Silicone vs Saline Breast Implants

Breast Implants have come a long way. Today there’s an enormous variety of sizes, profiles, textures and shapes, although only two materials are used: silicone and saline. So, if you’re considering implants, and the ‘silicone versus saline Breast Implants’ conundrum is running through your mind, we hope this article will help you.

Before we dive in, you may find it comforting to know that both materials used today are heavily regulated by Australia’s Therapeutic Goods Association (TGA). So, you can rest assured that no matter what you choose, both substances are safe in your body.

At Bella Plastic Surgery, Dr Eddy Dona exclusively uses silicone implants as he considers them far superior for numerous reasons. In a moment, we’ll explain why Dr Dona prefers silicone and discuss the differences between silicone and saline implants.

Here’s what we’ll cover in this article.

• Previous breast augmentation materials
• Silicone implants – essential info
• Saline implants – essential info
• What happens if a Breast Implant ruptures?
• What are the best Breast Implants?
• Safety concerns

Previous breast augmentation materials

Breast Implants have been used for decades. So it’s vital to note that if you’ve heard the odd disaster story, it’s likely due to older-style implants surgically placed long ago, using outdated techniques.

Today, Breast Implant surgery is the most common surgical procedure in the world, and results are far more realistic and durable than in the experimental days of decades past.

Experiments with breast enlargement began in the nineteenth century when somewhat cavalier doctors injected paraffin wax into women’s breasts. This disastrous surgery left patients susceptible to infections, uncomfortable lumps and bumps and even triggered cancers.

In the early twentieth century, more dubious experimentation took place. Various ineffective and carcinogenic materials such as Vaseline, rubber, olive oil, silicone oil, sponges, ox cartilage glass — and even snake venom were inserted into the breasts — with disastrous and sometimes fatal results.

Fortunately, surgeons moved away from such crude practices with the invention of the silicone Breast Implant by Cronin and Gerow in 1962.

Let’s look at the two different Breast Implant materials used today.

Silicone Breast Implants

Silicone Breast Implants have been used for over 60 years and continue to be the most popular choice for breast augmentation in Australia and across the globe. Why so? They are soft to the touch, longer-lasting, and appear more natural-looking with a more natural curvature — and when it comes to Breast Implant durability, they are far superior.

Both silicone and saline implants have an outer silicone shell. However, silicone implants have an inert polymer gel suitable for long-term use in the body. Because it is a gel (not a water-based solution), it moves differently and feels more like natural breast tissue.

Any breast implant can rupture; however, the risk of spontaneous rupture or leaking is much lower compared to saline implants — or the older version of silicone implants. It’s also important to understand that your Breast Implants sit in a pocket created by your surgeon and your body will always form a scar tissue capsule around the implantSo, if a leak occurs in today’s newer gel implants, it typically won’t spread beyond the implant capsule – these are referred to as intracapsular ruptures.

Silicone implants are also inserted differently from saline implants. A slightly larger incision is required, and they are inserted as a whole into a pocket created by the surgeon. In contrast, saline implants are inserted as deflated balloons, and once the empty balloon is in position, it is inflated with saline. Therefore, this can be done via a smaller incision.

Saline Breast Implants

Saline Breast Implants (or expanders) are often popular with patients undergoing breast reconstruction. This is because it’s possible to adjust the implant size after surgery. Using an injection port (months after the initial procedure), the surgeon can adjust the amount of fluid to reach the desired volume. The port is then surgically removed. This is typically changes at a later date for a permanent silicone breast implant of equal volume.

The downside with saline Breast Implants is that they don’t feel as natural as silicone implants. It’s easy to see the folds of the saline implant — known as ‘rippling’ — particularly if the patient has thin skin or little breast tissue.

Saline implants also have a higher chance of rupturing. One study that reviewed 72 implants removed for implant rupture indicated that rupture was diagnosed at an average of 5.6 years after surgery compared to 12 years for silicone implants.

However, although saline Breast Implants are more likely to rupture, when they do, they are easier to diagnose. Additionally, your body can absorb the saline from the implants safely.

What happens if a breast implant ruptures?

Silicone implants are basically silicone balloons that are filled with thick silicone gel. It is the silicone shell, or balloon, that creates and maintains the shape of the implants.

A ruptured implant means that the silicone shell breaks. It can happen within months after surgery or many years later with the rate of rupture increasing over the life of the implant.

If an implant does rupture, the implant shell breaks down and the silicone gel empties from the shell but remains contained within the breast implant scar capsule – these are referred to an intracapsular ruptures – and this is what happens in the vast majority of cases.

However, in some cases the silicone gel can pass through the implant scar capsule into the breast tissues and even the lymph nodes – these are referred to as extracapsular ruptures.

How to tell if your implant has ruptured

Most breast implant rupture patients have what is referred to as “silent” ruptures – in other words, you have no symptoms or issues and don’t even know they are ruptured. These patients usually discover they have ruptured implants whilst having a breast investigation for other purposes.

If you do have a ruptured implant, then it can affect how your breast looks and feels.

With respect to the shape, the change is most evident when lying on your back. In this position, the breast with the ruptured implant often has a loss of projection and appears quite flat. When standing up it can manifest with a loss in upper pole fullness.

As far as the feel is concerned, when you examine a breast with a ruptured implant, it typically has a very soft doughy feel to it.

Not to confuse the matter, but if the implants also have a degree of capsular contracture, then these changes to the breast’s shape and feel may not be that evident.

If a ruptured implant is clinically suspected, then an ultrasound or ideally an MRI should be performed for confirmation.

Symptomatic Silicone Breast Implant rupture

Whilst most women with ruptured implants have no symptoms, a small percentage can develop symptoms. This can include pain and lumps in the breast tissue or armpits, a change in breast shape, size or firmness.

It is usually the small percentage of extracapsular ruptures which become symptomatic.

Saline Breast Implant ruptures

As mentioned, saline Breast Implants have a soft silicon shell, similar to silicon implants. However, the implant is filled with sterile salt water, not silicon gel. Due to saline being far more viscous, if there is a rupture, the water will quickly leak into the surrounding tissues and be absorbed by the body. Therefore, the breast will soon take on a ‘deflated’ appearance. If this happens, the patient must contact their plastic surgeon immediately to address the issue.

Options for a ruptured saline implant are to remove the implant without replacement or replace it with a new one. Typically, if one ruptured implant is removed, the other will also be removed. The reason why? As both implants were placed at the same time, if one has ruptured, the other may also rupture soon.

These days, when patients have their saline implants replaced, they usually choose silicone implants instead as they are very safe, unlikely to cause issues — and look and feel extremely natural.

What are the best Breast Implants for me?

Choosing the right Breast Implants for you is entirely subjective. What may be best for you may not be appropriate for someone else. This is why there’s no such thing as

During your initial consultation with Dr Dona, he will carefully listen to you, develop an understanding of your wants and needs — and then perform a thorough physical assessment. As an experienced and skilled plastic surgeon, he can then discuss the best options for you and your body.

Dr Dona does have some preferences with implants, though. He prefers to only use silicone implants for the reasons outlined earlier. He also prefers placing the implants under a portion of the muscle rather than having them sit on top the muscle wall – a custom dual plane implant pocket – as he strongly believes this technique gives a better result.

Choosing the best Breast Implants for you warrants several considerations:

• Size of your frame and physical proportions
• Reasons for surgery – e.g. for breast reconstruction, to even out different-sized breasts or to enlarge both breasts
• Desired breast size
• Profile – how far forward you would like the breast to project
• Shape of implant/s – for some, a teardrop-shaped (anatomical) implant is better, while others are more suited to a round breast implant

Management of ruptured Silicone Breast Implants

As a rule, ruptured implants are not a medical problem and pose no significant health risks. So, it is not a problem that warrants “urgent” treatment.

If someone has ruptured implants, then they can be offered the choice of regular observation, or implant removal with or without replacement.

Of course, those with symptomatic ruptures would be more inclined for earlier surgical management compared to those with no symptoms.

References:

The evolution of breast implants

https://pmc.ncbi.nlm.nih.gov/articles/PMC6797490/

A Retrospective Analysis of Ruptured Breast Implants

https://pmc.ncbi.nlm.nih.gov/articles/PMC4228218/

Australian Journal of General Practice– Breast Implants: a guide for general practice

https://www1.racgp.org.au/ajgp/2021/july/breast-implants-a-guide-for-general-practice