Between 1991 and 2006, plastic surgeons were mandated by the FDA to use only saline implants for first-time elective breast augmentation, so any of us in practice that long have used plenty of both silicone and saline implants. I have been doing breast augmentation for 27 years, so I used previous generations of silicone gel implants before the FDA restrictions, mostly saline implants between the years noted above during the FDA restrictions, and now nearly 99% cohesive silicone gel implants since 2006.My nursing staff has an average tenure of 17 years, and ALL of my staff who had saline implants have switched to the latest generation of cohesive silicone gel implants in use for the past decade. They have seen the results (and any complications, dissatisfactions, and revisions) of thousands of saline AND silicone gel implants, so that should tell you something.I'm not sure what you mean by silicone "failing" since all 3 company's silicone gel implants are now cohesive and cannot leak. Rupture would require either a manufacturer's defect or such a severe blow that YOU would be injured terribly before your implant would ever rupture. MRI scans MIGHT have been an appropriate recommendation for the silicone gel implants used prior to 10 years ago, or for those (old ones) sitting on a surgeon's shelf for many years before use, but NOT for the present generation of cohesive implants. They cannot leak and are so durable that rupture would damage you far more than an implant. Thus, MRI is nonsensical and also potentially harmful, since there is a documented false positive rate of 21%. This means that 21% of the reports read as "Implant(s) ruptured" will have actually normal and undamaged implants at the time of surgical re-exploration to replace the supposedly "ruptured" but totally normal implant(s). Besides, if you have any issue with your silicone implants that might require surgical revision, your surgeon can examine your implant under direct vision and replace it if necessary. There is a reason that implant manufacturers give you free lifetime replacement for damaged implants--they have to for saline or no one would buy them since 5-9% will leak and deflate, and the silicone implants just don't leak, so it costs virtually "nothing" to warranty them. I've seen a grand total of 4 ruptured (silicone) implants in the past 15 years (all manufactured in the same year and hand-made early manufacturing process in 2002-2003, and 2 in the same patient). And, lots of deflated saline ones, with over 90% then switching to cohesive silicone gel implants!"Failure" other than leakage or rupture would have the same rates regardless of fill material--saline or silicone. Capsular contracture occurs with the same frequency now, regardless of implant filler, as do malposition, bleeding, infection, etc. ALL rare, but essentially the same regardless of implant choice.That is, except for leak and deflation, which happens ONLY with saline implants!Transaxillary incisions are associated with a higher risk of capsular contracture, so saline PLUS transaxillary doubles your risk of re-operation, IMHO.Most surgeons agree that submuscular placement reduces the risk of capsular contracture (CC) by avoiding bacterial contamination leading to biofilm development, which is associated with CC. The armpit is full of bacteria, as are breast ducts--periareolar incisions. Saline or silicone have about the same CC risk, but using an inframammary incision lowers these risks. No doubt saline is easier via axillary incisions, but I'd stay away from axillary incisions AND saline implants for the softest, most natural, and least likely to require re-operation results possible. Nothing wrong with saline or axillary incisions--I just believe they have higher complication rates. Some surgeons and patients are willing to accept that; I am not. For more information, click on the web reference link below. Best wishes! Dr. Tholen
