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Breast Implant Fill - Saline or Silicone?

Nov 8, 2007
As of November 17, 2006, women in the U.S. aged 22 and over have the option of choosing both saline and silicone gel filled breast implants. The first implants were filled with silicone gel. As breast implants evolved, saline (salt water) became an accepted alternative fill to silicone, although silicone can look and feel more like a real breast. Whether filled with silicone gel or salt water, the shell of both types is made of a firmer, silicone elastomer.

Background: In 1992, after decades of widespread availability of silicone gel-filled breast implants, FDA Commissioner David Kessler decided that the safety of silicone breast implants had not been established and had silicone breast implants removed from the market. For 15 years, silicone gel-filled implants were available only to breast reconstruction patients and patients undergoing breast revision surgery. In order to receive silicone, women had to enrolled in clinical trials mandated by the FDA.

The ban on silicone was lifted on November 17, 2006. To read articles about the FDA's approval of silicone gel breast implants.

Note: Soy filled implants are no longer available. The risk of infection on rupture from this substance was too high. Some claimed they also smelled bad!

A saline breast implant is a sac (implant shell) made of silicone elastomer (rubber), which is surgically implanted under your chest tissues and/or muscle, and then filled with saline, a saltwater solution, through a valve.

Breast implants have been used for breast augmentation for more than 40 years. Saline implants were long considered an inferior alternative to silicone gel-filled implants, which may look and feel more like a real breast than saline breast implants. Silicone implants were removed from the market by the FDA from 1992 to 2006 and saline (salt water) filled shells became an accepted alternative to silicone. Saline implants were approved by the FDA in 2000 and have always been available to women in the U.S. and worldwide.

Because of the FDA's ban on silicone for approximately 15 years, women had to be enrolled in clinical trials to get silicone implants. As a result, saline implants have been the most frequently used implants in the U.S. for cosmetic breast augmentation. With the availability of silicone as of November of 2006, those statistics may change.

Saline breast implants vary in shell surface (smooth or textured), volume / size (number of cc), shell thickness, profile and shape (round or anatomical), and are even available as expandable implants. Most saline implants are single lumen (only one chamber), and filled during surgery. Pre-filled saline implants were available for a short time but are no longer on the market.

Pros and Cons: Saline implants are more likely than silicone to cause visible rippling and are generally firmer to the touch and less natural in appearance than silicone gel breast implants. Saline implants are filled during surgery and allow the surgeon to make adjustments in the fill during surgery.

Overfilling past recommended manufacturer's guidelines can cause too much firmness. Not filling the implants sufficiently can cause the implant to have a fold which could lead to a failure of the implant know as crease fold failure. In the event of a rupture of a saline breast implant, saline is released and the empty implant can be removed and/or replaced.

Today's silicone gel breast implants are made differently than they were in the 1970s and 1980s. Initially, silicone gel breast implants had thick shells and thick silicone gel fills. In the 1970's, manufacturers began to use thinner shells, which were more likely to rupture. Today, both Mentor and Inamed make silicone implants with multiple layers of silicone elastomer surrounding the implant. This reduces the amount of gel bleed but can make the implants feel and look firmer. They are, however, much softer than saline.

Unlike saline breast implants, silicone gel breast implants are pre-filled. Surgeons order them in the requested size and they cannot be changed. Plastic surgeons have to make longer incisions in most cases to place a silicone gel filled breast implant than a saline filled breast implant, all other things being equal. The incision for silicone is 4cm compared to Saline which is 3cm, as there is not much difference in the size of the incision this is usually a small part in deciding which implant the patient chooses. Silicone implants cannot be placed endoscopically through a navel incision.
About the Author
Dave Stringham is the President of LookingYourBest.com an online resource for plastic surgery in Hawaii. Learn more about breast augmentation and cosmetic surgery procedures.
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