Why don't many doctors recommend saline implants anymore?

Question

I have had children and have breast tissue. I am around a b cup. I saw a surgeon who although said i would be a good canidate for either saline or silicone, actually recommend saline due to cost and the fact that I have enough breast tissue to disguise any rippling and have a natural look and apperance. He said i would also be able to avoid having to get mris and that they are cheaper and still very safe. What are other professional opinions on this?

Richard H. Tholen, MD, FACS · Answer

Short answer: Because saline implants can leak and deflate, requiring re-operation to replace. This occurs in as many as 10% of women who have saline implants, especially those that are textured or not (properly) overfilled. Saline implants also have a higher incidence of visible rippling, a less natural "feel," and move unnaturally (Baywatch coconuts, anyone?). But they are cheaper, and do generate more profit for the surgeon. Oops, wasn't supposed to let that "secret" out!
Longer answer:
In 1991, the FDA restricted the use of silicone gel implants in elective cosmetic breast enlargement surgery, and surgeons were "forced" to use saline implants. So those of us who operated back then have lots of experience with the pros and cons of saline implants.
When the FDA re-approved the use of silicone implants for elective first-time cosmetic breast augmentation patients in November, 2006, the majority of plastic surgeons switched back to (the newest cohesive) silicone gel  implants. Not 51%, but 85%! This is because silicone implants are softer, more natural, cannot "leak" or deflate, and despite the FDA's "recommendation," MRI scans every 2-3 years to look for "leak or unsuspected rupture" is nonsensical, since ALL silicone implants by all 3 USA implant manufacturers are now cohesive and cannot leak or deflate. Implant ruptures or manufacturer defects are exceedingly rare, and statistics you see regarding this are due, IMHO, to surgeon damage, not implant defect. Another dirty little "secret."
And, BTW, those MRI scans "recommended" by the FDA are wrong 21% of the time! Leading to unnecessary surgery in 1 in 5 patients! Older silicone implants could indeed "leak" or rupture, and MRI scans for older generations of silicone gel implants may be appropriate, but not for present-day implants!
So why do some surgeons still "push" saline over silicone? And continue to use "scare tactics" regarding silicone MRI scans or autoimmune illnesses (proven false, BTW)? Either they are "out of date" and stuck in the habit of saline implants . . . some surgeons believe change causes complications, and do things exactly the way they were trained many years ago. Others are motivated by the higher profit potential with saline, but of course they can't say that, so they discuss MRI scans and autoimmune illnesses. And let the patient "share" in the cost savings.
Silicone implants cost a bit more at first, but avoid later costs for re-operation to fix deflation. And, no, you DON'T need periodic MRI scans if you choose silicone. Honest. Read more in my Comprehensive Guide to Breast Augmentation by clicking on the web reference link below. Best wishes! Dr. Tholen

D`Arcy Honeycutt, MD · Answer

I prefer silicone gel implants because of all the usual reasons- more natural look and feel and fewer ripples.  Saline filled implants feel firmer and drop down or to the side more frequently due to the "water hammer" effect.  This makes the breast look abnormal and requires surgery to fix.  The newly released Ideal Implant is a new type of saline implant.  It is FDA approved and available to a limited number of surgeons.  Reportedly, it has a more natural feel.

Aldo Guerra, MD · Answer

Saline implant results are relatively poor compared to the awesome results with silicone. Saline implants ripple more, sag more and have a higher risks of revision surgery for a variety of additional reasons. When patients have a poor outcome they tend to blame the doctor and not so much the poor decision they made to go with a poor product. It's hard as a plastic surgeon to recommend an implant that leads to more headaches...

Gregory A. Buford, MD, FACS · Answer

The simple answer is that saline implants are an inferior alternative to the silicone gel implants.  They look fake, they feel fake, and they move like fake breasts.  For these reasons, most experienced Plastic Surgeons who specialize in breast enhancement (like myself) do not like to use saline implants because the results obtained are simply what they can accomplish with gel implants.  As for the comment about being cheaper...yes, they are cheaper.  But over the long run, the amount of money you save is definitely not proportionate to the quality you obtain by using silicone gel implants.  I hope that helps and wish you the very best!

Peter E. Johnson, MD · Answer

Surgeons do indeed recommend saline, and for all the reasons your surgeon has gone over with you. For many the gel might have a better feel and less tendency to ripple, though for others the match to saline can be very good. Remember all implants will leak in time, and about the same rate without texturing.

Matthew H. Steele, MD · Answer

Thank you for your question.  Both saline and silicone implants are safe and effective.  They have similar silicone outer shells but the volume filler is different (saline vs silicone).  Many surgeons become proficient in submuscular saline augmentation during the 90's and early 2000's due to the moratorium on silicone gel filled implants from 1992-2006.  For many women with adequate breast tissue, saline implants were really not a problem, except for the progressive rupture rate with time (1.5-2% added each year).  For thin women however, visible wrinkling and rippling were a real concern, even with placement under the muscle.  Additionally, most women were not candidates for placement of their saline implants over the muscle (traditional method) because of the rippling/wrinkling.  In an effort to decrease these problems, the saline devices were filled to the maximum recommend fill volume or higher.  This decreases rippling but increases the hardness/firmness.   Once silicone gel implants returned for cosmetic use in 2006, most surgeons have switched the majority of their implants to silicone gel.  The reason:  they look and feel much more natural, with less wrinkling and rippling.  As a result, thin women had less visible issues and patients with more breast tissue have the option again of subglandular pocket placement.  The downside for silicone gel is the labeling from the FDA regarding MRI exams despite lack of prospective studies demonstrating an absolute need for MRI in an asymptomatic patient.   The one benefit of saline implants is their cost, they are cheaper.  In my practice, nearly every patient is offered silicone gel and it is hard to remember the last time I used a saline device.  Best to get a few opinions from board certified plastic surgeons if you are confused or unclear.  Good luck.

Robert Singer, MD · Answer

Both the saline and silicone implants have the same
type of outer rubbery silicone shell. The inner fill is different: sterile
saline solution in the saline Implant and silicone gel in the silicone Implant.
There are advantages and disadvantages of each type of implant. Both are
utilized by surgeons across the country with satisfactory results. They are
both safe and approved for usage by the FDA. Currently there are more silicone
gel implants used in the U.S.
While either implant can produce excellent cosmetic results in the appropriate
patient, most patients prefer the feel of the silicone gel implant.
The best cosmetic result in any particular breast augmentation patient depends
on a variety of factors, including: your individual anatomy, desired outcome,
realistic expectations, a thorough discussion with the plastic surgeon about
the options, and an understanding of the pros and cons of any particular
implant choice. 
Keep in mind that following the advice from a surgeon on this or any other
website who proposes to tell you exactly what to do without examining you, physically feeling the tissue,
assessing your desired outcome, taking a full medical history, and discussing
the pros and cons of each operative procedure would not be in your best
interest. I would suggest that you discuss the options with your plastic
surgeon who should be certified by the American Board of Plastic Surgery and
ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS)
that you trust and are comfortable with. You should discuss your concerns with
that surgeon in person.
Robert Singer, MD FACS
La Jolla, California

Tom J. Pousti, MD · Answer

Thank you for your question.
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, many 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.
In regards to discussing breast size, communication with your surgeon is critical in achieving the results you wish. I find that this is best done with the use of pictures as opposed to trying to predeterming specific implant size or profile.
Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. ***Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “natural” or "C or D cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Connie Hiers, MD, FACS · Answer

Saline implants are still a great choice for many women, especially women who have some breast tissue. These implants have been available in the US since 1960's and are safe. They do feel firmer and have the risk of rippling.

William H. Gorman, MD (retired) · Answer

You will have silicone in contact with your tissue either way since both outer shells are silicone.The difference is what is inside the implant- saline  or silicone gel. Both are considered very safe. I personally prefer silicone gel implant because in my hands the results are more natural looking and feeling. Surgeons tend to favor the implants they are most familiar with and have the most experience with.You will likely be happy with whichever you choose. This is an example of a question with no wrong answer!

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