The return of silicone gel implants in breast augmentation has been refreshing in providing another option to some of the issues related to saline implants. Understandably, their return creates some questions about their history and past performances. Specifically, issues relating to their safety and what happens if they should rupture. I have found that the best way to address these issues is to understand the physical nature of the silicone gel used today.
Silicone is a manufactured material (polymer) composed of three elements, silicon, oxygen, and hydrogen. Silicon as a natural material is one of the most common elements that we as humans come into contact. (e.g., sand and rocks) The way silicone is manufactured determines how this polymer behaves as a material. It can be more like a liquid, like in many beauty products, or it can be like a solid such as a chin implant or a coating on an IV catheter. While once more liquid-like, breast implants today use a silicone gel consistency that is more cohesive….very similar to jello or a thick custard texture. In the ‘old’ days, the silicone in breast implants was more like old-style karo syrup (never flowed like a true liquid like water). Today, the silicone gel is more bonded together. So when one thinks of it ‘escaping’ from the breast implant…it really can’t. It is like each molecule is a person, but if one tries to leave the room it is pulled back by the others. This is what the term cohesive means. If you cut a piece out of a cohesive gel breast implant, it is like cutting out a piece of pie. (see attached picture)
All breast implants may eventually fail or develop a tear or hole in the bag, known as fatigue failure of the shell. This is a risk for every patient and eventually many breast augmentation patients, if you live long enough or had implants placed early in your life, will see this risk come to fruition. It is a natural phenomenon that develops over time through the motion of the implant’s wall as it is pushed about by external pressures on the breast. Eventually a crack (fatigue failure) will develop and a more visible hole or tear may be seen. But since the silicone gel is cohesive. it can’t not escape like a liquid. There is nothing ‘free’ to run loose into the body. Plus there is the added insurance of the surrounding breast implant capsule or scar, like an additional protective sac (2nd layer) around the silicone gel material.
Newer verions of cohesive silicone gel breast implants are also being used, known as ‘gummy bear’ implants. Just like the candy gummy bears, the silicone gel is even firmer and may ultimately be the best cohesive silicone breast implant yet.
Dr. Barry Eppley
Indianapolis, Indiana