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Beyond deciding that one wants a breast augmentation, the next big choice is whether it should be done with a saline or silicone gel breast implant. There are numerous advantages and disadvantages to either one and neither implant is perfect. Here is one implant choice consideration, implant failure, discussed in detail. One may initially think that how a device fails would not highly influence device selection, but it can.

All breast implants will eventually fail. No patient will live their entire lifetime and not have to replace one or both of their implants. Failure in breast implants refers to a disruption in the containment sac or the bag (shell) that contains the internal filling. This allows some or all of its contents to come out. Because saline is essentially water, any hole will result in near immediate loss of its contents, a term accurately described as deflation. In other words, your breast will almost immediately go flat and will be obvious.

Silicone implants do not fail in the same immediate way. Because silicone gel is a lot thicker and does not flow very well, little of the material comes out so there is no immediate loss of breast volume. Silicone implant failure is not known as deflation, rather it is called silent rupture. One can go for years and never know that their implant has failed because the breast volume does not change. Most of the silicone stays inside and can not be absorbed even if it does come out.

Because of the differences in how they fail, replacement of silicone ruptures can be done more electively than saline deflations. Saline implant failures are often viewed by patients as an ‘emergency’ although they can be done electively anytime after they deflate…even years later.

When saline breast implants deflate, many patients will replace both implants with silicone if it is financially affordable. Having had one breast implant deflation, they understandably worry about when the intact implant will similarly fail. When only the deflated implant is replaced, it is usually done because it is the lowest cost approach. I have yet to see a patient with an implant failure of any type that just wants both implants then removed.

Many patients wonder how saline breast implants fail and how the volume of saline placed in them may impact such failure. Implant sizes come with what is known as minimal volume fill. This means that a 350cc saline implant, for example, should be filled with at least 350cc. Underfilling is one of the known reasons for early saline implant deflation. It is generally accepted that overfilling a saline implant will improve their longevity, which is the opposite of underfilling. How much to overfill has never been shown to influence deflation prevention. The manufacturers recommend a maximum fill which is usually close to 10% of the minimum volume. (e.g., 350cc maximum fill is 400cc) Overfilling beyond the maximum range may have certain advantages but greater longevity is not one of them.

What causes silicone implant failure is not as clear. Since they come pre-filled and unadjustable, volume fill has no impact. One factor that I conjecture can lead to early silicone implant failure is how they are inserted. Pushing a silicone implant through a very small incision can place undetected stresses on its shell, creating weak points that eventually cause a fracture or tear months to years later. This theory can’t really be proven but the insertion stress on a silicone implant shell seems intuitive. One recent insertion device for silicone gel implants, the Keller Funnel, helps in reducing these stress point areas by distributing it more evenly over a greater surface area of the implant. It also avoids any human contact with the implant from the package to the internal breast pocket.

Dr. Barry Eppley

Indianapolis, Indiana   

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