Silicone Gel Implants Are Back: So What?by Guest Blogger Dr. Ted Eisenberg There’s an opinion that’s asserted by breast implant manufacturers – and echoed by many physicians – that silicone gel-filled implants are better than saline-filled implants. In my opinion, “It ain’t necessarily so.” In 1992, the U.S. Food and Drug Administration (FDA) determined that implant manufacturers had not provided adequate information “to demonstrate that silicone gel breast implants were safe and effective, so they took them off the market with a few exceptions. Like most U.S. plastic surgeons, I was limited to using saline implants for breast augmentation surgery. In 2006, after reviewing the data and failing to find a link between silicone gel breast implants and disease, the FDA lifted its 14-year ban and approved them for all women 22 and older. Implant manufacturer Mentor Corporation called the decision a “historic moment,” while its competitor, Allergan, said it “created new options for women.” Plastic surgeons predicted “that silicone gel implants would quickly become preferred among the nearly 300,000 women in this country who have breast implants each year,” according to an article in the San Diego Union-Tribune. That prediction has not come true: In the six-year period from November 2006 through June 2012, only 22 of my 1,850 patients have requested silicone gel-filled implants. The manufacturers’ main selling point was that silicone gel implants feel more natural. It is true that when you hold a saline implant in one hand and a silicone gel implant in the other, the gel feels softer. When implants are placed in front of the pectoral muscle (subglandular position), silicone implants can feel more natural than saline, but when they are positioned behind the pectoral muscle (submuscular position) saline and silicone gel feel similar in most patients. I rarely recommend subglandular placement because there are many more advantages to going behind the pectoral muscle: there is less chance of hardness (capsular contraction), less interference with mammography, and less chance of infection. Because the implant has a large pocket to move through, it is soft. Aesthetically, implants look more natural when placed behind the muscle. In fact, because a portion of her own breast overlies the muscle and implant, a woman usually can’t differentiate an implant –silicone or saline – from her breast. Here are some of the other differences between saline and silicone gel implants: Availability: The FDA has approved the use of silicone gel implants in breast augmentation for women age 22 and older, whereas saline implants are approved for women age 18 and older. Implant Size: The Mentor Product Insert Data Sheet warns that silicone gel implants larger than 350ccs may increase the risk of developing complications. In my experience, women generally want more than 350 cc implants. In fact, they choose an average implant size of 433 ccs. Incision Size and Ease of Placement: For saline implants, the incision averages 1-1/2 inches long; for silicone gel it’s closer to 2 inches. Silicone gel implants are prefilled, so the surgeon needs to make a larger opening to insert them into the space. By contrast, saline implants come empty and can be folded up and inserted through a smaller incision. It’s easier, and requires less dissection, to put an empty implant through an incision rather than to try to manipulate a gel-filled implant without breaking it. Rippling: In my experience placing saline implants in more than 5,000 patients, rippling is a very rare occurrence – even nine months or more after surgery when the skin is fully stretched, the muscle fully relaxed and the breasts completely healed into their final shape. Rippling might occur if a woman has had a significant weight loss with a corresponding loss of body fat, or if moderately droopy breasts get significantly droopier and skin becomes very thin after childbirth. If a woman is dissatisfied with the feel or look of the rippling, she would be a good candidate for an exchange to a silicone gel-filled implant. Implant Rupture: When a saline implant deflates, the breast returns to its original size, and the deflation is very obvious. When a silicone gel implant ruptures, the cohesive gel relatively maintains its shape. Usually, there is no physical sign of this change. To evaluate these implants for rupture, the manufacturers recommend that patients have an MRI three years after surgery and every two years thereafter. These MRIs are not covered by insurance. Cost: Silicone gel implants cost about $1000 more per pair than saline implants. When a woman requests silicone gel implants, I’m happy to oblige, but if she asks my opinion, I’ll tell her that saline implants are just as good and actually have a number of advantages.
 Ted Eisenberg
Dr. Ted Eisenberg is a Philadelphia-based plastic and reconstructive surgeon and author of The Scoop on Breasts: A Plastic Surgeon Busts the Myths. Since 1999, he has focused his practice exclusively on cosmetic breast surgery. He has performed more than 5,000 breast augmentations and holds the Guinness World Record for the most breast augmentations performed in a lifetime. He is also the creator of the IDEAL™ Breast Lift. www.lookingnatural.com
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