The most common distinction and greatest debate among breast implants today is whether they are filled with saline or with silicone. Each type of implant filler has unique characteristics that offer advantages and considerations for use. Before you consider the differences between silicone- and saline-filled implants, you need to understand exactly the parameters for use of these implants. Silicone-filled implants, as of the writing of this article, are only used in the United States in breast reconstruction cases, in specific research studies, or to replace existing silicone implants. In October 2003, a U.S. FDA advisory panel recommended reinstatement of silicone breast implants based on a petition filed by Inamed® Corp. for a new generation of cohesive silicone- filled breast implants, as an option to any women seeking breast augmentation. As of the publication of this article, the U.S. FDA has chosen to wait for the results from more long-term clinical studies before accepting the petition and giving approval with subsequent review scheduled for April 2005. Mentor Corporation has also filed for review and approval specific to breast augmentation of their version of the cohesive silicone-filled breast implant.
Silicone breast implants, both the earlier and newer generations, have a more natural appearance and feel than do saline breast implants. For this reason, they are highly preferred by both surgeons and women, particularly in breast reconstruction where little of a woman’s own soft tissue is present to cover and cushion the breast implant. In addition, the newest generation of silicone-filled implants come in a greater variety of contours (shapes) and therefore are more likely to result in more natural physical outcome. The earlier generation of silicone-filled implants had a somewhat higher rate of a complication called capsular contracture; however, this has not proven to be the case with currently available silicone implants. However, capsular contracture can be worsened in many women by the lack of soft tissue to cover the implant. This complication results in varying degrees of breast hardness and deformity. Saline implants do have a feel that is firmer and more palpable (more easily felt). But saline implants do not have as broad a range in shape and design. It is, however, a myth that an appropriately filled saline breast implant can make a sloshing noise as a woman moves her body. All saline implants will wrinkle, even if overfilled. Wrinkling may be visible, particularly where little or no breast tissue is available to provide implant coverage. These characteristics are generally not visible with clothing and rarely noticeable to other individuals. In addition, implants with a textured shell are more likely to wrinkle than implants with a smooth shell.
If saline implants should leak or rupture, the sterile saline solution they are filled with is safely absorbed and expelled by the body. You will notice if your saline-filled implant is leaking or ruptured, as your breast will slowly or rapidly deflate. Removal and replacement of a saline implant is a relatively minor surgical procedure when treated early. While it is to your best advantage to have the ruptured or leaking saline-filled implant removed or replaced as soon as possible, there is no apparent threat to your health. If silicone-filled implants rupture or leak, you may not notice it right away, and it is possible that the leaking silicone can cause pain or deformity. This was particularly the case for silicone breast implants prior to the newly introduced generation of cohesive silicone implants. The most effective non-surgical means to determine if a silicone implant is leaking is through magnetic resonance imaging (MRI). If a silicone implant is determined to be leaking, it should be surgically removed as soon as possible. Free silicone from leaking or ruptured implants can potentially migrate outside the breast capsule and into the body, and as much of it as possible should be removed to avoid hard nodules called granulomas. The procedure can be very involved and results in a significant recovery time.
Your choice of implants is best determined by discussing your options with your surgeon. Considerations include your lifestyle, the amount of enhancement you desire, and your personal preferences. To fully understand what implants will be used in your case, always request to examine the implant package insert from your cosmetic surgeon prior to surgery. Following your surgery, your cosmetic surgeon should give you the implant manufacturer’s device information. Keep this information in a safe place. It identifies the brand of implant you received, its size, the manufacturer’s lot number, and its warranty. Should your implants ever need to be replaced, this information is very important. According to data published by the U.S. Food and Drug Administration Center for Devices and Radiological Health, the following breast implants have greater palpability, that is, they are felt more easily: textured implants, larger implants, sub-glandularly placed implants (on top of the chest muscle, below the breast glands), and implants in patients with smaller amounts of breast tissue.
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