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Saline vs. Silicone Implants

Should I Have a Silicone Gel or a Saline Implant?

Many plastic surgeons believe that silicone gel-filled implants have a more natural look and feel than saline implants. Silicone gel has a texture that is very similar to natural breast tissue. Saline implants, on the other hand, do not feel as soft.

However, silicone gel also has certain disadvantages. For example, silicone gel implant ruptures are harder to detect. When saline implants rupture, they flatten visibly. When silicone gel-filled implants leak, the breast often looks and feels the same. As a result, silicone gel may begin leaking into surrounding areas of the breast unnoticed. Also, replacing a ruptured silicone gel implant is more difficult than repairing a saline implant. This is because the silicone gel that has leaked outside of the implant should be removed (if possible).

There have been some reports in the media of various health problems as a result of silicone gel. In these reports, silicone gel has been associated with lupus, rheumatoid arthritis, scleroderma, neurological disorders, and other conditions. Silicone gel-filled implants were removed from the market to give scientists time to study the effects of silicone. However, researchers have found no evidence thus far supporting the connection between silicone gel breast implants and medical problems. Women who have silicone gel implants appear to have the same risk of disease as women who do not. Because of this information, silicone gel implants are beginning to be offered again by certain doctors. Still, the vast majority of breast reconstruction is done with saline-filled implants. You should be aware that even the saline implants are made of a silicone pouch filled with saline.

Advantages of Implants


Implant surgery requires a shorter hospital stay and shorter recovery time compared with most other reconstruction options.
Because this approach requires less extensive surgery than other reconstruction methods, usually less recovery time is necessary. If you choose to have immediate reconstruction, you will likely stay in the hospital for one to two days after the combined mastectomy and tissue expander or implant surgery. When the reconstruction is delayed, your hospital stay will probably be about 24 hours. If you have a tissue expander, the second operation, in which the tissue expander is replaced with an implant, will require a hospital stay of four to 24 hours. Although every woman's recovery time is different, most women will be able to resume many of their regular activities after one week. After implant placement surgery, three to four weeks may be required before patients can perform more strenuous activities or return to work.
Implant surgery produces relatively predictable breast shapes in most women.
Since implants are made in pre-set shapes, it may be easier (compared with flap reconstructions) to predict what the reconstructed breast will look like. Therefore, you may have more realistic expectations about the surgery.
Implant surgery leaves fewer scars.
Reconstruction with implants usually results in only one or two scars around the breast. Often the mastectomy scar is used as the site of the new incision so you will have no additional scars after the reconstruction.

Disadvantages of Implants


Implant surgery may give a less natural breast shape.
It may be more difficult to ensure that both breasts are the same shape when implants are used. Implants do not allow the same degree of sculpting and shaping as natural tissue. As a result, the breast with the implant and the natural breast may not look exactly the same. Implants also do not feel completely natural to the touch.
Implant surgery may be time consuming and inconvenient.
If a tissue expander is needed, additional surgery and frequent doctor visits will be necessary. You must consider if you have the time and patience to undergo another surgery, hospitalization, and recovery period. You also need to think about whether you can attend doctor appointments every one to two weeks.
The results of implant surgery may not be immediate.
If a tissue expander is needed, you will not wake up from the initial surgery with a new breast. This can be disappointing if you are eager to see your new breast. If a tissue expander is required, it takes four to six months for breast reconstruction to be completed. During this time, one breast is bigger than the other, creating a "lopsided" effect. This may make you feel awkward or uncomfortable with your body. It may also limit the clothing you wear and the activities in which you participate. You may choose to wear a prosthesis or pad your bra to make your breasts the same size. However, this may not work if you are especially active.
If you have had radiation therapy, your skin may not respond well to the tissue expander.
Radiation tends to cause scarring in the radiated skin on your chest. This skin may not stretch well during tissue expansion, making the process more difficult.
Complications with the implant may develop.
About two to four women in 100 develop an infection near their surgical incision soon after the operation. Another two in 100 may experience bleeding ("hematoma") or fluid collection ("seroma") under the breast skin after surgery.
Implants may also develop complications over the long term.

The most common complication is leakage or rupture. This happens in approximately 10% of cases over the first 10 years. (No data yet exist to track the life of an implant after the first 10 years.) When this occurs, the implant must be removed or replaced. This surgery lasts from 30 minutes to 1 hour. It may be done on an outpatient basis or require an overnight stay. If the implant was filled with silicone gel, more extensive surgery, lasting at least one hour per implant, may be needed to remove as much silicone as possible from the breast area.

The second most common complication is encapsulation or "capsule formation." Scar tissue forms on the outside of all artificial implants when placed in the body. Usually, this does not pose a problem. However, in approximately 5-10% of cases, too much scar tissue forms. This may occur more frequently with silicone implants than with saline implants. The scar tissue may cause pain and discomfort and make the implant feel hard to the touch. When this happens, surgery may be necessary to break up or remove the scar tissue. It may also be necessary to remove or replace the implant. Capsules can form at any time, from a few weeks to many years after the implants are inserted.

In about 7 cases out of 100, the implant shifts relative to the breast tissue sometime after the surgery, causing a "wrinkle" or "dent" in the shape of the final breast reconstruction ("contour irregularity").

Silicone gel-filled implants are not available at all hospitals.
There have been some reports in the media of various health problems as a result of silicone gel. In these reports, silicone gel has been associated with lupus, rheumatoid arthritis, scleroderma, neurological disorders, and other conditions. Silicone gel implants were removed from the market to give scientists time to study the effects of silicone gel. However, researchers have found no evidence thus far supporting the connection between silicone gel breast implants and medical problems. Women who have silicone gel-filled implants appear to have the same risk of disease as women who do not. Because of this information, silicone gel implants are beginning to be offered again by certain doctors. Still, the vast majority of breast reconstruction is done with saline-filled implants. You should be aware that even the saline implants are made of a silicone pouch filled with saline.
Implants do not change to match changes in body weight.
Implants do not change size or shape. This means that the size and shape of your reconstructed breast will also remain the same, regardless of changes that may occur elsewhere in your body. Consequently, if you lose or gain weight, your breasts may seem disproportionate to your new body shape.

Implants: What are the risks?

Rupture and Leakage

The silicone shell of the implant may break, causing the saline or silicone gel inside to leak out into the surrounding breast tissue. This happens to about 10% of women during the first 10 years after implant surgery. (No data exist to track the frequency of ruptures after the first 10 years.) Another surgery must then be done to remove or replace the implant.

Capsular Contracture

Too much scar tissue may form around the outside of the implant, causing discomfort and making the breast feel hard. This can happen at any time, from several weeks to several years after the surgery. Another surgery must then be done to remove or replace the implant.

Contour Irregularity (Wrinkling)

The implant may shift relative to the breast tissue, causing a "wrinkle" or "dent" to form in the shape of the finished breast reconstruction.

Infection

The surgical incision may become infected soon after the surgery.

Hematoma or Seroma

A pocket of blood ("hematoma") or blister fluid ("seroma") may form under the breast skin soon after the surgery.

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