After years of waiting, silicone implants are back. Since 1992 there has been a ban imposed by the FDA on the sale of silicone gel implants. Women wanting silicone implants, since then, have had to “qualify” for the implants by meeting specific criteria to be included in a study. The ban was imposed due to claims of a connection between silicone gel breast implants and autoimmune diseases, connective tissue diseases and even cancer. Scientific evidence since that time conducted by the Institute of Medicine and experts from all over the world has shown no such connection to exist. In July of 05’ a letter was sent by the FDA to a silicone implant manufacturer stating that silicone implants could be used if certain criteria were met. And as of last week, November 2006, silicone implants are available to all breast reconstruction and revision patients, as well as women 22 years of age and older seeking cosmetic breast enhancement. A number of conditions come attached to the approval, including studies and follow-up.
So what’s different about these implants? In the 70’s and 80’s silicone implants were made of a more liquid consistency. Since the early 90’s implants are made of what is called a cohesive gel. That is the silicone in these implants is more cohesive or stable in form. If one of these implants is cut the implant for the most part will maintain it’s shape and not leak out. The shells of the implants in the 70 and 80’s were thinner and more likely to leak. The implants today have shells that are made of several layers. This makes the implants feel more firm but help cut down on gel bleed. Gel bleed is the term that describes small amounts of the silicone moving through the shell. Although these implants are firmer than the implants of the past they are still softer in feel in comparison to saline. The so called “gummy bear” implants are also a cohesive gel implant. These are even more cohesive than the standard gel implants and therefore maintain there shape more. Due to the added firmness, the incision much be larger and the shape of the implant is an anatomical shape. These implants are currently being used in Europe, and may have more use in reconstructive type cases.
Saline implants are the salt water filled implants that have been used in place of silicone implants, since the silicone ban. Now in addition to the choices of size, shape, shell type, incision site, location (above or below the muscle), patients will have to choose between silicone and saline implants.
So what are the advantages and disadvantages of silicone implants?
The main advantage of the silicone implants is that they have a more natural feel and less visible rippling. Breast implants have transverse creases which form around the edge know as rippling. Although silicone implants have this also it is far less evident when compared with the saline implants. This will be particularly important for women who have thin skin, perhaps after childbirth and breast feeding, or for women with extremely small breasts. For women with at least a B cup or with thicker firmer breast tissue rippling will most likely not be an issue. However, the silicone implants will have a softer feel.
The disadvantages of the silicone implants are that they come pre-filled. This means the incision sites have to be larger and the surgeon won’t be able to adjust the implants after inserting them. For example a mentor 450 saline moderate plus has a fill range between 450- 540 cc’s. This means the implant can be filled anywhere in this range depending on the type of look and size the patient wants and also to gain symmetry between the breasts. With the silicones the next size up after 450 is a 500 cc implant. So the surgeon will have less flexibility with the silicone implants.