Silicone vs. Saline Implants

Some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference. Replacing a ruptured silicone gel implant is more difficult than repairing a saline implant. Silicone implants also have a higher rate of capsular contracture and a higher deflation rate.

Saline Implants
Saline implants have a silicone rubber shell that is inflated to the desired size with sterile saline. Most implants have a valve that is sealable by the surgeon.

There are two types of saline-filled implants. One type is a fixed volume implant, which is filled with the entire volume of saline at implantation. Another type is an adjustable volume implant, which is filled intraoperatively and has the potential for further postoperative adjustment.

FDA Approval
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers' saline-filled breast implants are considered investigational.

Silicone Implants
Silicone implants have a silicone rubber shell that is filled with a fixed amount of silicone gel. Each implant has a patch that covers the manufacturing port of the implant.

Silicone implants vary in shell surface (smooth/textured), shape, profile, volume, shell thickness, and number of shell lumens. Most silicone gel-filled implants are not adjustable.

In the early 1990's it was reported that silicone breast implants were responsible for connective tissue diseases in some women. After a comprehensive evaluation of the evidence for the Association of Silicon Breast Implants with human health conditions, the Institute of Medicine concluded in June that there is "no definitive evidence linking breast implants to cancer, neurological diseases, neurological problems or other systemic diseases." However, silicone implants are still not available to the general public in the United States. They are still widely used in Europe and may be available again in the US.

Silicone gel-filled breast implants are available for select cases: women seeking breast reconstruction or revision of an existing breast implant, women who have had breast cancer surgery, a severe injury to the breast, a birth defect that affects the breast, or a medical condition causing a severe breast abnormality.

The U.S. Department of Health and Human Services states:

"For some years controversy has existed over silicone implants used for breast augmentation or replacement after mastectomy. Adverse effects from their use have been widely reported in the popular press, with conflicting information often appearing in the medical literature. This controversy and the attendant publicity led the Food and Drug Administration (FDA) first to ban any use of these implants and then to permit limited use, mainly as replacement after mastectomy.

"Silicone is used not only in breast implants but also in implants located literally throughout every part of the body. It has been used: to construct heart valves and other cardiovascular prostheses; to fashion catheters which are used for purposes ranging from drug delivery to cardiac monitoring; in dentistry; in the gastrointestinal tract; as a facilitator for nerve regeneration; in ophthalmology; in the ear, nose, throat, and respiratory tract; as a prosthesis or ingredient in prostheses for many parts of the skeletal system; as a tissue expander; as a cosmetic agent for treatment of scars and wrinkles; in the urogenital tract, including penile prostheses; and in many other applications."