In Your Experience, Which Breast Implants Have a Higher Complication Rate?

Hello: I'm considering having a breast augmentation and there is ALOT of information out there, I would like to have some feed back from the "experts". I'm wondering, in your experience, which breast implants have a higher complication rate? And secondly, in your experience, which implants have you known to last longer? I know a women who has had her saline implants for 19 years! This is quite uncommon and she likely got lucky, yes? Thank you!

Doctor Answers 5

The majority of complications related to implant surgery are unrelated to the implants

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Hi there-

Because implants represent foreign bodies, there is no doubt that complications can occur, but in the vast majority of cases (in the US), the complications were unrelated to the implant itself.

In other words, you should not allow yourself to believe that you can somehow lower you risk by insisting on a particular implant, as all implants used in the US are very similar in quality.

Complication And Failure Rates Are Similar For Saline- And Silicone Gel-Filled Implants

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When assessing risks and complications associated with breast implant surgery it is important to review the statistics published by the implant manufactures. These are the numbers you should use when evaluating the implant types and styles and deciding whether breast augmentation surgery is right for you. Surgeons will likely have their opinions about these statistics, and comments to suggest that the published data is incorrect are clouded by anecdotal information, biased by the limited experience of an individual practice, (unintentional) wishful thinking, and/or the result of a limited recollection of real events.

I would agree that the implants manufactured by Allergan and Mentor are similar in terms of function, life span / failure rate, and rate of associated complications.

Silicone implants may be a good choice for most women, but may not be for all. I do not believe that it is my job to select/choose the type of implant each patient should have. Rather, it is my responsibility to present each patient with detailed information, comparing and contrasting saline- and silicone gel-filled implants, and then let each woman choose which implant is best for her…after all, it is the woman that has to live with the implants and she should be comfortable with her decision.

I would also like to make several comments regarding cohesive silicone gel, implant failure, and the subsequent possibility of leaking silicone gel. To clarify, the currently available FDA-approved (4th generation) round silicone gel breast implants use a moderately-cohesive silicone gel filling. These are different from the investigational (5th generation) contoured silicone gel breast implants that use a highly-cohesive silicone gel filling. Moderately-cohesive silicone gel-filled implants may be referred to as “responsive gel” implants. Highly-cohesive silicone gel-filled implants may be referred to as “form-stable” implants. The term “form-stable” refers to the fact that this implant maintains the same shape (without any collapse) no matter what position it is in; this form stability makes the nickname 'Gummi bear' implant an appropriate one.

If we use the word “leak” the mean that the implant fill material can escape through a defect in the shell and enter the intracapsular space, then both saline and moderately-cohesive silicone gel-filled implants can leak. The gel matrix of the current implants has a structure, and this moderate cohesion certainly limits the possibility of gel leakage through the shell; but to say that these implants can’t leak or never leak is incorrect. It is the highly-cohesive form stable silicone gel-filled implants that do not “leak”, based upon the above definition. But since these are investigational and not available to the general population, discussion should focus on the moderately-cohesive gel implants that are available to everyone.

As a patient you should learn as much as you can about breast implants and breast augmentation surgery. There are many resources, including: the internet, women who have had breast augmentation surgery, and your surgeon. The first two you can utilize before your consultation. Your surgeon should be able to clarify and expand upon the knowledge you have gained independently. You should be able to develop a solid relationship with your plastic surgeon; one of open communication and mutual trust and respect. This will go along way towards ensuring a positive and successful experience.

Best wishes, Ken Dembny

Kenneth Dembny, II, MD
Milwaukee Plastic Surgeon
4.9 out of 5 stars 36 reviews

Best breast implants

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I think that in general the two main manufacturers Mentor and Allergan have similar implants with fairly similar complication rates.  Good luck.

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

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Breast implant complications

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I have patients whose 20+ year old implants are still intact and without complication. Seriously, anything an individual physician will tell you is basically anecdotal and based on his patient population. All of the data is available on-line. I will say that I am most comfortable using implants from Mentor and McGhan and found a higher complication rate when Porex was selling its implants in the US. It is important to ascertain that your implants are subject to a warranty and have been purchased from a reputable manufacturer with FDA clearance and are not off-shore goods.

Silicone implants are the best choice for a majority of women. Complications are rare for both saline and silicone.

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If you ask enough plastic surgeons, you will eventually discover that there are many different opinions based on training, experience, past (good and bad) outcomes, ethics, profit motivation, etc.

Each option has pros and cons. For an exhaustive review of all of these, click on the web reference link below and read to your heart's content. Then, read other answers here and elsewhere. You should begin to see a concensus.

Worldwide, the vast majority of plastic surgeons still utilize silicone gel implants much more frequently than saline implants. The ratio is nowhere near 50-50, but closer to 80 or 85% gel and 15-20% saline.

Since the shells are exactly the same silicone elastomer with BOTH saline and silicone gel implants, theoretically they should both last an equivalent length of time. But with the present generation of cohesive silicone gel implants that cannot leak even if the shell were to rupture somehow (surgeon cut or nick, external severe trauma, manufacturer defect), you still maintain an intact soft solid implant in a well-healed scar capsule.

With saline implants, especially with textured surface implants, or underfilled ones that exhibit rippling, even a tiny pinhole leak can lead to deflation of the implant. Even though all the implant companies will replace your implant (lifetime replacement policy) should there be a leak or defect found, you still have to undergo another operation, and the cost of that may not be covered. Saline implants commonly last longer than ten years, though deflation is always a possibility. Silicone implants never leak or deflate, plus they feel softer and more natural, and exhibit substantially less rippling.

So, all of a sudden, having the 1cm shorter incision and saving a few hundred bucks with saline implants instead of silicone ends up being a fool's savings, IMHO. Plus, they don't look or feel as good in some patients. That being said, we (US plastic surgeons) did lots of saline implant breast augmentations between 1991 and 2006 when silicone implants were restricted by the FDA, and most of them turned out just fine. Still, now that silicone is again available in the US for elective breast augmentation, a majority of US plastic surgeons and their patients choose the newest cohesive silicone gel implants, and are quite happy they did.

I once believed that saline implants had a slightly lower likelihood for developing capsular contracture, but the newest cohesive silicone implants do not exhibit gel "bleed" and seem to have no higher rate of capsular contracture than saline, so even that slight difference is moot. All other risks (bleeding, infection, malposition, wrong size, etc.) are not related to composition of the implant. Most common complication for which re-operation is requested: size too small. This is of course unrelated to the type of implant.

The biggest risk factor for complications is not related to saline or silicone, but the surgeon chosen. Honest! Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 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.