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Choosing Saline or Silicone Implants Written By: Leonard M. Hochstein, M.D., P.A. Miami Florida, Board Certified Plastic Surgeon In recent years there has been some debate as to which implants are better and what kind of maintenance or replacement is necessary. The FDA ruling to allow the use of silicone again has certainly raised the popularity of these implants and I have seen a greater demand in my own practice in Miami. So what are the differences? Breast implants are composed of a shell and a filling. The shell consists of solid silicone. In saline filled implants there is a valve through which saline is added. The Silicone implants come pre-filled so there is no valve present but instead their surface is completely smooth. The main difference of course, is the filling. Saline implants are filled with salt water and silicone is filled with silicone gel. The surgery of implant placement also differs. Because saline implants are empty they require a smaller incision for their placement and they are filled and positioned in the pocket. Because silicone is pre-filled this incision has to be larger (generally about half an inch more). For this reason, some surgeons have used the lower fold incision for placement which I consider a cosmetically inferior choice. I have preferred to extend the areola (nipple) incision rather than using the lower fold. The wound closure is identical when I used absolvable sutures which do not need to be removed and do no leave a mark. Postoperative care is also identical. Now that the implants are in how do they differ in look, feel and durability? From across the room it is practically impossible to tell the difference but when bending over the saline implants will demonstrate more rippling on the sides of the breast. The feel is unmistakable. Silicone implants are soft and feel almost like breast tissue. Saline implants are much more easily felt, meaning that the edge of the shell can be felt, as well as the rippling in the areas where it is not covered by muscle especially in the lower and outer areas of the breast. The last issue is durability and the statistics may surprise you. In a comparison of 3 year data saline implants had a leak rate of 3.3% whereas silicone implants had a leak rate of 0.5% signifying a much lower rate of replacement or re-operation. At year 4, the risk goes up to 1.8% for silicone and 10% for saline. Based upon this data I would consider silicone to be the more durable implant to date. If the implant does develop a leak the treatment can differ significantly as well. A saline implant deflation is easy to diagnose as the breast basically goes flat quickly. Silicone implants that have been compromised are not visible by self exam or mammogram but require an MRI to diagnose because the silicone used now is cohesive and it will maintain its shape even if compromised. While saline leaks are easier to diagnose, saline replacements may be more difficult. When saline leaks, the reduced size of the implant can cause the pocket to collapse. The new silicone implants retain their form even after a rupture so the pocket will maintain its shape, potentially making the replacement easier. Both of the implants are well made and stood behind by Mentor. They offer a 10 year warrantee on saline implants and currently a lifetime warrantee on silicone. I don’t think that you could ask for much more. On average silicone implants are about $1,000.00 more for a pair than saline but based upon the data and experience I would say it’s more than worth it. Article Courtesy of Leonard Hochstein, M.D. - Miami, Florida

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