The current generation of silicone breast implants is more advanced than other previous silicone implants. Whereas older silicone implants may have been filled with a liquid silicone that could slowly leak out of a rupture in the implant shell in fashion similar to molasses, the newer silicone implants are filled with a cohesive silicone gel. This cohesive silicone tends not to flow out like a liquid but actually tends to stay within the shell even when the shell has a defect. In fact, one manufacturer has a photograph of their silicone implant that has been cut in half. This photograph shows the cut half of the implant with the cohesive silicone still within the half in a fashion similar to gelatin.

It may therefor be more difficult to determine if there is a rupture or leak in the shell of a silicone implant. The FDA recommends an MRI at 3 years to evaluate the implant, however, unless the implant coincidentally has a rupture at that time, this study will not provide lifetime information about whether the implant is intact.

More likely is that when a woman is performing her monthly self breast exam, she may feel that there is an abnormal change in the feel of the implant and/or its shell. If that is the case then an examination by her plastic surgeon followed by a mammogram, ultrasound or MRI as necessary may be necessary to determine if the implant has ruptured. A small rent in the surface of the implant may not be detectable by physical examination alone until it enlarges.

Saline implants are made of a shell that is filled with a salt water solution.  Specifically, this fluid is IV fluid which is identical to the fluid which flows into your veins when an IV is started in the hospital. Should the implant leak, the fluid will be harmlessly absorbed by your body. There is no pain or discomfort in fact one cannot feel the implant leak at all. Generally, when a woman dresses in the morning she may notice that one breast is somewhat smaller than the other and by the end of the day it is generally clear that the implant is leaking because the breast has noticeably decreased in size.

This is not an emergency. Simply contact your plastic surgeon and have the implant replaced within the next couple of weeks. If the implant is replaced in a short period of time, it is a simple matter of putting a new implant in the same pocket. If one waits too long (a month or more), the pocket may begin to decrease in size. Then it becomes a greater matter to reopen the implant pocket to create enough room to replace the deflated implant. This may require a partial or complete removal of the pocket capsule.

There is no current evidence that there is any additional health risk to a woman who has silicone implants versus saline implants. The FDA at one time placed a restriction on the use of silicone implants for cosmetic breast enlargement because they were unsure if there was any health risk associated with silicone implants. They were never removed from the market. Silicone implants could just not be used for pure cosmetic breast enlargement. There was no restriction on their use for breast reconstruction, provided the proper documentation was carried out.

The restriction of cosmetic use of silicone implants was lifted after years of study of women who already had silicone implants and women who received silicone implants after the restrictions were placed. The restriction was lifted at the recommendation of the review board because they could find no safety issues related to the use of silicone implants compared to saline implants. Specific information about the studies and further links may be found at http://drnein.com/silicone-breast-implant-safety

Now any woman 22 years of age or older may have the option of silicone implants if she wishes.

Both of these implants are good implants and one is not inherently better than the other. There are, however, some differences which may influence the decision to choose one implant type over the other.

Saline implants are made of a shell that is filled with a salt water solution, Specifically, this fluid is IV fluid which is identical to the fluid which flows into your veins when an IV is started in the hospital. Should the implant leak, the fluid will be harmlessly absorbed by your body, and the implant will flatten.

The saline implants look quite nice and are very durable. The disadvantage of the saline implants is that the round ones tend to give the breast a slightly circular appearance, they tend to be somewhat firmer in feel and they tend to ripple.

An implant ripples when the fluid in the implant shifts (generally towards the bottom of the implant when the woman is upright) and because there is less filling of saline in part of the implant, the surface of the implant changes shape and gets waves in it. If there is not enough padding over the implant (meaning not enough breast tissue), especially near the top of the breast, then the rippling may be visible on the surface of the breast as well – commonly referred to as visible rippling. This can be eliminated or minimized in the majority of cases by putting the implant underneath the pectoralis major muscle of the chest wall. (More on this later).

The silicone implants tend to be noticeably softer, the tissues tend to drape over them in a more natural fashion and they tend not to ripple. When a woman feels her breast with a silicone implant, the edge between her natural tissue and the surface of the implant tends to be more obscure and harder to determine. The silicone within the implant flows differently than saline and tends not to ripple even when there is less natural tissue over the implant. Consequently, the tissues tend to drape over the implant in a more natural fashion and the overall appearance tends to be less like an implant. The major disadvantage of these implants is cost as they are more expensive than saline implants. This cost is from the manufacturer not from the hospital, anesthesia or us.