Breast augmentation is the most commonly performed plastic surgery procedure in the United States. Implant-based breast augmentation involves the surgical placement of a silicone-shelled implant under the breast tissue or pectoral muscle. From 1992 until 2006, saline-filled implants were the only implants approved for cosmetic augmentation. Today, after 14 years of medical trials, silicone implants are also an option.
Silicone Implants
A “silicone” implant is prefilled with a silicone polymer of various consistencies. The first generation implant designed in the 1960’s contained liquid silicone. It had a higher incidence of internal scar formation called capsular contracture as well as leakage and rippling. It has been replaced over time with gummy bear consistency type implants. Unfortunately, the first generation implants are still used in other countries.
Since 2006, fifth generation cohesive silicone implants have been the implants most often used in the United States. They leak less and maintain a natural feel. They can be placed through small incisions using a special device called a Keller funnel.
The latest advancement in silicone technology is the highly cohesive, form-stable (tear drop shaped) implants. FDA approved in 2013, these implants have a true gummy bear texture. They have virtually no leakage while maintaining a natural feel and look as rippling is unlikely. However, these implants do have some drawbacks, which are discussed below.
Saline Implants
Saline implants became the only choice for augmentation after silicone implants were taken off the market in 1992 to be further studied. They are made of a silicone shell that is placed in the breast pocket and then filled with saline to the chosen volume on the operating table. They have the benefit of allowing placement of any size implant through a small incision. Until recently, this was a major benefit to saline implants versus silicone implants. In addition to this, saline implants have always been less expensive. The downside, however, is that they definitely lack the natural feel of silicone implants. Visible rippling of the implant, especially in thin patients is a major concern. Overfilling the saline implant helps this issue to some degree, but increases the risk of implant leakage and warranty disqualification. Despite this, many patients still opt for saline implants and they are widely available.
Pros and Cons
It is important to note that neither silicone nor saline implants need to be removed or replaced unless there is a reason. Manufacturers estimate that implants have a 10-year lifespan before they may need to be replaced. This does not mean that the implant expires in 10 years. In fact, the vast majority of people do not experience a deflation and will not need replacement implants.
This being said, saline implants are the only style of implant that can deflate. Deflation is a rapid decrease in size of the implant. This does not pose a systemic health concern but may result in a local abnormality that is felt on a breast exam or seen on a mammogram or MRI. On the other hand, highly cohesive silicone implants will not leak or deflate and will largely go unnoticed. Studies have shown that other silicone implants have a 1-3 % chance of this happening to a patient in the first six years. The FDA recommends that people who have silicone implants have an MRI periodically starting three years after the implant has been placed. This is done to continually track the rate of silicone implant rupture. Due to the fact that silicone implants are highly safe, people usually only have an MRI if there is a concern of implant rupture.
Advanced Cosmetic & Plastic Surgery offers the newest and most sophisticated cosmetic surgery procedures for men and women, including breast augmentation, neck and face lifts, eyelid surgery, rhinoplasty (nose surgery), liposuction, abdominoplasty (tummy tuck), reduction or reconstruction, as well as Botox, Juvederm and other injectable fillers. All procedures are done by ASC surgeons Dr. David Goldenberg, Dr. Sohel Islam, Dr. Prashant Soni, and Dr. Julia Toto. ASC offices are located in the Fairfield County, CT towns of Danbury, New Milford, Norwalk, Ridgefield and Southbury.
– Dr. Prashant Soni