Thank you for your thoughtful question. It is important to understand the difference between the terms "BIAI" (Breast Implant Associated Illness) versus "BIA-ALCL" ( Breast Implant Associated Anaplastic Large Cell Lymphoma). BIAI is a controversial term used to describe a clinical presentation of any multitude of signs or symptoms that may be found in a woman with breast implants (usually silicone gel filled but also possibly saline filled). The reason BIAI is controversial is because there is no clear proof that breast implants are "immunogenic" or can indeed stimulate an immunology response by the human body. The most current thinking that there may be a small subset of women who may be more prone to react to (usually a silicone gel filled) breast implant. This needs tone understood within the context of millions of women around the world who are enjoying a healthy quality of life WITH their breast implants without any evidence of BIAI. The second condition, BIA-ALCL is specifically related to a rare late onset type of inflammatory process that constitutes a low grade cancer that is associated with a specific textured surface of the breast implant. There are two basic categories of implant shell surfaces-one is smooth (like a beach ball or bowling ball), and the other is textured (like most basketballs). Only the textured surface implants of primarily one single manufacturer (NOT Mentor) have been associated with this rare yet serious condition, and it does not relate to the gel, but rather to the surface of the shell or envelope or "bag" that container the gel, or the saline. This is a lot of detailed and complicated information to absorb, and it is therefore best that you supplement your own research with a consultation in person by an experienced board certified plastic surgeon. Most patients your age would probably do really well with a saline filled implant, but this can only be determined after evaluating you in person with a detailed history and physical examination.All of the major implant manufacturers offer both saline filled and silicone gel filled implants, and one manufacturer ("IDEAL") has developed a novel implant design which is saline filled yet has more of a feel similar to silicone gel filled implants. The main advantage of saline filled implants is that they are adjustable to correct any minor asymmetries, and if they were to leak one day, which is indeed a distinct possibility, your body simply absorbs the harmless salt water which has an electrolyte balance similar to your own body's blood. A ruptured silicone gel filled implant may require more extensive surgery to remove the implant and its contents. The main disadvantage of saline filled implants is that they tend to make the breast feel a bit firmer than a silicone gel filled implant might. Continue to do your research and you will hopefully make the best decision for yourself, with the guidance of your plastic surgeon. Best of luck to you.
