August 2007

Silicone or Saline?

Saline breast implants were approved by the FDA in 2000 and silicone gel breast implants were approved by the FDA in 2006. Most plastic surgeons prefer silicone gel because they feel more like a breast. But there are reasons why some plastic surgeons and some women like saline implants better.

Advantages of Saline Implants Compared to Silicone

Saline implants are empty during surgery, and filled afterwards. That means that the incision (and scar) will be smaller.

Saline implants cost about $1,000 less than silicone gel breast implants, but there are other reasons why saline implants are much less expensive than silicone.

When saline implants break, they deflate quickly. When silicone gel breast implants break, they may look the same for months or even years. That might seem like an advantage for silicone gel, but it is really a disadvantage, because a broken silicone implant can slowly leak silicone into the breast, the lymph nodes under the arms, and from there to the lungs and other organs. To prevent that from happening, the FDA and the implant makers warn that women with silicone gel breast implants need to have a breast MRI 3 years after getting their implants, and every other year after that. In 2007, the average cost of a breast MRI was $2,000, and it costs much more at some hospitals. Like most medical costs, the prices are likely to go up. That will add more than $10,000 in the 10 years after getting implants, even if there are no other problems or complications.

In addition to the higher costs, the risk of leaking silicone is much greater than the risk of leaking saline. Saline is salt water. Although mold and bacteria can grow inside a saline implant, any resulting illness can probably be treated with antibiotics. If silicone gel gets into a woman's breasts, surgery will remove her breast tissue at the same time as the silicone is removed. If silicone gel gets into a woman's lymph nodes, the nodes will need to be removed. If silicone gets into her lungs or liver, it can't be removed.

Advantages of Silicone Gel Implants Compared to Saline

Women with saline breast implants sometimes complain that the salt water implant doesn't warm up the way a natural breast does, so their breasts feel cool rather than warm. The implants can get unpleasantly cold in very cold weather, according to women who like ice-skating and similar sports. Women with saline implants also complain that the implants may make a swooshing water noise that makes them feel self-conscious.

Similarities between Silicone Gel Breast Implants and Saline Breast Implants

All breast implants have a high complication rate. Saline implants may have more cosmetic problems, but silicone gel breast implants seem to have more serious complications. For example, capsular contracture causes the breast to feel firm or hard and painful. It can happen with either saline or silicone gel, but is more common with silicone gel implants.

All breast implants interfere with mammograms, hiding tumors that are above or below the implant. That's because the implant shows ups as a solid white shape on a mammogram, and cancer shows up as a small white shape. The white shape of the implant hides the white shape of the cancer.

All breast implants have a silicone outer shell, whether they are filled with saline or silicone gel. Implant manufacturers warn that no breast implants were tested on women with autoimmune diseases such as rheumatoid arthritis, lupus, or MS. The reason is that the manufacturers were concerned that the implants could be especially risky for those women. Women with family members having those diseases should also be especially concerned about the risks.