Saline V Silicone Breast Implants

When patients are researching for breast implants in Dubai, one of the common questions they have is whether to choose saline breast implants or silicone breast implants

Dr. Faisal who is a UK board-certified and one of the best plastic surgeons in Dubai discusses the differences between the two, and the decision-making process he goes through when choosing between the two

There are multiple factors that can influence the decision to choose either saline or silicone implants. These can be broadly broken down to 3 factors:

1. Implant performance and appearance
2. The patient’s anatomy, desires, concerns
3. The surgeon’s preference

All of these criteria must be considered prior to make the choice

Silicone is a naturally occurring compound that can also be made synthetically. By altering its molecule and increasing the cross-linking the material can be changed from a liquid to a more viscous gel or a more rubbery type material

All gels are more cohesive than liquids and by altering the cross-linking of the silicone the gel can be made more liquid or viscous. The more viscous silicone material is often referred to as ‘gummy bear’ implants due to the material not running even if the implant is cut.

Silicone breast implants were first introduced in the 1960s and have since been developed over time as different generations. We are currently using fifth generation silicone implants

Saline breast implants were also developed in the 1960’s

Implant Characteristics

There are several important characteristics to consider of implants

Of great importance is its ‘feel’ and how closely it mimics normal breast tissue.

Silicone gel-filled implants can be manufactured using different thicknesses of gels to impart different characteristics. A softer gel feels more like normal breast tissue. On the flip side, the firmer gel implants are able to hold their shape better.

Saline implants, by contrast, feel more firm than soft gel silicone implants, and this is more pronounced as the volume of saline increases

The softness of the implant is of more importance in patients lacking breast tissue, as the implant will form more of the volume of the breast. If a patient has ample breast tissue then the softness of the implant is of less concern. The more the implant forms the volume of a patient’s breast the more the characteristics of the implant become important. This is particularly true when using larger implants or in patients who are having a revision procedure following implant surgery previously.

The natural tendency of tissue is to yield to the pressure applied by the implant. This causes tissue to thin out and stretch over time.  This means that in these revision cases if saline implants or highly cohesive silicone implants are used, then they will be more palpable

If a patient has to have their breast fold lowered to accommodate the size of their implant, then the implant will basically form the lower part of their breast as there will be very little breast tissue or muscle to cover it here. The characteristics of the implant in these situations will be felt

Silicone breast implants come prefilled by the manufacturer, and therefore their volume is fixed

Saline breast implants are filled by the surgeon and so there is room for variability in the operating theatre

The softer silicone gels and saline implants are less shape stable and are influenced by gravity. Gravity will cause the filler material to be evenly spread in a lying position but more in the lower part of the implant material in the upright position.

An implant that has a more cohesive silicone gel will have a shape that is stable in every position. This is desirable in patients who are lacking their own tissue, a cohesive implant will give a more predictable and better shape than a softer gel or silicone implant

Shape stable breast implants are even more advantageous in revision procedures where rippling, thin skin, and shape deformities must be corrected. These highly cohesive implants can be thought of as shape-altering devices in addition to adding volume.

Rupture of a breast implant is now a rare event. This is a characteristic in which saline and silicone implants differ greatly. When a saline breast implant ruptures the fluid immediately leaks out and there is an immediate reduction in the volume of the breast. This is very distressing for both the patient and the surgeon

Another obvious difference between saline and silicone breast implants is the ease of insertion. Because saline implants are filled after insertion, they can be inserted through very small incisions. This allows their use in the axillary approach and the peri-areolar. Silicone breast implants require a larger incision and as such are restricted to the incision in the breast fold

There have been a few controversies surrounding silicone implants. During the 1980s a few cases of autoimmune type illness caused a ban of silicone devices in the US. Following extensive research, no direct link has been found and these implants have now been reintroduced

More recently a type of lymphoma has been associated with silicone implants. The incidence 1:30000 and as yet there have been no reported deaths from the disease. The association is linked to the type of surface on 1 particular brand of implant. This has now been removed from the market.

In conclusion, Dr. Faisal feels that silicone breast implants are his preferential choice. They provide a safe and natural feeling implant. They can be tailored with regard to the shape a patient may be looking for.