October 6, 2008

Saline or Silicone - You Now Have More Choice in Breast Enlargement

Prior to the early 1990's, silicone implants were used most often for breast augmentation surgery in San Diego and across the United States. Then, the "silicone implant scare" occurred, and the FDA removed silicone implants from routine breast augmentation surgery. Saline implants then became the standard for breast enlargements. Silicone implants never disappeared from the market, but their use was limited and based only on specific medical criteria. And, any patient who received silicone implants was required to participate in a long term study.

It can be said that the "silicone implant scare" was triggered by a combination of legal opportunism and some arguable medical "science", coupled with real patients' concerns over breast implant complications. After much debate, and based on extensive medical data, in November of 2006 silicone implants were once again approved by the FDA for use in breast enlargement surgery. The conclusion by the 13-member committee of the IOM (Institute of Medicine of the National Academy of Science) appointed by the Department of Health and Human Services of the US government determined the following at the end of the research:

"Evidence suggests diseases or conditions such as connective tissue diseases, cancer, neurological diseases or other systemic complaints or conditions are no more common in women with breast implants than in women without implants."

Both of the countries largest manufacturers of implants, Mentor and Allergan (formerly Inamed) contributed patient records to the implant study and both requested approval by the FDA of their newer silicone gels. And, both companies received approvals.

One of the restrictions included in the recent FDA approval is that the patient must be at least 22 years of age. And, not all types of silicone were approved for general use. For instance, the newer more cohesive implants commonly known as "gummy bear" implants require that the patient participate in a study. It does not mean the product is "unsafe", it just means that it wasn't one of the newer silicone products that made it into the November FDA approval. Both Mentor and Allergan are currently working with the FDA to get these implants added to the list of approved gels.

This FDA conclusion legitimized what most plastic surgeons already believed — that silicone has always been a safe choice. You can find more information about the particulars of breast implants and the FDA approval by using this link: www.fda.gov/cdrh/breastimplants/qa2006.html.

There are significant improvements in the current gel implants. In the 1970's and 1980's silicone implants had a more liquid consistency inside and the outside shells were thinner and more apt to leak. Today the implants have outer shells that consist of several layers and are now made with an interior "cohesive" gel - one that is more stable and stronger. With the development of the newer gels there are also more implant "profile" choices for the patient helping to give the patients the "look" they want. The choice of multiple shapes and sizes are available in both saline and silicone implants.

Even though silicone implants now have approval from the FDA, saline implants are still a good choice for many women. Saline is available to women 18 years and older, unlike silicone where the minimum age is 22 years (that applies to simple breast augmentation). Saline implants, like their gel counterparts, have silicone shells, but the inside is filled with salt water instead of silicone gel.

So what are the advantages and disadvantages of each? One of the advantages of silicone implants is that they feel more natural to the touch and there tends to be less "rippling" around the edges of the implant. For women who are thin or have small breasts or stretched skin, this is a distinct advantage. One disadvantage of silicone is that the implants come pre-filled and a slightly longer incision is needed at surgery. So for those patients who want the shortest possible scar, saline implants are the only choice.

An advantage of saline implants is that the doctor is able to fill them after they are inserted into the breast pocket. These implants are ideal for patients who want smaller incisions — examples being those who prefer a transaxillary or transumbilical breast augmentation. Also, if a saline implant should leak it becomes readily apparent as the saline is quickly absorbed by the body. Saline implants cost less than their silicone counterparts and this is frequently a consideration. Understand when making your choice that usually comparable and excellent results can be obtained with either type of implant.

So, if you are over 22 years of age, the decision is up to you. And, in our opinion, either choice is a good one. The best thing to do if you are thinking of having a breast enlargement is to meet with a board certified plastic surgeon. When the physician meets with you, the advantages and disadvantages of each approach will be discussed, based on your anatomy and personal feelings. The FDA approval of silicone implants has removed the silicone "fear factor" from the decision for most patients considering breast augmentation. Now patients have the ability to choose either saline or silicone and that's good!

If you would like to have a breast augmentation or wish to know more about breast enlargement surgery call make an appointment with one of a board certified plastic surgeons and discuss which choice is best for you. It is estimated that there are over one hundred board certified plastic in San Diego alone so you will be able to obtain good and helpful information by visiting a few of these surgeons and discussing your situation with them.

You might also find it helpful to visit the websites of the two implant manufacturers in the United States. Links to their websites are: www.mentorcorp.com and www.allergan.com.

Note: The specific risks and the suitability of breast enlargement surgery for a given individual can be determined only at the time of consultation with a surgeon. All procedures have some degree of risk. The information provided here is not a substitute for a consultation.

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