As you probably already know, the FDA approved the return of silicone gel implants for general use for cosmetic breast augmentation this past November. Initially there was some reluctance on the part of our patients to consider this option over saline implants, but over the past few months the number of women choosing silicone has steadily increased. It would therefore seem a good time to pause and share my general impressions regarding the differences between silicone and saline.
My overall impression is that silicone implants are a lot nicer than I expected. They are definitely softer with a more natural look and feel than saline. However, to be fair this difference in look and feel becomes less important in patients who start with more breast tissue. For the woman who wants to go from a C to a D cup, she is not likely to notice much of a difference. Silicone implants truly shine in the thin woman with little breast tissue and even less body fat. Saline implants were always less than ideal in this type of patient and now with silicone I can offer patients an option that looks natural, which by the way is still the number one request that I hear: to look natural.
A silicone implant also does not weigh as much as the same volume of saline. The weight difference becomes more of a factor for women choosing a larger volume implant. In larger volume implants, the extra weight of saline may cause more sagging, and in extreme cases could be a source of back or neck pain. I ask patients who want implant volumes greater than 400 cc to consider silicone, although I explain that no one knows the exact volume at which the weight difference becomes important and it will not be the same for all patients.
The last issue is a comparison of risk. The two main long-term risks of breast augmentation are implant leaks and thickening or tightening of the surrounding scar tissue, a condition known as capsular contracture. A saline leak is harmless because the saline is simply salt water than can be absorbed by the body, and the implant can be easily replaced. In the case of silicone, it has a tendency to cling to itself rather than spread and as long as it remains inside the scar capsule there should not be any effects on the surrounding tissue. In all of the research that has been done over several years, there has not been evidence of the silicone spreading to other parts of the body or causing any other side effects. As for capsular contracture, the risk that has been reported thus far is not significantly different for the two types of implant.
To sum up, my own personal experience with silicone gel implants to date has been a very positive one. If that should change in any way, you will be the first to know. My approach at this time is to share with each patient what I believe are the pros and cons of each implant type so that they can make an informed decision. If you are considering breast augmentation, gather this information, consider it carefully with the help of your plastic surgeon, and you will make the decision that is right for you.