Cohesive silicone gel implants vs Saline Breast Implants
The degree to which this difference is noticeable postoperatively varies a great deal with regard to two factors: the amount of breast tissue that exists prior to augmentation, and the size of the implant that is used. A silicone gel implant’s more natural feel will be much more important to patients who are slender and who fit in an A cup bra preoperatively, as they have less subcutaneous soft tissue and breast tissue to conceal the implant. In such a patient a saline implant is usually very easy to feel through the skin, and may even be visible externally – especially in the lateral aspect of the augmented breast where the tissue covering the implants is the thinnest.
The difference in feel between saline and silicone gel implants will be less noticeable to a patient who is more full-figured and whose pre-operative bra size is a full B or especially a C cup. In some fuller-figured patients saline implants may be undetectable by palpation (meaning they feel completely natural). Saline implant palpability is primarily a matter, therefore, of how much natural tissue there is to disguise the implant.
Another important difference between gel and conventional saline breast implants is what happens if the implant shell fails. If a conventional, single-chamber saline implant ruptures, that breast will rapidly ‘deflate’ as the body absorbs the saline. Most patients have little tolerance for having just one augmented breast, of course, and a saline deflation thus requires a return to the operating room to replace that implant.
When a gel implant fails, there is no change in the appearance or feel of the breast, as the gel material is inert and is not absorbed by the body (and with cohesive implants the vast majority of, if not all of the gel material, remains within the implant’s outer shell). As there is no outward sign that the implant has failed, the only way to discover that a gel implant has ruptured is to undergo a radiologic test such as an MRI, which is the best means currently available for diagnosing silicone gel implant failure.
The FDA recommends that women receiving gel implants have MRIs at certain intervals postoperatively to monitor the status of their implants (this is an FDA recommendation but not a requirement). The cost of an MRI scan (which includes the charge for performing the test as well as a charge for the test being interpreted by a radiologist) can range from $1000-$2000. The FDA also recommends that patients with a ruptured silicone gel breast implant have the implant removed and replaced.
Structured saline implants (the brand name is ‘Ideal Implant’) represent an attempt to create a saline-filled breast implant that is less easily palpable and more life-like than a conventional, single-chamber breast implants Although not quite as breast-like as cohesive silicone gel implants, structured saline implants definitely feel more natural than single-chamber saline implants. And unlike silicone gel breast implants, a radiologic study like an MRI scan is not required to detect a structured saline implant shell failure.
If the outer, smaller chamber of and Ideal Implant leaks and empties then the implant loses a relatively small percentage of its total volume and the augmented breast will appear slightly smaller than the other side, so implant replacement is not urgent. If the larger, inner chamber leaks and empties then the affected breast will appear much smaller than the other side, and immediate replacement of that Ideal Implant will be necessary.
Schedule a consultation with board certified plastic surgeon Michael Law MD.