There’s an opinion that’s asserted by breast implant manufacturers — and echoed by many physicians — that silicone gel-filled implants are better than Celebrity Plastic Surgeon saline-filled implants. In my opinion, “it ain’t necessarily so.” Since the FDA moratorium on silicone gel-filled implants began in 1992, I, like many plastic surgeons in the United States, had been limited to using saline implants for primary breast augmentation surgery. Between 1992 and 2008, I placed Mentor smooth round saline implants in more than 3,500 patients.
In November 2006, the FDA approved silicone gel implants. Soon after, the San Diego Union-Tribune reported “that plastic surgeons said they would quickly become preferred among the nearly 300,000 women in this country who have breast implants each year.” Mentor called the decision a “historic moment,” while Allergan, the other silicone gel implant manufacturer, said it “created new options for women. “The main selling point was that silicone gel implants feel more natural.
In the two-year period from November 2006 through October 2008, only 4 of my 709 patients requested silicone gel-filled implants. They have not become “preferred” over silicone implants. It’s true that when you hold a saline implant in one hand and a silicone gel implant in the other, the gel feels softer. So it’s reasonable that some doctors suggest that silicone implants are better than saline when placed in the subglandular position (in front of the muscle). I never recommend this placement because there are many more advantages to going behind the muscle: it looks more natural, there is less chance of capsular contraction or hardness, less interference with mammography, and it may be preferable for thin women. There is also less chance of infection. When the saline implant is placed behind the muscle, it feels similar to a silicone gel implants for most patients. Also, because a portion of her own breast overlies the muscle and implant, a woman usually can’t differentiate an implant — whether silicone or saline — from her breast. Because the implant has a large pocket to move through, it is soft.
Advantages of Saline Implants: Availability:Silicone gel implants are restricted to women 22 and older, while saline implants are available to women 18 and older. These young woman who have not developed report that they are self-conscious when they are on the beach with their peers and that they can’t find clothing or swimsuits that fit.
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 want more than 350ccs. (In fact, they choose an average implant of 433ccs.) Therefore, I prefer to use saline implants, and I’ve experienced very few complications with them. My patients choose their size by looking at pictures of women similar to them in height, weight, breast diameter and starting volume of breast tissue, as if they are looking in a mirror at themselves. They see pictures of women at nine months post-op, when the implants have fully settled, and pictures of women in clothes.
Incision Size and Ease of Placement: The saline implants, which are empty, can be folded and placed through a small incision. My incisions are usually about 3 cm, whereas a pre-filled silicone-gel implant requires a 5-7 cm incision on average. Also, it’s much easier, and requires less dissection, to put an empty implant through an incision than to try to manipulate — without breaking — a gel-filled implant.
Rippling: In my experience, 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 patient 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 were dissatisfied with the feel or look of the rippling, she would be a good candidate for an exchange to a silicone gel-filled implant, but only at this point.