Now that you’re ready for breast augmentation, you have to decide what type of implants to get. All breast enlargements are not created equal. You and your surgeon will weigh what will work best for you based on your anatomy, your skin, and what end result you have in mind.
One important thing to know is that all breast implants are made from a silicone elastomer (rubber) envelope or sac. The difference is in the material used to fill this sac. There are essentially only two choices (saline or silicone-gel filled) but lots of considerations, such as shape, size and profile, so don’t be overwhelmed by your options.
Silicone vs. Saline Breast Implants Explained by Dr. Mark Epstein M.D., F.A.C.S.
Another important factor is that most breast implants come in two shapes: round and anatomical (a.k.a. tear drop shaped or contoured). Round implants can shift around somewhat without changing the breast’s shape, unlike their anatomical counterparts. Round implants are available smooth or textured and are less expensive than anatomical implants.
Tear drop shaped (or bottom heavy) implants are very popular because some women think they have a more natural look. However, these implants must be placed in the proper location by an experienced plastic surgeon to prevent them from moving or slipping. For this reason, anatomical implants are available only with textured surfaces to help reduce the risk of movement. The textured surface may add to the price. Interestingly, the size of breast implants usually has no impact on the cost.
In the U.S., two manufacturers make FDA-approved breast implants – Mentor and Allergan (Natrelle™). Both offer high-quality implants. Your surgeon may prefer one manufacturer’s products over the other, but they are both equally safe and durable. Read through our extensive guide for everything you always wanted to know but were afraid to ask about the various types of breast implants!
History of Breast Implants
Lest you think that trying to augment breasts is a modern invention, think again! In the late 1800’s, physicians began experimenting with suitable ways to increase the size or change the shape of breasts. Some tried paraffin injections; others tried filling materials like glass balls, ivory, ground rubber, ox cartilage, wool, polyester, sponges and other curious substances. Even as recently as the 1950s, doctors tried using silicone injections or excess chest wall tissue to increase breast volume. As you can imagine, many of these experiments were disastrous.
In 1961, the Dow Corning Corporation developed the very first silicone-gel implant. This implant had a tear-drop shape and the rubber shell was filled with a firm medical grade plastic, or silicone, substance. At the time it was thought that the implant would have to be attached to something to make it stay in place, so there were little mesh patches (not unlike Velcro) attached to the back to make the implant adhere to the chest wall.
The first saline breast implants were manufactured by the French company, Laboratoires Arion, in 1964. After implantation, the empty envelope or sac could be filled with a sterile saline, or saltwater, solution. The big advantage of this implant was that the surgery required a much smaller incision (because they were empty) than for silicone-gel implants, so the resulting scars were much smaller. By the 1990s, when the FDA imposed restrictions on silicone-gel implants, this saline implant became the usual implant used in breast augmentation.
The first silicone-gel implants were much too firm to the touch and caused other problems like capsular contracture (abnormal tightening of scar tissue that forms around all implanted materials). So, in the 1970s, a new silicone implant was developed with a thinner sac and a more liquefied form of silicone gel filling. A polyurethane coating on the sac was added, but this caused inflammation and other potential health issues. Yes, these implants were softer and more life-like, but the thinner sac was easily ruptured and sometimes the silicone leaked out. There was also little improvement on the capsular contraction and other complications. These second-generation implants are the ones that spurred so many lawsuits leading to the U.S. FDA’s ultimate 14-year moratorium in 1992. (They continued to be available to women in Europe and South America, however.)
During the 1980s, the third and fourth-generation silicone-gel implants were developed. This time the sac was coated with a silicone elastomer substance to decrease leakage, and the filling was made thicker. These models offered different shapes (round and tapered) and textures. The fourth-generation implants are the ones that achieved re-approval by the FDA in 2006.
Improvements continued to be made and, by the mid-1990s, the fifth-generation silicone-gel implants came on to the European market with a soft-solid gel that nearly eliminates leakage or rupture, and reduces the instances of capsular contracture. These are known as cohesive breast implants. They are also called “gummy bear implants” due to their similarity to the consistency of the gummy bear candies – they are soft, flexible and maintain their shape. When cut, they do not leak. These appear to be the safest silicone-gel implants yet but they are currently undergoing clinical trials in the U.S. Only a few dozen surgeons have been allowed to participate in the trials. Maybe you could be one of the lucky patients to qualify to take part?
As you can see, there have been significant improvements in breast implant technology over the last centuries. Now let’s take a look at the differences, costs, and the advantages and disadvantages of both types of breast implants so you can make an informed choice.
Saline breast implants
Due to the FDA’s moratorium on silicone breast implants between 1992 and 2006, the most frequently placed implants in cosmetic breast enhancement surgeries over the past few decades have been saline filled. However, according to the American Society of Plastic Surgeons, 56% of all breast implants placed cosmetically in 2010 were silicone gel implants, so the popularity of silicone is increasing.
Pre-filled saline implants are not approved for use in the U.S.
Advantages of saline implants
- Saline implants require smaller surgical incisions because they do not have to be filled until they are implanted.
- Unlike silicone gel-filled implants, saline implants can be adjusted after implantation. It is possible for the surgeon to add or remove the saline solution by means of a syringe to correct any asymmetry.
- The cost of saline breast implants ranges from $800 to $1,000 per pair (this does not include the cost of surgery), making them about half the price of silicone implants. This is probably because the saltwater solution is inexpensive in comparison to the silicone gel.
- Some women believe that saline implants feel less like real breasts than silicone gel implants. However, women who decided on saline implants report being satisfied with their choice.
- If a saline implant ruptures, the sterile saltwater solution will simply be absorbed by your body. However, ruptures of saline implants are immediately noticeable because they will go flat.
- Silent rupture of saline implants is not a concern so there are no specific recommendations for frequent breast MRIs to detect it.
- Saline implants have a very low infection rate.
Disadvantages of saline implants
- Saline implants tend to ripple or wrinkle more than silicone implants, and the rippling may be seen or felt. For this reason, your doctor may recommend placing them only in a submuscular (under the muscle) position.
- Saline implants are usually firmer to the touch than silicone implants. Some people believe this makes them feel less like a natural breast but others believe there is very little difference once they have been implanted underneath skin and muscle tissue.
- Large saline implants have a higher rate of downward displacement than silicone implants simply because they are heavier.
Silicone gel implants (standard)
The use of silicone gel in breast implants has been very controversial. In the early 1990s when a moratorium on their use was imposed by the FDA, some patients had filed lawsuits and complaints that their autoimmune or connective tissue diseases (e.g., multiple sclerosis, rheumatoid arthritis, lupus, and scleroderma) and cancers were caused by leaking silicone gel implants.
Improvements have been made in silicone gel breast implants since the 1980s. Today they are made with multiple layers of silicone elastomer around the implant. This reduces the likelihood of rupture and leakage.
Advantages of silicone implants
- Silicone gel implants are said to feel much softer and natural than saline implants.
- Silicone implants have a lower incidence of wrinkling and rippling. This means they can be placed over the muscle for thin women with very little breast tissue.
- Silicone is lighter than saline so they are less likely to be affected by gravity than saline implants.
Disadvantages of silicone gel implants
- Silicone gel implants are about twice the cost of saline implants.
- If you are younger than 22 years of age, you cannot currently obtain silicone-gel implants for breast augmentation purposes.
- Silicone gel implants are pre-filled and must be ordered in a specific size. This cannot be changed by adding or removing gel.
- The surgical incision for silicone gel implants is longer than that of saline implants because they are already filled and have to fit through the incision. This means the implants cannot be implanted through an incision in the navel (as can saline implants).
- The risk of capsular contracture is lower than for saline implants.
- Rupture of silicone breast implants can cause silicone to leak into the breast or lymph nodes, although usually in very small quantities. Studies continue to be done with regard to the safety of silicone in breast implants.
- Rupture of silicone breast implants is more difficult to detect than with saline implants. Consequently, a breast MRI every two or three years after implant is highly recommended to determine if the silicone implant is ruptured or leaking.
Cohesive silicone gel implants a.k.a. “gummy bear” implants
All silicone gel is cohesive to some extent, meaning that it’s less liquid and more solid than standard silicone gel implants. Cohesive silicone gel implants, commonly known as “gummy bear” implants because of the gel consistency, were developed to offer a better shape and to make a longer-lasting breast implant.
Although these implants have been available worldwide for about 15 years, they are restricted for use in the U.S. except for patients who take part in a clinical trial. There are three clinical trials underway – with Allergan 410, Mentor CPG, and Silimed/Sientra Nuance and Enhance. Each trial is limited to a few selected surgeons who can purchase and implant the gummy bear implants and there are strict qualifications and follow-up requirements for participating patients.
Advantages of gummy bear implants
- Cohesive silicone gel implants may keep their shape better than either saline or standard silicone gel implants.
- Folding and rippling rarely occurs.
- Research is underway, but it appears that the incidents of rupture are less for cohesive gel implants than for saline or standard silicone gel implants.
- While rupture of the silicone sac may occur, the cohesive silicone gel is not likely to move. Consequently leaking is minimized.
- Cohesive silicone implants may cause less development of scar tissue (capsular contracture), but this is still being studied.
Disadvantages of gummy bear implants
- Care must be taken when selecting the shape of a cohesive gel implant. These implants are not affected by gravity so the shape of the breast will not change over time.
- Gummy bear implants are a little bit firmer than standard silicone gel implants but most patients claim this is barely noticeable.
- Gummy bear implants are a few hundred dollars more expensive than standard silicone implants. However, because they are only available to patients who are part of the clinical trial, most of the implant cost will be reimbursed over a 10 year period.
- Gummy bear implants require a sizeable surgical incision.
- Most gummy bear implants come only in an anatomical (or teardrop) shape. If the implant rotates after implantation, the only way to remedy the problem is to remove the implants and replace them with round implants. This is more often a concern for patient who are having a larger implants replaced with smaller ones.
- On rare occasions, cohesive gel implants can crack.
In summary, more important than debating about the variety of available breast implants is for you to choose a competent and skilled plastic surgeon. Your doctor will discuss all of your implant options, the pros and cons of each, and potential risks and complications. Do your homework and choose a qualified board-certified plastic surgeon to make sure you get the very best care and the very best results.