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The Pros and Cons of Saline Breast Implants

Monday, August 18, 2014

When patients choose to undergo breast augmentation surgery at Avenue Plastic Surgery, they are presented with a variety of options regarding the size, shape, and texture of their breast implants. They also have the opportunity to choose between silicone and saline implants. I know that the decision regarding which implant to choose can cause a lot of anxiety- silicone or saline, textured or smooth. The following is taken from my “Open letter to Patients” which you can find on my website.

“The first thing you need to understand is that any medical device when implanted in the human body is going to have a certain life span. Whether that device is a heart pacemaker, an artificial hip or a breast implant, its life span can be expected to be about 10 years. Some devices may last longer (many of our patients with saline implants have had them for over 20 years without any problems) but no-one can be sure what will happen after about 10 years. With breast implants, the risk is that they will leak.

This may happen after 10 years or at some time sooner if, for example, the woman has an accident, breaks a rib and the rib punctures the implant. With a silicone implant, if the implant leaks then the silicone can spread into other tissues. This is especially likely when the implant has been placed deep behind the muscle when any leaking silicone can go directly to the lymph glands.The consequence of this may be that the patient will develop multiple small lumps of silicone called silicone granulomata and these can be very difficult to remove without also removing some of the surrounding tissue. Even if silicone granulomata do not form, the silicone can be very difficult to remove as it sticks to the tissues like chewing gum. This was the reason saline implants were developed.

Saline implants have one remarkable safety feature. If they leak, for whatever reason, then the salt water (intravenous saline solution) which they contain is simply and harmlessly absorbed by the body. The shell of the implant can easily be removed and another implant inserted in its place. With such an overwhelming safety advantage, the only other consideration is whether saline implants are as soft as silicone implants. This depends on the design of the saline implant. how much it is filled and on where it is placed. If the implant has a smooth-wall and is placed under the muscle, then it is very difficult to feel the actual implant and patients are unable to tell the difference between a silicone and a saline implant.

If, on the other hand, the implant has a thicker, textured surface and especially if it is placed in front of the muscle in a thin person, then not only will the implant be palpable but rippling may also be visible and the result may not be satisfactory. For these reasons most women, when presented with this information, have a clear preference for saline implants with a thin smooth wall placed behind the pectoral muscle.

Recently three new types of breast implant have been made available. The first is the high cohesive gel silicone implant which has a much higher viscosity than the original silicone implant and thus the silicone may not travel into the tissues if a leakage occurs. This implant however is much heavier and firmer than other implants and some models may also leak silicone oil and other residues into the tissues with time. Some are more brittle and have been known to fracture. After a few years inside the body (where they are maintained at body temperature) the thicker silicone gel liquefies! In fact MRI studies have shown that 80% of these implants are leaking after 8 years!

Another new development is the tear-drop implant. This is supposed to resemble the breast more closely however, studies have shown that it looks artificial as it does not move the way the normal breast moves. For example, a round implant adopts a tear-drop shape when the person stands and becomes flatter when the person lies down – just as the normal breast does. Thus the implant moves with the person the way a normal breast moves. The tear-drop implant on the other hand always maintains its shape and this is the reason it appears firm and unnatural. A further complicating feature is that the implant may move after insertion and in some cases even settle in an upside down position. This will require re-operation in order to achieve a reasonable result.

The “Gummy Bear” or “Furry Brazilian” is yet another breast implant which has recently be reintroduced into Australia. This is a silicone gel implant which has been covered with polyurethane foam. This implant was originally marketed about 25 years ago but withdrawn because the foam was known to breakdown over 1-2 years and that at least one of the breakdown products was carcinogenic. The sole benefit of this type of implant is that it is supposed to reduce the risk of capsule contracture. However the risk is already very low provided the implant is placed behind the muscle and antibiotics are taken.

So is the potential benefit worth the increased risk? I don’t think so but for a full appraisal click here. For these reasons most women prefer not to experiment with these types of implants.”

If you are considering breast augmentation, we would be pleased to answer any questions you have about the procedure, including those regarding the advantages and disadvantages of saline breast implants.

Please contact our plastic surgery office to schedule your initial appointment with Dr. Kalus today.

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