There are two main types of breast implants currently available in the United States with FDA approval for use in cosmetic surgery – silicone and saline. Within these two categories there are dozens of different models and styles. Here’s an overview of what sets the various implants apart from each other.
Saline Breast Implants
Sterile saline solution is the filler material in these implants; but the shell is constructed of silicone elastomer similar to the shell of a silicone gel filled implant. Saline implants (at least the models available in the United States) are not filled until after they are placed in the “pocket” created in the subglandular or submuscular tissue. Patients and surgeons report the following benefits of using saline implants:
- Lower cost per implantable device compared to silicone
- Smaller incision size since empty implant can be folded up and squeezed through a small opening
- More choices for incision placement (including through the navel in certain situations)
- Surgeon can make last minute judgment call about the amount of volume to add for best symmetry once the implant is actually in place
- If deflation occurs, it is easy to see – no MRI is required for diagnosing implant rupture
- Teardrop shaped implants are available that closely mimic natural breast shape
Silicone Breast Implants
These are round implants that have a thick, flexible silicone shell and gel silicone filler. These implants are delivered prefilled from the manufacturer in a range of popular sizes (very large sizes can be custom ordered). Patients and surgeons report the following benefits of using silicone implants:
- Soft texture that feels more like breast tissue
- Less visible edges – especially when leaning forward
- Little or no rippling of the overlying skin during movement
- Overall appearance is more like natural breasts (this is partly due to the prevalence of submuscular placement for silicone implants)
The FDA recommends that women with silicone implants have an MRI three years after their augmentation surgery and every two years going forward to check for rupture or leaking. Silicone implant failure is difficult or impossible to detect with visual or manual examination. The filler material may leak very slowly or remain contained within the “pocket” or capsule of scar tissue holding the implant for years.
Understanding Generational Differences in Silicone
If you read about the history of silicone implants, you’ll see a lot of talk about the different generations of these devices. Once you reach the third and fourth round of devices, the lines separating the generations become a little blurred. However, the later the generation, the thicker the filler tends to be. A third generation silicone filler is a jelly like substance (semi-fluid but not nearly as watery as saline). The fourth generation filler material is much more cohesive, a gel that tends to stick together better. It could still conceivably leak from a ruptured implant, but the gel might be less likely to migrate out of the capsule. The fifth generation of implants has a form-stable cohesive gel. Even if it becomes cracked or breaks open entirely, it retains its basic overall shape rather than oozing out.
More About Gummy Bear Implants
These fifth-generation implants are being used in FDA approved trials in the United States and are already widely used in other countries. These are silicone implants that have a teardrop shape and a textured surface. They are designed to (hopefully) last longer than both traditional saline and silicone implants. Surgeons who have used them report results that are excellent in terms of texture, shape and appearance for patients who have received these implants in clinical trials. Some patients do report that the implants are firmer than they expected. These implants come in a very broad range of sizes and shapes to accommodate different preferences and body types. The risk profile for complications appears to be good so far. However, there is no long-term data on outcomes and potential side effects at this time.
Combination Saline/Silicone Implants
There is a double shelled variety of implant that has an inner compartment filled with saline and an outer compartment filled with silicone gel. The volume of saline filler in the implant can be adjusted after surgery. This type of implant is only approved for breast reconstruction. Being able to increase the size of the implant gradually over a period of several months helps expand the overlying skin. This is an important consideration for women after mastectomy that has left too little skin for immediate placement of a full-sized implant.