Since 1992, when it was banned, we could no longer offer silicone to our patients. I switched to “saline” and wrote an article on the subject, deploring this ban.
Not familiar with saline, after using it for a few years, I discovered its advantages over silicone.
These advantages are:
1. Saline allows a better size symmetry. Indeed, silicone cannot be as close because it is prefilled and goes by 30-40 cc increments. This precludes more accurate size adjustment during the surgery.
2. This incidence of capsular contracture is somewhat higher with silicone. This is due to two reasons:
- The so-called “low bleed” of silicone gel through the envelope of the implant. Though minimal in new implants, it can be a problem.
- The new silicone implants have silicone gel that is more cohesive than the old ones in order to leak less. This has made the “armpit” (transaxillary approach) no longer possible, because the implant is no longer soft enough. We must go through the “nipple” or “under the breast” to insert the implant. The main advantage of the armpit is minimizing the tissue trauma caused by the other two techniques. The less the trauma, the lower the incidence of hematoma (bleed), seroma (serum fluid collection), and the less the risk of capsular contracture.
3. If a problem results from a breast implant, it is usually more difficult to treat if the implant is silicone versus saline. The silicone gel can contaminate the pocket, with formation of silicone granuloma (mass of scar tissue).
4. In the case of rupture, the saline leak is immediately diagnosed. The breast flattens down and it is very easy to correct. A silicone leak is not diagnosed clinically. There is no sign of rupture. This is why the manufacturers (Mentor and Allergan) stipulate, “It is recommended that a first MRI evaluation take place starting three years after implant surgery and then every two years after that, even if you are experiencing no implant problems”. This precaution implies a more difficult and expensive followup, since an MRI is not usually covered by insurance for this type of indication.
5. Finally, the cost can be another consideration since silicone is twice as expensive as saline. The higher cost of silicone might lead one to believe that silicone is better. It is incorrect. The silicone engineering is more costly, but the main reason is the consequence of the silicone crisis. This crisis has cost the manufacturers about one billion dollars, lost in lawsuits and compensations. That money needs to be recovered some how.
All of this said, the return of silicone is quite welcome.
It allows the women to have the choice. If they want it, it is available.
It allows me to recommend and use it when indicated. Indeed, it is definitely indicated when women have tissue that is too thin to cover a saline implant, which is rougher on the tissue than silicone. In that case, silicone is better because the saline implant may become palpable. The possibility of rippling is a little higher with silicone, but rippling is possible with both saline and silicone implants.
The patient now has the choice between the two types of implants. I hope that they understand the advantages of each type before making an educated choice. I remain at the disposal of our patients to recommend one or the other on a case-to-case basis.