Since the 2006 FDA approval for silicone implants to be used in breast augmentation, I have received several emails a week inquiring whether silicone implants are better than saline implants.  Lately, my patients have been asking this question almost every day.   I feel part of this is due to recent marketing campaigns being conducted by the major breast implant manufacturers in the United States.  Silicone is all the rage.  Right? 

First, I’d like to respond to this question by saying that both types of implants have benefits and trade-offs.  As a board certified Plastic Surgeon, I feel that I am obligated to educate and inform my patients about their options. 

In the plus column for silicone implants:  There is little doubt that the texture of the gel more closely mimics breast tissue than saline does.  Also for patients who are extremely thin or who have little breast tissue, rippling and wrinkling can be less of an issue with gel implants than with saline implants.   Lastly, the satisfaction rates for silicone implants are very high and approach 97% in some studies. 

In the negative column:  Silicone implants are more costly in both the short and long term to patients.  At the time of surgery, the devices are approximately twice the cost of saline implants and this cost is translated into a patient’s quote for surgery.  Over the subsequent years, breast MRIs are currently recommended to monitor for silicone implant rupture.  Under the current guidelines, this study is to be performed at 3 years after surgery and then every 2 years thereafter.  Patients should understand that this study is very costly and not likely to be covered by insurers.  Very quickly, the cost of repeated MRIs will exceed the cost of the initial surgery.   Also silicone implants come prefilled and due to this require incisions that are twice as large to place them.  This impacts recovery times and scarring.  Furthermore, patients need to understand that breast implants don’t last forever and very often they will need to be replaced in the future due to rupture.  Silicone implants can complicate these future surgeries.  Lastly, the capsular contracture rate associated with silicone implants should be considered.  A capsule is a scar that develops around an implant on the inside of the breast.  This scar can shorten or contract over time causing firmness in the breast, change of breast shape, or pain.  The historical rates for capsular contracture at 10 years is on the order of 38.5-90% for silicone implants.  Saline implants have a 10 year capsular contracture rate of 16.6%. 

So to answer the question, “Are silicone implants better than saline implants?”  It depends.  Blanket statements by the public, surgeons, or manufacturers can not be made.  The individual needs of a patient will make this determination.  One woman may decide that the feel of the silicone implant in comparison to a saline implant makes it better for her, and with this, she is willing to accept certain tradeoffs.   Another woman may decide that the benefits of saline implants in terms of capsular contracture outweigh the feel of her implant.  I truly believe that a patient who is fully informed about her options will choose the best implant for herself, be it silicone or saline. 

Here is an example of a patient that underwent a silicone breast augmentation in my practice.  She is a 26 y/o woman that presented desiring silicone breast implants.  She was very concerned about the feel of her breasts after surgery and wished to have an augmentation that would closely mimic the natural feel of her breasts.  On examination, she has some mild asymmetries and only fair soft tissue coverage.  Here is the preoperative photograph:

During our consultation, she expressed that she would like to have a large augmentation.  She decided that she would like to use 500 cc silicone implants.  Due to her soft tissue characteristics and due to her desire for a silicone implant, I recommended that she undergo a dual plane breast augmentation through an inframammary (breast fold) approach.  Here is the postoperative result:

The operation achieved her goal of a large breast augmentation with implants that feel very natural. 

Our websites www.beauty-surgeon.com and www.drmckane.com have additional information about breast augmentation and before and after photographs for review.  I invite you to schedule a consultation with me if you would like to learn more about silicone implants or breast augmentation.  Please feel free to contact our office at (713) 661-5255 if you have any questions.

-Brice W. McKane, M.D.

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