Silicone implants are available for patients who are at least 22 years old. They provide a very natural feel, especially for patients who have a limited amount of breast tissue.
Multiple scientific studies have shown the safety of silicone implants. Silicone gel implants were introduced in 1963 and were used routinely by plastic surgeons until January of 1992 when they were taken off the market for cosmetic patients (not reconstructive patients). At that time there were concerns about the potential causal relationship between certain diseases such as lupus and Rheumatoid arthritis and breast implants. Further research in both the United States and throughout the rest of the world (where silicone implants were not removed from the market) showed that these diseases were common in women and so were breast implants but there was no causal relationship between the two. There was even a study of multiple sets of twins in which each twin had lupus but only one of the two had implants.
Silicone implants require a slightly larger access incision than saline implants- 4.6 cm to be exact. This limits the incision choice to the inframammary (beneath the breast) and in some patients the areolar (if the pigmented area around the nipple is large enough) approach.
The FDA recommends MRI evaluations of these implants over time to monitor for possible rupture. This is not a requirement, but a suggestion.
Historically the capsular contracture rate (scar tissue formation around the implant) of silicone implants is slightly higher than saline implants.
Saline implants have improved significantly over time. It is very rare that we see an implant failure due to a manufacturing defect. I can’t even remember one over the past three or four years.
It is important for patients to choose a saline implant that fits well with the existing breast dimensions. If the implant is wider than the patient’s native breast, then it is more likely that the implant will be felt and possibly seen in its lateral aspect. This can occur even when the implant is placed beneath the muscle (which does not extend into the lower lateral chest).
Saline implants are flexible in their fill volumes which are nice especially when there is a size difference between breasts. The smaller side then can receive more fluid in the operating room. Silicone implants come prefilled and can’t be adjusted. If a saline implant is filled too much it can feel hard. Saline implants can be placed through smaller incisions than silicone implants
In most cases saline implants can provide a very nice result. If patients have a bare minimum of their own tissue, however, then silicone implants are probably a better option.
Saline implants are the only option if for patients younger than 22 years old. They are also less expensive than silicone implants.