There seems to be a lot of confusion out there about what distinguishes saline and silicone breast implants currently available in this country. I would like to take this opportunity to clarify some misunderstandings. First of all, the shell of both implants is the same - medical grade silicone. What is different is what the shell is filled with. Saline, which is a salt water solution, is used to fill the saline implants and silicone gel is used fill the silicone implants. Because the two substances have different chemical composition, they behave differently in the body. While the look either kind of implants delivers to the patient is very similar, the feel of the implants differs significantly. There is no question in my mind that the silicone implants provide the softest, most natural feel to the patients, particularly to the women with thinner breast tissue and skin. The chances of developing rippling is lower with silicone implants. However, silicone implants are more expensive then saline implants and this needs to be considered in your decision making. What I tell my patients is that if a natural feel is the most important issue for them, to choose silicone. If size improvement is the primary concern and the feel a secondary one, then saline will do the job very well.
Another issue which is often brought up during consultations is relative safety of the implants. Even though the FDA released silicone implants for unrestricted use to general public, the perception that saline is safer persists. In fact, the notion that silicone is harmful is just a myth. Silicone is probably the most studied implantable material available today. After over 35 well-conducted studies of new generation silicone implants from many countries, it seems certain that this material does not cause disease. The results of more than 7 long-term follow-up studies show that women with implants have a reduced incidence of breast cancer than is otherwise expected in the general population, though there is no hard evidence why this may be so and I would not count on implants to reduce your breast cancer risk. No hard evidence reveals that a broken implant is harmful. I have not seen any problems with silicone implants in my practice.
The best thing for any patient to do is to bring up all of her concerns during the consultation and to ask as many questions as is needed to make her comfortable with the decision. Remember, our first job as surgeons is to educate our patients.