Cohesive Silicone Gel Vs Saline Breast Implant for Patient with Lupus?

I'm considering the transaxillary endoscopic Breast Implants using either cohesive silicone gel (gummy bear) or saline implant material.

For a person with potential to have lupus (I tested positive on ANA test 3 years ago and had symptom. At that time, doc said it's not lupus yet, but said I may have lupus potential), which is safer in terms of not causing lupus in potential lupus patient?

I read cohesive silicone gel doesn't migrate far if shell's ruptured, does this make it as safe as saline? How about the outer shell of saline implant, which is still silicone? Thanks!

Doctor Answers 7

Lupus and breast implants

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There was some concern in the 1990's that silicone breast implants were related to rheumatic disorders including lupus. All of the research that has been done since that time has not shown any link bwteen implants and lupus. So, if you did eventually develop lupus, it would be very unlikely that the implants caused this. In terms of your procedure, keep in mind that it is more challenging to place a silicone implant, and particularly a "gummy bear" implant, through an incision in the axilla. You may be limited to smaller implant. If you do really want to use the armpit incision, a saline implant may be better if you want a fairly large size. Discuss this with your surgeon and he or she will be able to advise you about your options. Good luck.

Silicone Gel transaxillary implants in Lupus

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The incidence of capsular contracture is higher in lupus overall using implants. If you really don't have the condition, but a positive ANA and a history of symptoms then I'd move forward with the surgery. If your rheumatologist is telling you that you have the condition and clearly are simply awaiting the next lupic symptom to come up then I'd be much more concerned with capsular contracture, because I believe the incidence is higher in your patient population.

Overall, the treatment for lupus can decrease a capsule formation, but typically the control of lupic symptomatology and general systemic immune response ocurrs in waveform (good control, then not so good control). You could very well develop a capsule at some point in that time.

The transaxillary approach requires a quite large incision for a gel implant. It's not a great idea that I usually discourage because someone is losing sight of the benefit of this and other approaches. I've done it before and it is possible without much struggle, it just makes more sense to do it via IMF or PA approaches.

The Mentor and Inamed statistics on contracture rates are available for your review at their specific sites for thier 3 and 6 year studies but your case will likely fall into a patient demographic (lupus) that was excluded from these studies.

Pick a board certified (ASPS) plastic surgeon in your community and discuss these issues in detail to come to a sound decision and conclusion.

Best Wishes,


Ricardo A. Meade, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 125 reviews

Breast implants for individuals with Lupus

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Breast implants may be one of the most studied medical devices of all times and clearly there is no known illness or disease related to or caused by silicone gel breast implants. Those with Lupus or at risk for Lupus or other autoimmune disorders will not suffer any ill effects from a silicone gel breast implant, or a saline implant for that matter.

From a peace of mind issue, you may find that you enjoy a saline submuscular breast augmentation through a very small underarm or transaxillary approach. You will enjoy a soft implant without any risk of gel bleed or leakage, and can wear the implants without the need to monitor for leakage (MRI study). Note that the form stable or gummy bear implant is not yet available in the US for augmentation, and if it were it is very unlikely to fit through a transaxillary approach. Best of luck!

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Lupus and Breast Augmentation

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There is no correlation or issues with having lupus and breast implants whether saline or silicone.

The issue that you need to look at carefully here is having breast augmentation thru the axiallary incision with placement of silicone. This is difficult and may have the silicone shell, specially if you are having any implant of good volume size. Placing saline implants thru the arm pit incision is fine.

What I would do would be to think which implant suits your needs better and then choose the incision rather than vice versa.

Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 reviews

Cohesive gel versus saline implants? Transaxillary (armpit approach)

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No studies to date have linked auto-immune disease and breast implants. So your concerns of silicone gel migration and lupus are not scientifically supported. That having been said, unless you go with a small implant, placing a true cohesive (form stable) implant via the axilla is an extremely challenging operation and requires a sizable incision.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Lupus and breast augmentation

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First, there has been no proven association with breast implants and Lupus. second, it is my understanding that gel implants should not be placed through a transaxillary approach. So you should have saline if going that approach.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 37 reviews

Breast Implant questions

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There are no good studies linking rheumatologic disorders with implants. Cohesive gel implants are not on the market yet. Placing them through an armpit incision would be extremely difficult.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.