Given these two choices, how does one decide which type of breast implant is better for them?

In reality, neither saline or silicone breast implants are perfect. If one was truly better than the other, there would be only one choice not the two that we have. Each type of breast implant is safe (FDA-approved) and has its own unique set of advantages and disadvantages. Both of them will do the job and do what they are intended to do… make the breasts bigger. But there are some differences between them and understanding these differences helps you make the best implant.

Saline breast implants have the advantages of a lower cost and can be placed through a small incision high up in the armpit that is not on the breast. That incision location may be an advantage in the Hispanic woman who may be concerned about any scarring around the breasts. Saline implant disadvantages are that there may be some implant rippling that can be felt on the bottom or sides of the breast and the risk of immediate deflation of the breast should the implant rupture.

Silicone breast implants have the benefits of a slightly more natural feel (no rippling) and the breast will not go flat should the implant rupture. However, they do require an incision in the lower breast crease and have higher implant costs.

Other than these implant differences, everything else about the breast augmentation procedure is the same including recovery time (one week or less) and how long the breasts will be swollen. (two to three weeks)

What is the best type of breast implant for you? I tell patients to make their choice based on which of their disadvantages you can live with the best. Both saline and silicone implants work for breast augmentation…which of their disadvantages is more acceptable to you?

Dr. Barry Eppley

Indianapolis, Indiana

A: This is a good question and it doesn’t make sense to you because, although the name silicone implies that all is the same, they are somewhat different chemically and how they are packaged. This turns out to make a big difference when introduced into the body.

Injectable silicone used for illegal soft tissue augmentation is an oil that is less polymerized and less stable. It is also dispersed in the soft tissues in small droplet form. This leaves a lot of surface area of the oil onto which inflammation and scar tissue can form. Silicone in breast implants is in a more highly-polymerized (stable) form that is encased in its own protective bag or barrier. This results in no actual silicone being exposed to the body so no reaction to it occurs. The only reaction the body as is to the bag that contains it. If ruptured, the released silicone is further protected by the body by the natural scar (capsule) that always forms around the implant. (a second bag or barrier if you will) The more polymerized silicone gel causes less inflammation or reaction from the body than oil even if it does become exposed to it. Silicone gel in breast implants has also been highly studied and evaluated by the FDA with rigorous scientific scrutiny as to its bodily effects. Injectable silicone oil has never been exposed to such scientific scrutiny as a soft tissue filler and thus has never been approved for an injectable augmentation approach.

Dr. Barry Eppley

Indianapolis, Indiana

One important, but often overlooked, aspect of the surgical implantation of breast devices is getting them placed into the breast pocket. When only saline implants were available this was never a concern as they were inflated after they were placed. This meant that very small incisions could be used for their introduction that were not even on the breast. Rolled up like a burrito, a saline implant is inserted through a one inch incision and then inflated to the desired size. With the re-introduction of silicone breast implants in 2006, larger incisions are needed as they are pre-filled and must be inserted as such.

This makes the issue of larger scars with silicone breast implants a concern for some patients. Plastic surgeons will frequently push and cram the breast implant through a small incision because of this concern. Needless to say, this technique is not good for the implant and undoubtably weakens its shell and leads to premature rupture and the early need for replacement. That has all changed with the introduction of an improved delivery method.

Known as the funnel, and looking exactly like what is used to decorate a cake, the breast implant is now easily propeled into the implant pocket….all without ever touching the implant or squeezing it too hard in one place. This incredibly simple but highly effective delivery method now makes it possible to use very small incisions again and even do silicone gel breast augmentation from a remote armpit incision.

As silicone gel has returned as an implant option to saline, it has again become a sought after breast implant material. With no risk of ever spontaneously deflating like a saline implant can (and eventually will), its more natural feel makes it a very popular choice. While the health concerns from the early 1990s with silicone has long been dispelled, the concern about rupture and what happens to the material persist. This has lead to the development of advanced silicone materials that hold together more like a solid, resulting in what is known as the gummy bear breast implant.

The gummy bear breast implant is more than just a cute nickname. It is a reflection how the silicone filling looks and feels…soft and spongy. And just like those cute little red, green and yellow bears, you can push and pull on it and even cut the material and it won’t lose its shape. The physical similarity between this new implant and the candy are striking and it is no wonder how it got tagged with this name.

Breast augmentation continues to get better and more safe as the materials and techniques to deliver them improve. This gives women more options to choose what they feel best fits their bodies.

Dr. Barry Eppley
Indianapolis, Indiana

A: Breast augmentation poses multiple choices for prospective patients to consider. These options are driven by implant choice which can secondarily control the placement of the necessary incision. Saline breast implants are often placed through a small armpit incision because they are inserted deflated and then inflated once into position. Silicone gel breast implants, unless they are very small, can not be placed through the ampit because they are inserted pre-filled or fully inflated. Thus, they are usually placed through a lower breast crease or inframammary fold incision.

But the incision is not the most important part of the breast augmentation procedure, the implant is. All incisions heal really well and are rarely of any secondary cosmetic consequence. Therefore, it is important to understand fully the differences between saline and silicone gel implants. While both work well and do an equally good job at making a larger breast, there are some important minor differences in them that are relevant in the long-term. This is especially pertinent to you at your young age since you will live to see them. These include such risks as implant deflation (saline) and silent rupture.  (silicone) You will be replacing these implants at least once on your long remaining lifetime so understanding these differences is important to you.  

Dr. Barry Eppley

Indianapolis, Indiana

A: Your question/concern about the impact of breast implants in the water is neither strange nor new. Women have asked me about that numerous times in my Indianapolis plastic surgery practice. One the one hand, millions of women over the past thirty years have had breast implants and such potential problems have never surfaced or been reported. This would strongly suggest that what your friend is telling you is nothing more than an urban myth.

From a scientific standpoint, the question is one of the buoyancy of breast implants. Depending upon the type of breast implant, the answer differs slightly. Saline implants are neutrally buoyant, meaning that they will neither float nor sink. This makes perfect sense since they are essentially the same density as the water in which they are immersed. The two fluids are only separated by the thin containment shell of the implant. Silicone implants, however, are a little more dense than water and  will have a slight sinking effect.But they will not completely sink and essentially float as well. This can be easily demonstrated by placing both type of implants in a sink filled with water.

When placed in the body, however, the buoyancy of breast implants demonstrated by benchtop testing becomes irrelevant. Their impact will be the same as any other enclosed body part. Their only potential impact on swimming is on the aerodynamics of the body shape, which is only relevant if one is an Olympic or competitive swimmer.

Dr. Barry Eppley

Indianapolis, Indiana

A: The ‘need’ to replace breast implants occurs either to a desire for some type of further enhancement (size change) or an existing problem with one of both of the implants. When it comes to saline implants, the absolute need to replace them is when one fails or deflates. There is no need to change just because they are getting older. My Indianapolis plastic surgery practice motto has been on this very subject…’if they look and feel fine, then there is never a need to replace a saline breast implant.’

That being said, most saline breast implants will eventually undergo a deflation usually in the 10 to 20 year range after their initial placement.

One of the unrecognized (by patients) phenomenon of breast implants is that they can change position over time. Whether it be weight loss, pregnancy, or a larger size implant, the soft tissue containing them can and often does change. When the soft tissue around the implant changes (stretches or relaxes), the position and shape of the breast may soften and settle. In larger implants, their size and weight may cause the lower breast fold (inframmary crease) to drop. This sounds like what has happened in your case.

While silicone gel breast implants were not available 10 years ago, you should seriously consider converting to them at this point if you are looking for further breast improvements. They will not have rippling and may feel softer and more natural. You would also eliminate the lifelong risk of a spontaneous implant deflation. When replacing the implants, you may also consider repositioning of the lower breast fold back up higher to correct any implant bottoming out that has occurred.

Dr. Barry Eppley

Dr. Barry Eppley discusses Breast Augmentation