Breast implant options – silicone or saline implants?

There is a large amount of different breast implants and manufacturers around the world. The breast implants differ in terms of contents, surface, size, shape and quality. It is therefore, as a patient, important to understand the breast implants different characteristics and the importance of them being of a high quality. The first part in this series about breast enlargement is thus about this.

To begin with, there are two main types of breast implants, silicone and saline implants. Both types have a silicone coating but can be filled with either saline (saltwater), cohesive (firm) silicone gel (gummy bear) or viscous silicone gel.

There are also breast implants with a combination of these two main types, developed with the purpose of combining the advantages of the different types of implants. However, these are used less often.

Breast enlargement surgery (breast augmentation)

Silicone breast implants – by far the most common

Based on information from the two largest suppliers of breast implants, Mentor and Allergan (previously Inamed), silicone implants are the most used in the UK. Most silicone implants are of cohesive type containing a firm gel, known as gummy bear breast implants.

There is no doubt which type of breast implants the UK surgeons and their European colleagues generally prefer to use – cohesive silicone implants.

Saline breast implants more common in the USA

However, in the USA it is different. The sale there is divided 50/50 between saline and silicone breast implants. The explanation is that the American commission FDA up until 17 November 2006 banned the sale of silicone implants. Most likely many American surgeons will continue to use the implant type they are familiar with which explains the differences between Europe and USA.

The reason for the sales ban in the USA was because of a study in progress investigating possible connections between breast cancer and silicone filled breast implants. When it became clear that no such connection was found the sales ban was lifted. Although it is still only cohesive gel silicone implants which are allowed to be sold in the USA and the only distributors with a sales permit are Mentor and Allergen.

Breast implants with liquid silicone gel on their way out

Since the cohesive silicone implants arrived, they have almost completely replaced the use of implants containing liquid silicone gel. Most surgeons imply that they are obsolete and there is no reason to still use them.

The first choice for UK plastic surgeons in 2009 was silicone implants filled with cohesive silicone gel.

The cohesive breast implants (gummy bear implants)

Cohesive breast implant firmness grade 3 also called "Gummy bear".

The silicone that fills the cohesive breast implants can be of varying firmness. For the lowest firmness (cohesivity) the gel is very slow running compared with the highest which is completely firm.

The manufacturers often chooses to divide the firmness on a grade from 1-3, where 1 implies the lowest cohesivity and 3 the highest. The so called gummy bear implants are always cohesive. Some do however choose the term gummy bear only for the implants with the highest degree of firmness.

The effect of cohesivity on the final result

The difference between the different grades of firmness and how they affect the final result is continuously debated. A natural difference is however the more liquid the implants are the more it sinks towards the bottom of the implant. In that sense the breast implants with lower cohesivity greater resemble the shape of natural breasts.

You will need to trust that  your plastic surgeon chooses the firmness that he/she thinks will provide you with the best results. But do ask what firmness he/she recommends and why.

Saline breast implants characteristics

Proponents of saline breast implants agree that silicone implants can give a more natural look and feel due to that its content has a texture which is largely similar to natural breast tissue. They argue that this factor is more important for women with small breast tissue than women with sufficient breast tissue to cover the implants. They propose that women with enough breast tissue can achieve as natural results with saline implants.

Differences between saline and silicone implant

According to the proponents of saline implants, the main disadvantages with silicone implants are that there is a greater risk for capsule contracture which is the most common complication associated with breast augmentation, that the incision is longer, the insertion alternatives are less and that they are more expensive than the saline implants.

As for the problem of capsule contracture both sides are in relative agreement that the risk of capsule contracture is greater with silicone implants than with saline implants. The proponents of silicone implants do however suggest that the difference between the factors is so small that the advantages of silicone outweigh the disadvantages.

An argument that the proponents of saline implants use is that if an implant filled with silicone gel (non cohesive implant) ruptures, the silicone may leak into the capsule pocket around the breast implant. Where tissue irritating lumps can afterwards be formed and cause scarring and shrivelling. These changes are painful and must be treated, whereby the lumps are surgically removed.

The argument is not faulty but only applies to implants with liquid silicone. The cohesive silicone implants do not leak silicone even if damaged.

If/when a saline implant ruptures the outer layer sinks whereby the saline leaks into the breast and is transported away and leaves the body through the urine.

The cost of exchanging breast implants is generally the same as putting new ones in, sometimes slightly less. An advantage of changing implants is that the aftercare is less painful.

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