Silicone Implants versus Saline Implants

Published: 2009-01-02. Updated: 2009-01-02
Content
List of types of implants
Controversial theme silicone vs. saline implants
Summary of advantages and disadvantages of implants

Comparison of silicone implants and so-called saline implants is very discussed theme among plastic surgeons. Partially it is caused by different development of implantology in the United States of America and in Europe and partially is this theme still topical due to new technological processes of implant production.

List of types of implants

Types by coating

  • Silicone coating - Silicone is inorganic-organic polymer. It is very close to body thanks to its organic component, which is attached on atoms of silicon and oxygen. This organic-silicon-oxygen unit repeats regularly. Silicone is thanks to its unique features widely used not just in medicine but also in technical industry and cosmetics. All silicone implants and devices used in medicine must be tested according to law about health care and it must have CE certificate (notification of products that fulfilled standards of European Union.)

  • Polyurethane coating - It is also very unique polymer compound that consists of repeated units. Its features also cause its various usage. It can be used also as a glue, intelligent textile fiber and paint.

Types by refill

  • Silicone

  • Saline

  • Combined (Silicone, Saline)

With the expansion of plastic surgery also implants have developed. This development brought positive effects and showed some disadvantages.

Silicone implants are divided in several generations.

1. Generation: Those were implants manufactured in 1960s. They were filled with very viscous gel. Their posterior shell was made with small juts against possible rotation. Often there were complication with scars. Today they are no longer used neither in Europe, nor in USA and Canada.

2. Generation: It was evolved approximately in 1970s. The main request was better aesthetic look of the implants. Implants were filled with less viscous silicone and silicone coating was also thinner. Second generation brought higher possibility of ruptures and following complications. Also the durability of these implants was not satisfactory.

3. Generation and 4. Generation: In the 1980s there came third and fourth generation to the market. During the development there was improved especially the technology of manufacturing silicone coating. It became velvet-like, which reduced on minimum creation of contracture and restraint excessive rotations at the same time. Silicone gel cohesion was again a little bit increased. And that reduced the leakage of the gel. More substantial coating also increased its durability. Today they are commonly used in Europe and in South America. Little controversial is the topic of silicone in the USA, where the use of silicone implants was strictly limited due to great awareness of the lawyers.

5. Generation: The newest implants. They keep the shape perfectly. Stable shape eliminates the risk of migration. These implants have been preliminary approved in the United States.

Saline implants

Saline implants are much less used in Europe and North America. They are used only in approximately 5%. The saline is in this type of implants inserted in a silicone cover.

There are two types:

  • By the first type pre-filled implant is inserted.

  • The second type is placed into the tissue with no refill and is filled with sterile saline during the surgery. The advantage of this second type is small scar even by larger size of breasts.

Controversial theme silicone vs. saline implants

Do the silicone implants cause cancer??

Due to very known cases in the United States scientists from all over the world dealt with this problem. Hypothesis of relation of silicone with cancer was not proved in any of these studies. It is also manifested by large use of silicone in medicine (heart valve, vascular replacements and so on.). It is true that any type of implant hinders the examination of breasts with the help of mammography. Mammography specialists warn against late diagnosis of tumor disease. Therefore a special access by screening of cancer is recommended in women with breast implants. Special mammograms or magnetic resonance imaging are used. Although there was never proved any relevant connection between breast cancer and silicone filled implants surgeons in the United States prefer use of saline filled implants. It has been caused by several lawsuits that ended successfully mainly thanks to the ability of lawyers.

Do the polyurethane implants cause cancer??

Like by silicone fillers also polyurethane coating was argued to be potential cancerous substance. It has naturally never been proved and even American agency for drug control FDA indicated this risk as minimal.

Do silicone implants cause autoimmune diseases???

Again it has been proved thanks to many studies that there is no relevant connection between silicone and autoimmune diseases. It was mostly speculated about damage of connective tissue and its association with evoked autoimmune disease but any connection has been denied.

Risks

  • Common risks of surgical procedures (infection, bleeding, changes of sensitiveness, complication in scar, hematomas, pain)

  • Implant rupture, consequent gel migration and creation of silicone granulomas. It can happen any time. Rupture of silicone implants is diagnosed worse than rupture of saline filled implants. The saline absorbs in case of rupture into the tissue and the breast is suddenly smaller. In both cases the patient must undergo reoperation.

  • Capsular contracture. The breast is round and impossible to move, it occurs in the first month after the surgery. It is mainly reaction of the tissue and the implant coating.

  • The necessity of special screening by breast examination on mammogram.

  • Calcium residue around the implant. They are similar to calcium residue around initial tumor, which worsens early diagnosis.

  • Shrinkage of implant coating

  • Expulsion of implant. The tissue that covers the implant is ischemic and with necrotic changes. This complication occurs by extra large implants.

  • Leakage of silicone into surrounding tissue and possible transport into nodes.

  • Breasts asymmetry

Summary of advantages and disadvantages of implants

Silicone ImplantsSaline Filled Implants
They look naturally. Silicone is much more similar to structure of breast tissue and therefore its look is natural.
Its natural look is worse.
It is more difficult to diagnose  rupture.
Rupture is revealed immediately. Breast implant suddenly reduces in size.
By larger implants the scar is greater.
The scars are smaller even by larger size of implants (filling after implantation).
Leakage of the gel is not so often.
More often leakage of the fluid through the valves that enable the filling.
There is no sound phenomenon by moving.
Some patients observe something like “plopping”.
There forms inflammatory granulomas by leakage of gel and even the nodes can be affected.
By the leakage the saline is normally absorbed by surrounding tissue.
 Complication of infection inside the implant during filling.

Notices at the end

Implants have no negative effect on breast feeding or pregnancy. If a woman with implants plans to have a family it is good to notify the gynecologist and also the surgeon in maternity hospital.

Since 2005 plastic surgeons in United States have started to use again silicone implants. FDA (Food and Drug Administration) something like our State Institute for Drug Control allowed their usage. Plastic surgeons have returned to them exited especially because of their better aesthetic features.

(Editorial)

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