SALINE OR SILICONE,WHAT IS THE BEST IMPLANT CHOICE FOR ME?

As a plastic surgeon who sees patients from Dallas, Plano, Richardson, Rockwall, Garland, Mckinney and Allen, one of the most common discussions with patients interested in breast augmentation and breast implants concerns the relative merits of saline versus silicone implants.  

The photo above is a patient of mine who underwent an augmentation and a breast lift at the same time.

The good news is that both saline implants and silicone implants are excellent devices and patients are choosing between two great options!

To understand the advantages of the different implants, it is helpful to understand the most common problems with breast augmentation, and what issues we are trying to avoid or minimize.  The most common problem with breast augmentation is that sometimes the body forms hard scar tissue around the implants, resulting in an abnormally firm breast that may ride high or have some distortion.  This hardness is called “capsular contracture” and is the most common reason for redo or revision surgery.  Other complications include breast implant leaks, asymmetric or unsatisfactory positioning of the implants requiring revision.

In order, I would like to detail the advantages and disadvantages of both silicone and saline implants. 

The pros of silicone implants:

1) silicone implants have a more natural feel than saline implants: reproducing more accurately the softness of a natural breast

2)silicone implants will have less tendency to show implant edges at the lower and outer edges of the breast and hence may be a better choice for thin patients without much soft tissue to hide or cover a breast implant.

3)silicone implants have lower leakage rates than saline implants, even when carefully followed by MRI scanning.  Leakage of a saline implant is most often a complete loss of volume, often creating asymmetry that can be socially troubling. 

4)silicone implants are pre-filled and hence do not require intra-operative filling: probably translating into slightly shorter time under anesthesia

5)the short term follow-up of the new silicone implants show overall complications and specifically capsular contracture rates comparable to saline.

The pros of saline implants are as follows:

1)the long term complication rate of saline implants is well known and is relatively low (most commonly estimated at a 1% risk per year…so after 30 years of having implants, the risk of hardening is roughly 30%).   The long-term capsular contracture rate of silicone implants is unknown; the old silicone implants had high rates of leakage and hardening after 10 years (over 60% rate of leakage alone).  We hope the new silicone implants will have a better track record, but we honestly don’t know yet.

2)saline implants cost, on average, $1000 less than silicone implants

3)saline implants can be placed through a smaller incision. Some incisions are therefore possible with saline that are not possible with silicone; for example it is difficult to place a moderately large silicone implant through an axillary incision or through a peri-areolar incision in a woman with a small areolar diameter).

4)saline implants are available for women under 22 years of age (the FDA has limited the use of silicone implants to woman 22 and older).

5)the follow up care for saline implants is simple and cost effective.  However the recommended follow-up care for silicone implants is more costly and complicated.  Allergan recommends an MRI scan three years after implant placement and then every two years thereafter.  Insurance largely does not cover this cost (an MRI scan of both breasts commonly is over $15oo per study).  Many woman choose to stick with routine mammograms and sonograms for their follow-up  care (about 80% of the sensitivity of an MRI scan).   Mammograms and sonos are normally covered b insurance.  The breast implant warranties are still valid even if MRI scans are not obtained, but the fact that the implant companies recommend the MRI scans is a concern for some patients.

6) Saline implants have a variable fill volume for each size implant, hence small breast asymmetries can be corrected without having to change the diameter or size of the breast implant

7)although saline implants leak more; if they do leak, there are no concerns for causing tissue problems.  Silicone gel however, over a long period of time, can cause tissue inflammation, granulomas, implant calcification and can rarely migrate to regional lymph nodes.

The superior aesthetics of the silicone implants together with the excellent results in the recent studies (admittedly with relatively short term, 4 year follow-up)  has led to higher utilization of silicone implants than saline both in our practice and nationally.  Currently in my own practice, aproximately 80% of recent patients have been choosing silicone implants. 

However, it is very important to realize that every patient has  highly specific goals and desires: every potential breast augmentation patient must weigh their options with their own needs in mind. 

If you would like to have an individual consultation, we would be glad to meet and discuss these issues with you in person.  Call 972 470-5000 ext 203.  Our cosmetic coordinator Stacey will be happy to give you additional information and schedule an appointment.

Denton Watumull MD FACS

BREAST AUGMENTATION AND BREAST IMPLANTS IN DALLAS, PLANO AREAS: SILICONE IMPLANT HISTORICAL CONCERNS

As  a plastic surgeon who sees patients from many cities, including Dallas, Plano, Garland, Mckinney, Rockwall and Frisco: one of the most common questions I get asked concerns the pros and cons of silicone versus saline implants. 

The above photos are before and afters of one on my patients. I would like to review some of the factors that help me advise patients about making the best choice for breast implants.  First I find it helpful to review an abbreviated history of the concern about silicone implants from a plastic surgeon’s perspective.

In the late 1980s and early 1990s there was extensive litigation and concern about silicone implants.  There were concerns about:

 1)  A high rate of local implant complications (capsular contracture, leaking and high re-operation rates).

2)  Lack of accurate follow-up data on long-term complications

3)  A question of whether the implants caused systemic sickness such as auto-immune diseases or cancer

 The above concerns lead to the FDA withdrawing silicone implants from the market in 1992.  Subsequent litigation costs eventually caused the bankruptcy of Dow-Corning Corporation: the largest manufacturer of breast implants. Much of the litigation was won due to fabricated lab reports and extensive use of pseudo-experts without legitimate scientific or medical credentials.  United States courts have subsequently adopted rules preventing the use of “junk science” in front of juries.

 Extensive scientific studies from several countries have shown that silicone implants do not cause systemic illnesses and the FDA allowed the reintroduction of silicone implants for augmentation purposes in November of 2006.  To deal with the other legitimate concerns about local complications and follow-up data needs, the following steps have been taken:

 1) Both the implant manufacturers and plastic surgery profession is committed to providing better follow-up data (for example, at Regional Plastic Surgery Center we are attempting to enroll 100% of silicone implants in Allergan’s Breast Implant Follow-up study (called BIFS).

 2)  The plastic surgery community has put extensive educational and scientific resources into lowering capsular contracture rates and re-operations rates through meticulous planning and technique improvements.  For example, in my own practice, I have had no revisions or re-operations on primary breast augmentation patients in over 4 years (a re-operation rate of 0%).  I have had a few revisions in higher risk categories such as simultaneous augmentation/lift patients or capsular contracture patients from other plastic surgeons, but none in my primary breast augmentation group (to my knowledge). I do not feel I will keep this track record forever, and do not feel this low rate of problems is specific just to my practice; many excellent plastic surgery groups locally and nationally are demonstrating large series of patients with very low complication and revision rates.

The available follow-up data to date, as of September 2009, demonstrates that the new silicone gel implants have capsular contracture rates that are comparable to the rates of  saline implants.  In addition, even when carefully evaluated with post-operative MRI scans, silicone implants have lower leakage rates than saline implants.  Hence the overall complication rate of silicone implants (with our relatively short follow-up of approximately 4 years), is equal or slightly lower than for saline implants. Hence the choice of whether to choose saline or silicone implants for an individual patient is now often dictated by other concerns, not so much for a concern for higher complications with silicone implants.  In a subsequent blog, I will detail the up-to-date pros and cons of silicone as compared to saline  implants.

Please  contact our office if you have additional questions or desire a consultation: we would be happy to help!  Our office number is 972 470-5000 extension 203.

Denton Watumull MD FACS

Regional Plastic Surgery is excited to be able to offer a huge fall beauty event October 15th.   We will offer give aways for free laser hair removal and microdermabrasions as well as record low prices for botox, juvederm, obagi, microdermabrasion and fraxel resurfacing.   We will also be presenting our new Fraxel dual laser resurfacing technology.  All three physicians will be present to give lectures on current topics in plastic surgery.  We invite all interested to be our guest at the event!  Please call 972 470-5000 ext 203 to rsvp.  Hope to see you there!

Denton Watumull MD FACS

Dr. Joshua A. Lemmon has joined Regional Plastic Surgery Center as of August 2007. He has completed his plastic surgery training here in Dallas at the prestigious University of Texas Southwest Medical School. He has also completed extensive additional training in surgery of the hand and wrist while attending the hand surgery fellowship program at the University of Pittsburgh. He performs a wide range of plastic surgery procedures, including cosmetic and reconstructive plastic surgery. He has office hours in both the Richardson and Las Colinas offices.

In November 2006, the FDA approved silicone breast implants for breast augmentation and in reconstruction. These silicone gel filled breast implants were found (after years of rigorous testing) to be safe and not cause autoimmune diseases or cancers. Silicone gel breast implants are available as well as saline filled breast implants for a variety of breast surgery; including augmentation, mastopexy (breast lift) and reconstruction after mastectomy. There is no longer the stringent paperwork or complicated process for using silicone gel breast implants. Call our office for more details.