People have very strong opinions on this topic and, unfortunately, most of the information on this topic is not based on facts. Understanding the history of the different types of implants may help shed some light on the topic.
THE HISTORY OF SILICONE & SALINE IMPLANTS
The first silicone implant for breast augmentation was made in 1961, and the first saline implant in 1964. The silicone implant went through various changes for the next several decades in attempts to improve the longevity, feel, appearance, and texture. Saline implants were not used frequently, as the feel and look of the silicone was far superior. In 1992, the FDA placed a moratorium on the use of silicone implants, stating there was insufficient data proving their safety. Basically, the FDA was saying not to use these until we have a lot more research showing they are safe. At this time, saline implants were used in almost every case except for patients undergoing reconstruction or those involved in the clinical trials.
CONCERNS WITH SALINE OPTIONS
Saline implants worked fine, but there were problems. Saline implants tend to show more ripples, so placement was almost always under the muscle. This requires slightly longer recovery, and over time the implants, in some patients, tend to shift down and out. This is perhaps due to the action of the muscle in combination with the viscosity of the saline. At any rate, pocket revisions for implants sliding off to the side of the chest were not uncommon. Because the muscle only covers a portion of the implant, ripples could be seen on the lateral or outer portion of the breast. The biggest downfall of saline implants is the rupture rate of 3-6 percent at three years, and 7-10 percent at 10 years. Saline implants can rupture without any cause, and it usually happens a week before a scheduled vacation. Joking, but its never convenient to wake up and discover your breast has gone flat. The rupture rate of silicone, by comparison, is less than 1 percent at 6 years.
RISE OF SILICONE IMPLANTS
In 2006, the FDA allowed the manufacture and use of silicone implants once again. The studies proving their safety were to continue for an additional 10 years. During this time, there were no studies that showed a correlation between silicone implants and any disease process or syndrome (chronic fatigue, fibromyalgia, lupus, etc.). The silicone implants used today are vastly superior to the ones used back in the ’60s. The outer shell of the implant is pliable but very resistant to tearing or leakage. The biggest improvement is in the quality of the gel. All silicone implants made now have some form of cohesiveness. That is, the silicone gel isn’t a liquid that will leak out if the outer shell is damaged. There are gummy bear, memory gel, and cohesive gel implants that all have slightly different qualities, but basically, if the implant is damaged, the gel will stay within the shell. If pressure is applied to a damaged implant, the gel will come out of the implant and then return to the inside of the shell once the pressure is removed.
Silicone implants can be placed in front of the muscle or behind the muscle, depending on the amount of available breast tissue. If a patient has adequate tissue to cover the implant, then in front of the muscle is an excellent option. The recovery for this surgery is two to three days. In very thin patients with little breast tissue, the implant is placed behind the muscle.
The bottom line? Both saline and silicone implants will augment the breast. Silicone implants, in my opinion, are vastly superior to saline in terms of natural feel, appearance, and longevity.