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Michael Law MD Aesthetic Plastic Surgery

Cohesive silicone gel implants vs. conventional saline implants vs. structured saline breast implants

Women considering breast augmentation now have the luxury of deciding between three kinds of breast implants: cohesive silicone gel implants (approved for cosmetic use by the FDA in 2006), conventional (single-chamber) saline implants, and structured saline implants. There are a number of pros and cons to consider with each type of implant, however the most important thing to know is that patient satisfaction is very high with all three. You can’t really go wrong with this decision – it is merely a matter of deciding which is best for you personally.

Regarding silicone gel implants, it is important to understand that a cohesive silicone gel implant is a very different (and vastly superior) medical device compared to the older liquid silicone gel implants that were available for cosmetic use in the 70’s and 80’s, but were not approved by the FDA for cosmetic use from 1991 to 2006 (although they still could be used for breast reconstruction). The new cohesive gel implants are manufactured so that the gel material is in a semi-solid to solid state which, means that if the implant’s outer shell fails the gel material does not easily leak out of the implant – as it would with the older liquid silicone gel implants.

The design and manufacturing process for the outer shell has also improved a great deal, resulting in significantly lower implant shell failure rates. These improvements make gel implants much more appealing as long-term medical devices, and because of these major improvements and positive data from clinical trials the FDA cleared them for cosmetic use in 2006.

One very important issue to consider is implant palpability, i.e. whether you can feel the implant or not when you – or someone else – feels your breast. Silicone gel, structured saline and conventional saline implants are soft to the touch and compressible. Most surgeons and patients agree, however, that silicone gel breast implants tend to feel much more natural than saline breast implants, at least in patients who are starting out with a relatively small breast volume (say A to B), and that structured saline implants fall somewhere in between.

Because saline is non-viscous, it tends to allow the edges of the implant to collapse and this makes the implant edges of a conventional, single-chamber saline implant much more easily palpable in a patient who has a small preoperative breast volume. This will be quite obvious to you when you examine samples of saline and silicone gel implants during your consultation.

breast augmentation

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As suggested above, 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.

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