Women interested in breast augmentation need to make a number of decisions regarding their breast implants. These important choices include the selection of breast implant volume and projection, the final placement of their implant, and where they would prefer their incision to be made. One key decision patients must also make is which implant filler material they want: silicone or saline.
My plastic surgery team and I will help you during your consultation and make a recommendation based on your desired outcome and anatomy. However, the saline vs. silicone choice is highly personal and is the patient’s decision to make.
Simplifying Your Choice
In some ways, the type of implant decision has been simplified as there are now fewer devices to choose from today than there were just a few years ago. The longer-term risks associated with texturing on the surface of breast implants has resulted in most anatomically (tear-drop) shaped breast implants and some round implants being withdrawn from the market.
At YES Medspa & Cosmetic Surgery Centre, we only offer Health Canada-approved, smooth-surfaced, round implants for cosmetic breast augmentation. Whether you are choosing implants filled with cohesive silicone gel or saline, know that your implants were designed with your safety in mind and that each has a long track record of achieving high levels of patient satisfaction.
Saline Implants
Saline-filled implants have been available for more than 30 years. These devices have the same medical-grade silicone shell as cohesive silicone gel-filled breast implants. Saline-filled breast implants come in an extensive range of dimensions but every device has a round shape.
What determines the size of the implant?
The base width and the implant projection determine the recommended fill volume of each device, and during surgery, saline (aka sterilized saltwater) is used to optimally fill the device. Saline-filled implants when manufactured, are filled with air.
Saline implants are filled during surgery.
In the operating room, a valve on the device allows your surgeon to remove the air and then fill the device with sterile saltwater using a closed filling system that prevents the saline from being exposed to the air in the operating room. Each saline implant has a small range of volumes recommended for peak performance of the device, and this allows for further customization of the final implant dimensions during surgery.
Saline implants may be right for you if:
- You have enough of your own natural breast tissue. Since saltwater-filled implants have very different tactile and movement characteristics compared to breast tissue, thin chest and breast tissues may not adequately camouflage these “water balloon” features. Although all breast implants can have some degree of rippling of the outer shell contours, saline-filled implants with rippling can be more easily felt and seen compared to those that occur in cohesive silicone gel-filled devices. These problems are magnified in patients who choose to have implants that are larger, when implants are placed in front of the muscle and in patients with thinner tissues. For patients with enough tissue to completely cover the implant and for those who desire a more natural-looking final breast size and shape, saline implants can be an excellent choice.
- You are under 22 years old. Saline breast implants are FDA & Health Canada approved for patients 18 years and older. Silicone breast implants are only FDA & Health Canada approved for patients over the age of 22 years. This discrepancy is a result of the regulatory history of breast implants and is not related to safety. For patients between the ages of 18 and 22 years old, silicone implants can be considered after discussion with your surgeon. When these are selected, the devices will be used “off label”. The main consequence of this decision would be that the manufacturer does not need to honor the device warranty when it is used “off label”. This is an important consideration as all implants will eventually rupture and need to be removed or replaced. About 10% of saline and gel implants will rupture in the first 10 years after surgery.
- You want to avoid the need for medical imaging to check on your implants. Implant manufacturers and regulatory agencies recommend silicone gel-filled implants be checked every couple of years using Ultrasound or MRI imaging. We currently recommend an examination and possible imaging of the implants with any significant change to the look or feel of your augmented breasts. The current FDA guidelines for monitoring of silicone-filled implants is to consider an MRI or High Resolution Ultrasound 5 to 6 years after the surgery date and then every 2 years even if the breast continues to look and feel normal. Alternatively, imaging of saline-filled implants is rarely needed to confirm a rupture or leak. When these devices rupture it is usually quite obvious because most of the implant saltwater fluid will be resorbed and the breast size and shape will appear deflated within several days or a few weeks.
- You prefer the concept of a saline-filled implant. Although there is no medical evidence that a ruptured or leaking implant causes any health concerns, some women prefer knowing that only sterile saltwater is inside their implants.
Silicone Implants:
The most common breast implants selected by patients worldwide are those filled with cohesive silicone gel.
Silicone gel implants usually feel more like natural breasts.
Currently, silicone gel implants approved in Canada are manufactured by one of three companies: Allergan, Mentor, and Sientra. Each company has smooth, round implants of varying width, projection, and volume. These devices are believed by most to better mimic the feel and movement of natural breasts when compared to saline-filled implants.
Is one brand of silicone implant better than another?
The firmness of the silicone gel within each manufacturer’s implants is different, and occasionally I may feel that one brand of implant should be considered over another. Satisfaction is equally high when Allergan or Mentor silicone implants are used. Although the term “gummy bear” implants has become popular, it is not accurate. The cohesive gel fillers utilized are much softer and much less solid feeling than that of this popular candy. I will share my 25 years of breast implant surgery experience with you when recommending an implant brand, style, width, volume and projection.
Silicone implants might be right for you if:
- You want a more natural feeling breast. This is particularly applicable to patients who have very little natural breast tissue and to patients wanting to choose larger implants. The cohesive silicone gel mimics the feel and movement of a natural breast better than a similar-sized saline-filled device. Although there is very little difference in the weight of silicone and saline-filled devices of the same size, silicone gel implants subjectively feel less heavy and move less during exercise because the cohesive silicone gel filler moves around less vigorously than saltwater. We explain more about choosing the right implant size in a related blog post.
- You have limited breast tissue. Statistically, there is little difference in the incidence of visible rippling of the shell between saline and silicone gel implants. However, if your tissues are thin (allowing you to see your rib contours), then silicone gel-filled implants are less likely to cause severe rippling and visual disappointments.
- You are comfortable with the need for medical imaging to determine when your implants have broken. Silicone gel implants can “silently rupture.” Fortunately, there are no health consequences of this. Ruptured implants usually produce some change in the shape or feel of the breast over several months. These changes then trigger patients to see their plastic surgeon. When ruptured silicone gel implants need to be removed and replaced, the surgery can be more complicated than the surgery required to remove and replace a ruptured saline implant.
I and my team of experienced nurses and care coordinators will help you to decide on the breast implant that matches your desired outcome, your preferences and your lifestyle. During your consultation, you can touch and try on implant samples of the implants recommended for you. We also offer VECTRA 3D simulations to help you to visualize the outcome of breast augmentation surgery.
To get answers to your questions about breast implants or to schedule a consultation, call our office at (604) 888-9378 to speak to one of our experienced and caring team members. You can also use our convenient online form to request a consultation. We look forward to hearing from you.
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