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What are the pros and cons of silicone gel fill vs. saline fill? Ask Dr. Brian Evans

Both the silicone-gel-fill and the saline-fill implants are excellent. But they have many differences between them.

The major differences concern the eventual failure of the implants: how to tell that they have failed, and how to deal with the failed implant. The implant lifespan, that is the time until failure, is the same for silicone-fill as for saline-fill. And neither saline nor silicone gel make the woman ill, even after the implants fail. When a saline-filled implant fails, the salt-water leaks out into the scar capsule, and then passes out through the scar capsule where it is absorbed and then passes out just as if the woman had taken a glass of water. When a silicone-gel-filled implant fails, the silicone will be free to pass into the space between the implant shell and the scar capsule, and with today's cohesive implants, it is only a small quantity that does so. But the silicone does not continue on through an intact scar capsule, instead remaining trapped within it, except for a tiny amount of microscopic droplets or molecules. So it is easy to picture what effect these two events have on the size of the breast: the breast gets smaller when a saline implant fails, but stays the same size when a silicone implant fails. So which is better? It depends upon the patient's priorities.

Some patients want to know right away when their implants fail so that they can get them replaced promptly. With saline, they will know right away as the breast gets smaller, and there is no need for special tests to be done. So those patients would say the advantage goes to saline. Other patients do not want a leak to produce a noticeable decrease in their breast size, not to have anyone else be able to tell. So those patients would say that the advantage goes to silicone gel. Our patients who do swimsuit modelling, for example, could find their career impacted negatively if they experienced a size change while on a shoot in a remote location, so many of them prefer silicone-gel fill. The other side of that issue is: how can failure of a silicone-gel-filled implant be detected if there is no size change? Special testing can be done as follows.

Failure of a silicone-gel-filled implant can only be detected by doing special testing:

 

Accuracy of different special tests for silicone gel implants failure:

  • Physical examination is less than 10% accurate.
  • Mammography is less than 50% accurate.
  • MRI is about 95% accurate, but costs $2500-$3000 each time. FDA recommends every 2 years.
  • Ultrasound is up to 98% accurate if done by an expert ultrasonographer.
  • Operative endoscopy is nearly 100% accurate.

Note that complete ruptures are easier to diagnose, small leaks are harder to detect.

Then there is the question of what kind of operation is needed to replace a failed implant of each type. Replacement is fairly simple for the patient to go through for saline implants: The major part of the original enlargement operation was the formation of a pocket for the implant where there was no pocket before. So if a saline implant fails, the pocket is already there, and all that is needed is to slip the old deflated saline implant out of the pocket, and slide the new one in, through a tiny incision. Usually the same incision site is used, including through the navel. It must be pointed out that so far there is no way to put silicone gel implants in through the navel.

Replacing a failed silicone implant is usually a much more involved procedure. In that case, there are usually tiny silicone droplets within the scar capsule, and most plastic surgeons agree that removal of the scar capsule is adviseable in this situation. And so that requires a longer incision, and more time in the operating room, thus greater expense.

There is also the issue of cost. The silicone implants themselves cost more than saline implants. The surgery to insert silicone implants costs slightly more than for saline implants. Offsetting those costs a little is the fact that the extended warranty is provided free with silicone implants. An important cost consideration with silicone gel implants is the matter of the MRIs. The FDA recommends that every patient who gets silicone implants go for frequent MRIs (at her own expense about $2500-$3000) at 3 years after surgery then every 2 years thereafter. Most women say they intend to get these studies performed on schedule because it is important to them to know if their implants are no longer intact. On the other hand, we do have patients who have shared with us that they have no intention of following the FDA recommendations since there is no FDA penalty for not complying. It is entirely patient choice.

On the other hand, some women prefer the way that silicone implants feel to the touch. It is difficult to put the differences into words, but the best terms women have used are that the silicone implants feel "squishier" or more "doughy" than saline. A little experiment that can be done at home to sort of simulate the two is as follows: take two baggies; fill one halfway with water, and the other halfway with honey; remove the air from each and seal them; hold them such that the bags are fairly tight; then press a finger into the side to indent the bag and pull back the finger quickly. The difference sort of simulates the way that the implants feel when compressed. Usually it is extremely difficult to tell by squeezing the breast whether the implants are saline or silicone. Similarly, it is generally not possible to tell by appearance or photos whether the implants are silicone or saline.

As far as hardening of the scar tissue capsule is concerned, the chance of such capsular contracture is higher with silicone than saline: about 5% chance with saline, and about 15% chance with silicone.

Which is better? It should be clear that both saline and silicone are excellent choices, but just different from each other. Both result in happy patients who are glad they chose to have the operation done!

Dr. Brian Evans is an experienced, board-certified plastic surgeon who specializes in breast augmentation can be invaluable in helping you decide how large you want to go.

 

At Brian Evans Plastic Surgery clinic, we spend time during every breast implant consultation to address your questions or concerns, and we personalize every procedure based on your aesthetic goals.
A thorough first consultation is scheduled to understand the requirements of patients before procedures are performed. We will also take into account how lax, or loose, your skin is — an important consideration because, for an aesthetically pleasing augmentation, you must have enough tissue to cover the breast implants.
Contact Dr. Brian Evans (818) 676-4001 today to schedule your West Hills Hosptial & Medical center breast augmentation consultation

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