Antonio M. Carbonell, MD

Great question Pamela.  As you can see from the many responses there's an overall consensus about the stability and durability of both the saline and gel implants.  Anything man/woman/machine made has a potential for failure, since nothing in our body remains stable for very long.

The implant replacement issue was very prevalent during the early years of breast augmentation and before the newer 'models' were redesigned after the 10 yr moratorium by the FDA.  Back then we had thin walled incompletely polymerized gel implants, sometimes enclosed in another implant of saline (the double lumen implant) and both had the problem of capsular contracture.  Since we didn't know what was causing the contracture, we assumed it was silicone, and the implant was often removed with the capsule.  Those were the years when multiple types of synthetics were used and multiple surfaces applied to the implants including Dacron patches to keep them from 'moving around' - a concept borrowed from hip replacement prosthesis - not exactly applicable to breast 'natural' function.

Today, with the advent of endoscopic breast augmentations and thicker implant shells, cohesive (better polymerized) gels the intrinsic problems contributed by the implant are much less.  A recent disclosure that cotton (one of the most reactive of substances within the body) may be the main culprit in capsular contracture has led many of us to dispense with using any cotton gauze within the wounds, to dry any fluid drainage or use as dissecting tool (as we were taught in years past) and the capsular contracture issue is much less (from 20% to less than 0.5%) than it used to be, and implants are not removed as often.

I am starting to see patients that have had submuscular implants with several muscle induced deformities come to the realization that a submammary gel implant can give them a more natural cleavage with less 'folding' 'creasing or rippling' and enhance the overall breast texture than it ever was with saline, especially if the implant pocket was small to begin with, so I'm removing saline implants and replacing them with gels and improving the patient's overall satisfaction with their breasts.

I suspect that when the current trend of submuscular placements begins its reversal as it did 20 yrs ago when we had to use the pectoralis muscle in breast reconstruction and became disillussioned with the abnormal movement and lack of cleavage, we will see more women ask for cleavage and texture, bounce and giggle than they had in the past.  The best way to achieve that will be with submammary gels and a resurgence of primary gel augmentations will occur.  Time will tell.

Ultimately it's the woman who has grown accustomed to her implants as her own breasts that will decide what happens.  The body image incorporation is so strong as to produce the same emotional effect as a mastectomy when an implant deflates.  The idea of 'having to go through that again' will ultimately determine the decision to reach for the non-deflatable gels and get on with their lives.

I hope this helps.

Dr."C"