere and aren’t absorbed. While this doesn’t appear to cause any harm (and this is after years of research), you won’t see or feel any change and probably won’t know you have a leak. In the United States, the FDA requires patients with silicone implants to undergo routine MRI screening for leaks three years after surgery. Canada does not require it.

The big advantage of silicone implants is how they feel and look. When you don’t have much breast tissue and body fat of your own, saline implants tend to feel a little too much like what they are, a salt- water filled silicone bag. Waviness (called “rippling”) may be visible through the skin.

Silicone implants, because the “gel” isn’t liquid, don’t do this anywhere near as much. This is much less a problem with saline when implants are under the pectoralis major muscle.

But if you are very thin with little breast gland tissue, silicone offers a distinct advantage. Because the majority of breast augmentation patients have very small breasts, the majority of them end up choosing silicone gel implants.

There are other choices beyond the basic silicone vs. saline split. The final decision is one you can only make with advice from your surgeon, in the course of a consultation.

Writer: Benjamin Gelfant, plastic surgeondirector, Broadway Cosmetic Plastic Surgery Centre

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Category: Breast

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