Why Do Doctors Suggest Silicone Implants More Than Saline?

The return of silicone gel breast implants raises an important question for prospective breast augmentation patients: are silicone gel implants better than saline implants? The answer, in my opinion, will be different for each patient, and will depend on the patient's personal feelings and opinions about a host of issues related to silicone gel implants, including implant cost, the monitoring required to detect silicone gel implant rupture, the incisions required, and the potential need to replace the implants (as in buy a new pair) if a reoperation is required for capsular contracture or other issues. Additional factors that will impact a patient's choice of implant include the pre-operative breast size and the desired post-operative breast volume.

Breast implant manufacturers have indicated that the cost of gel implants will remain more expensive than saline implants. This adds about $800 to the cost of breast augmentation. Another cost issue associated with silicone gel implants which may, over time, be much more significant than the increased implant purchase price is post-operative monitoring for gel implant rupture. While saline implant ruptures are immediately obvious, silicone gel implant ruptures are not generally detectable by the patient or physician, and an MRI scan is required to conclusively make the diagnosis. The FDA recommends that patients with ruptured silicone gel breast implants have the implants replaced or removed.

The FDA is also recommending that women with silicone gel implants have a breast MRI scan 3 years following breast augmentation, with repeat scans every two years thereafter. It is difficult to imagine that health insurers, who in most cases do not provide benefits for cosmetic surgery or for the management of complications of cosmetic surgery, will be willing to pay for these follow-up scans. The cost of an MRI scan includes a charge for performing the test as well as a charge for the test being interpreted by a radiologist, and the combined charges for regional scans of the body are generally greater than $1000.

Yet another cost issue to consider is the fact that the FDA has mandated that silicone gel breast implants are a 'single-use item'. Some surgeons have interpreted this to mean that at the time of a reoperation for capsular contracture the implants may have to be discarded, once they are removed from the implant pockets so that capsulotomy / capsulectomy may be performed. Capsular contracture is one of the primary causes for reoperation in patients with breast implants. A physician performing surgical treatment of a capsular contracture would therefore, in order to adhere to FDA guidelines, have to insert a new implant or implants, the cost of which would be passed along to the patient.

As silicone gel implants are pre-filled, they require a larger incision for implant insertion, which of course varies with the size of the implant that is used. Saline implants are filled after insertion, and can therefore be rolled into a long, narrow shape for insertion through a smaller incision. A patient with a small areolar diameter may not be a good candidate for silicone gel implant insertion through a peri-areolar incision, while essentially any patient may have a saline implant inserted through that approach.

Most surgeons agree that silicone gel breast implants, in general, tend to feel more natural than saline breast implants. However, the degree to which this difference is significant varies a great deal with regard to two issues: the amount of breast tissue that exists prior to augmentation, and the size of the implant that is used. The more natural feel of a silicone gel implant will be much more important to patients who are slender and fit in an A cup bra preoperatively, as they have less subcutaneous soft tissue to conceal the implant. The difference will be less noticeable to a patient who is more full-figured and has wears a B cup bra.

Smaller saline implants in my opinion, better simulate natural breast tissue than larger implants. If the goal of breast augmentation surgery is to produce a natural-appearing breast profile, and by 'natural-appearing' I mean that it matches the rest of a woman's figure and does not look like surgery, I think that most patients are best served by an implant smaller than 350cc in volume. Saline implants in this size range, in my experience, tend to produce results that not only look natural but also feel natural.

Silicone gel implants look and feel more natural than saline implants, pure and simple. Most plastic surgeons are interested in having natural results and silicone gel implants do that better than saline implants. The implants otherwise are basically the same in terms of rupture and capsular contracture. The saline implants may have a higher chance of visible or palpable rippling.
As long as the patient is well informed as to the other differences(undetected rupture, bigger operation for replacement if ruptures, possible local problems with free silicone if rutured) the decision is up to the patient.