Natrelle Cohesive Silicone Gel Implants: if Ruptured Do They Cause Any Harm to the Surrounding Tissue?

Hi Meg,

In general I agree with the statements made by your plastic surgeon.  The silicone gel in the current implants is very thick and sticky; thus it really cannot "seep" into the tissues.  Also, as already pointed out, the capsule which forms around the implant usually "contains" the leak, preventing the silicone from getting into the tissue.  However, if the implant has a leak, and  the capsule tears, for example after an accident, it is possible that some silicone would be forced out of the implant and into the tissues.  There is no evidence that this would cause you a medical problem, such as leading to some type of systemic disease.  However, it could cause a local problem such as the onset of capsular contracture or lumps in the breast which patients usually want removed.  When deciding between saline and silicone I explain it to my patients this way.  Silicone implants have all the aesthetic advantages:  they are more compressible and hence usually feel softer, they have less rippling, they are lighter, they stretch the tissues less.  Saline implants are the opposite:  heavier, in thin patients do not feel as natural, more rippling, more tissue stretch.  The advantage of saline is that it is very easy to detect a leak (because the breast gets smaller) and very simple to remove and replace if leaking.  I do not consider the lower price an advantage because this is a short term advantage and I don't advise making decisions regarding your body/health based on cost.   The disadvantage of silicone is that in most cases one needs an MRI to detect a leak; this may or may not be covered by insurance.  In our area breast MRI can cost between $500 (unusual) and $2400.  Secondly, the surgery to remove a leaking silicone implant is slightly more involved as it involves a capsulectomy.  So these are the issues we focus on.  The most important thing is that you are comfortable with the type of implant you have and education about the implants is important for you to make an informed decision.  My only absolute is that I do not recommend saline implants for patients who have very thin tissues or who need a breast lift.  I have many patients with saline implants who have a beautiful result.  The key is that they had enough breast tissue to really cover the implant.  Hope this helps.

Tracy M. Pfeifer, MD, MS

No implant lasts forever.  I tell my patients to think that the life of the implant should be about 10 years.  They will last less time if the patient gets a capsular contracture, and the implants feel hard.  This causes a fold in the implant and then they wear out at the fold.  The best way to get them to last is to keep them soft, and not get a contracture.  There have been 5 different generations essentially of gel in implants. 

1.  Silicone in the late 60's and early 70's was a bit more cohesive

2.  Second generation implants were made in the late 70's to the mid 80's.  The silicone was very runny and would "bleed" through the tissues and into the lymph nodes

3.  The implants of the Mid 80's to the late 90's were the 3d generation silicone that became a bit more cohesive, but mainly the shells became stronger.

4.  Fourth generation implants are the implants of today (started in the late 90's) that are more cohesive and is much less runny.  But not as much cohesive in the patient as it is in ads.

5.  Gummy bear implants are the 5th generation implants that when cut in half really does look like gummy bear, and is much less runny. 

Each generation has less risk of bleeding into the surrounding tissue, and into lymph nodes.  But you should get an evaluation frequently by your plastic surgeon that is certified by the American Board of Plastic Surgery.  Good Luck to you.