Which implants are the safest?

Question

I was confident in my decision in choosing inspira soft touch implants, but my mom had a BA with saline implants (& she has close friends that have had the same type of implants without an complications). She has me second guessing that I am taking a bigger risk in choosing something that is new on the market rather than something that has been proven to be safe for years. I would like to know which is more safe, and/or the risk & benefits of the two.

Stephen M. Krant, MD, FACS · Answer

I have not used the Inspira prostheses. The concept is interesting, but not totally tried and true.
I personally prefer gel prostheses that are moderate-plus or high profile to give the ideal projection. In my practice, my gel/saline prostheses are 98%/2%. It is the patient's ultimate decision as to which prostheses to use. 
As far as saline prostheses, I think the "look and feel" of a gel prostheses is preferable.

Ronald J. Edelson, MD · Answer

I personally prefer saline implants.  They have far fewer problems in the future and they really feel about the same in most women.  They also provide better peace of mind.  Many surgeons don’t feel the same way and push for silicone saying they have been proven to be safe.  It depends on what you are comfortable with.  I will do either saline or silicone as long as the patient is well informed on the difference.

Daniel Barrett, MD · Answer

Dear PreciousJenBee,there have been numerous studies on the safety and efficacy of silicone breast implants. The FDA has approved them to be safe and breast augmentation is the most common cosmetic surgical procedure performed in the United States every year. Implants are much different than they used to be with rigorous testing and cohesive gel. I can't tell you how happy my breast augmentation patients have been with their implants.
I would recommend a consult with a plastic surgeon to go over all of your concerns. Saline implants are also a perfectly good option if you are still concerned and are less expensive.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Donovan Rosas, MD · Answer

Both silicone and saline devices are safe and reasonable options.
Patients should be aware of the inherent differences between the available implants.
Saline vs. Silicone differences include:
-The "feel"- silicone is more natural
-The "look"- silicone is less prone to rippling
-The "cost"- silicone is more expensive
-Customization-Silicone implants are pre-filled to a particular volume. Saline can be adjusted on the table within a recommended range.
-Monitoring-Saline implants, if ruptured, will deflate and the saline fill will be absorbed. Silicone implants require surveillance MRI's at 3 years and every 2 years after.
-Incisions- Because saline implants are placed empty they can be passed through slightly smaller incisions
-BIA-ALCL and Textured gels- Breast implant associated Anaplastic Large Cell Lymphoma is a rare phenomenon which has only recently come into the spotlight. The are a few hundred cases worldwide and all have been associated with textured gel implants.In summary, one is not better than the other. They simply represent different options. In my practice, most patients choose silicone devices for the reasons listed above.As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Tom J. Pousti, MD · Answer

Thank you for your question.
Both saline and silicone are good implants, each associated with pros/cons;  in some cases, the use of a specific type of breast implant may be indicated for a specific patient.

In my practice, the type (saline versus silicone gel) of breast implant utilized is individualized mainly depending on the patient's starting anatomy and goals.  The type of implant used may determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. In other words, if a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
 
 My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as  well. Working together you will come up with a good plan to achieve your goals.

Best wishes.

Johnson C. Lee, MD · Answer

Numerous implant studies which have looked at thousands of breast implant surgeries according to different brands and types have shown that the FDA-approved implants are all very consistently safe very low complication rates. The implant type is not a significant contributors to complications. Instead, it is the surgeon's technique and surgical planning which can affect your risk of infections, capsular contracture, rupture, and other implant associated complications. Generally speaking silicone feels more natural however it is harder to detect a rupture or leaking implant than a saline implant. Once a saline implant deflates it will be instantly noticeable. Hope this helps!
Johnson C. Lee, MD 
Board-Certified Plastic Surgeon
@drjohnsonlee

Tim Sayed, MD, MBA, FACS · Answer

Saline and silicone implants, along with the newer Ideal Implant (a type of saline implant designed to feel like a silicone device, which you may wish to consider), are all FDA-approved breast implants in the US. Patients have a variety of choices when deciding on implant size, style, manufacturer, profile, etc. Here is a simple list of pros and cons of various implant choices:
Saline Implants
Saline implants are introduced deflated and filled with sterile salt water in the operating room. For this reason, they can often be placed through slightly shorter incisions, though it really depends on the pocket size and the ability of the surgeon to safely create the pocket through the planned incision approach.Saline implants may feel slightly firmer to the touch when the breast is handled; this is because the water in the bag is less compressible than silicone and the shell can feel stiffer when the water is compressed, like a water balloon. Some patients want this firmer, stiffer look and feel, whereas others think this is less natural.Saline implants can leak and if they do, the fluid will typically come out of the device and it will deflate, requiring replacement.Some surgeons believe saline implants are more likely to ripple, causing unusual waviness to the breast.Leaking saline fluid is harmless in the absence of infection, so some patients prefer this for piece of mind.Any patient who is a candidate for breast augmentation can have saline implants without age restriction.Saline implants generally cost a little less than silicone implants.Sometimes patients can detect sloshing of fluid in the implants, which may be annoying.Silicone Implants
Silicone implants generally are preferred by most plastic surgeons because they tend to feel more like natural breasts. There is a “give” when a silicone implant is squeezed, which can make the implant harder to detect inside the breast.Silicone implants are now manufactured with a next generation silicone gel that is more cohesive, which means the implants are unlikely to spill out silicone if the shell loses its integrity. This is one of the main issues that originally led to problems with the older generation silicone implants. The newer generation are often referred to as “gummy bear” implants because the consistency of the gel is more uniform and less likely to liquefy.A leaking silicone implant may not result in symptoms, as the gel stays together better and usually remains inside the capsule of the implant. In uncommon cases, silicone can leak out and cause a local reaction of painful hardening or swelling.If a silicone implant is shown to be leaking on mammogram or MRI, plastic surgeons usually recommend replacing it to reduce the risk of inflammatory reactions, and also for patient piece of mind.The FDA recommends an MRI after silicone breast augmentation every few years after surgery as a matter of surveillance in order to continue to gather long-term data, and also because the rare implant that leaks may not show symptoms.The FDA recommends that only patients 22 and older have silicone implants.Silicone implants cost more to manufacture and test so they cost more to put in.Sometimes the incision needs to be larger, especially if very big implants are being put in, since the silicone is already pre-filled in the implant.Ideal Implant
The Ideal Implant is a brand name of a new, FDA-approved saline implant that is designed with internal chambers to “slosh” around less, giving more of a silicone feel to the device.These implants are very new and are not yet mass marketed and mass produced, which means they cost more.Long-term data is not yet available on leak rates but early data is very encouraging, and these implants share the benefit of saline implants in terms of just containing salt water in the event of a leak.The procedure may take a little longer because the device has to be filled a little differently from the regular saline implants.Not many surgeons have much experience with this type of implant yet, but more and more are starting to use them.Incision size can be around the same size as regular saline implants.

Josh Waltzman, MD, MBA · Answer

This is a common question for patients.  I think that silicone and saline implants are both safe.  Silicone has been on the market for a very long time as well and has a proven track record of safety.  There is no doubt that the newer generation of silicone implants (like the soft touch) is much better than what was available 10-20 years ago.  I don't believe you are taking a risk choosing a silicone implant these days.  Saline provides the "peace of mind" factor in that you know right away if you have a rupture or problem with your implant.  Many women do not know if there is a small rupture in their silicone.  Talk with your plastic surgeon and ask them as well to explain differences between the two choices and why they recommend that particular implant for you.  I use both and think we can obtain beautiful safe outcomes with either option.  Best of luck!

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and I would go on some complimentary consultations with experts and ask their opinions after a full examination.  That way you will become fully informed what might be the best implant for you specifically.  That said all the implants used today are safe but there are differences between them that may make one a better choice for a specific patientDr Corbin

Jon A. Perlman, MD (retired) · Answer

From the standpoint of pure "safety," one would have to select saline.  Practically however, my experience over 30 years suggests that saline implants have a noticeably higher rate of deflation in the first 10 years and in thin tissued patients shows a much higher incidence of rippling and waviness.  Safer perhaps, but many patients return seeking change to silicone implants if and when their saline implants deflate, become rippled or feel like bags of water.    Current cohesive gel implants have an excellent safety profile although no implant is perfect in all respects!  Discuss with your ps to make your own best decision.  Best wishes,Jon A. Perlman, M.D., FACS
Certified, Am. Board of Plastic Surgery
Member, ASAPS ASPS LASPS
Extreme Makeover Surgeon, ABC TV
Best of Los Angeles Award 2015 2016
Beverly Hills, CA

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