The most important choice a woman makes in breast augmentation is the choice of filler material of the breast implant. As of 2006, silicone gel implants became available again and thus one has to choose between saline (which has been the only implant option available since 1992) and now silicone. The thing to remember is…..neither type of breast implant is perfect. If one was so much ‘better’ than the other….we would have only one implant type, not two. Both can satisfactorily increase breast size equally well, they just have some different features (pluses and minuses). Knowing what their benefits and liabilities are can help you make the right choice for you.
Saline implants have the following benefits: 1) They are put in deflated, rolled up, and inflated after they are in proper position. Therefore, they can be put in through very small remote incisions such as the armpit, 2) They cost less than silicone, typically $1,000 less per operation, and 3) They are the most natural material (salt water) so if they leak, you are essentially just taking a big drink of water. Saline implants have the following two liabilities: 1) They have the phenomenon of wrinkling or rippling. In other words, you will be able to feel, and sometimes see, ripples along the bottom and sides of your breasts. Most saline breast implant patients will experience this ‘normal’ appearance, 2) The risk of spontaneous deflation (rupture of the implant) is ever present and increases the longer the implants are in place. When a saline implant fails (ruptures), you will know it almost immediately because you will develop a ‘flat tire’ quite quickly. While some saline breast implants may never deflate, it is unlikely they will last beyond 10 to 20 years.
Silicone implants have exactly the opposite benefits and liabilities of saline implants. On the positive side, 1) Silicone breast implants do not have the ripple phenomenon that saline implants do. Therefore, they feel the most natural. It can be very difficult, by feel, to ever know that a breast has a silicone implant in place, and 2) While a silicone gel implant can rupture, the filler material is cohesive and does not come flowing out. As a result, the breast does not deflate in size or get smaller. The ruptured implant is essentially undetectable, and as long as the breast remains soft and pain-free, you can live with a ruptured silicone breast implant without the need for further surgery. On the liability side, 1) Silicone implants come pre-filled, thus needing a larger incision to surgically implant it. The most common incision location for silicone implants is in the inframammary crease (breast fold). Remote incisions like the armpit, and often even the nipple, are not big enough to insert the implant through. And 2) they cost more than saline, at least $1,000 more in most cases.
The best way to chose which type of breast implant is for you……which of the negatives can you live with the best……risk of rippling and deflation (saline)……or higher cost and a bigger incision (silicone)…the choice is truly yours!
Dr Barry Eppley
Indianapolis, Indiana