Silicone VS Saline Breast Implants

Silicone Breast Implants

Among the many choices that need to be made when planning a Breast Augmentation, choosing between a saline-filled breast implant or a silicone-filled implant is one of the more difficult decisions. Both types of implant have specific advantages and any number of these factors may influence which option could be more beneficial for you:

  • Your existing breast anatomy
  • The look and feel you desire
  • The placement of the implant above or below the chest muscle
  • The size of the implant
  • The incision used to insert the implant under your breast

The information given below is intended to give you an overview of your silicone implant options, thereby allowing you to make a more informed decision. To further assist you in the decision-making process, during your Breast Augmentation consultation with Dr. Jugenburg, you will look at and feel various pre-filled implant samples, and try on a range of sizes.

At the Toronto Cosmetic Surgery Institute, we offer all sizes and shapes of breast implants so that we will be able to create just the look and feel our clients desire.

Silicone implants are more ideal for women who are very thin and have very little skin/fat to hide the implant. Silicone is a little softer and has less rippling than a saline implant, and these differences are seen in a thinner patient, which is why Dr. Jugenburg may recommend a silicone implant over a saline implant.

What Are Silicone Breast Implants?

A silicone breast implant consists of a highly durable, elastic silicone shell prefilled with a viscous medical grade (see below) silicone gel that has a pliable consistency closely matching that of natural breast tissue.

Silicone implants are available in a wide range of sizes and profiles, and with different shape and surface texture options, to suit the individual requirements and goals of each woman.

  • Base width (or diameter) – width on the chest wall; women with narrower chest walls require smaller diameter implants for a proportionate appearance.
  • Size (or projection) – protrusion from the chest wall; a suitable size for any given women will depend on her existing breast anatomy and body proportions.
  • Shape: Round or Shaped (Teardrop or Anatomic) – Round implants can give a natural or fake looking appearance depending on their placement. Teardrop implants are designed to mimic the gentle contours of a natural breast (for Breast Reconstruction patients only).
  • Shell surface: Smooth or Textured – a textured surface for greater tissue adherence, while the smooth surface is less prone to rippling/wrinkling.
  • Further information on your breast implant choices is given here.

    Medical Grade Silicone

    Antiperspirants, skin lotions, hair care products (shampoos, conditioners and styling products), and many other non-cosmetic items, including baby bottle nipples (teats), contain some form of silicone.

    Two different types of silicone are commonly available: medical grade silicone and industrial grade silicone. While industrial grade silicone is found in sealants, lubricants and adhesives, the manufacturing process for medical grade silicone is altered to avoid production of a toxic substance (hydrogen chloride gas) found in industrial silicone.

    All of the silicone implants available at the Toronto Cosmetic Surgery Institute for Breast Augmentation contain medical grade silicone, have passed through rigorous Health Canada approval processes, and are pure.

    The Benefits of Medical Grade Silicone:

  • Manufactured in a clean environment using special non-toxic techniques to ensure that it is free from any unwanted substances and compatible with the human body.
  • Tested to be safe (it does not cause unwanted reactions, illnesses or cancer).
  • Found on medical devices, such as needles, catheters, medical tubing, anesthesia equipment and many others.
  • Found on pacemakers, artificial joints and many other devices that are implanted in bodies.
  • Also used in many non-medical fields.
  • Recognized Safety of Silicone Breast Implants

    Silicone breast implants have been successfully used in Breast Augmentation by millions of women for more than 50 years. When first introduced, the popularity of silicone implants continually rose due to their superior, natural feel compared to saline implants.

    Despite this, silicone implants also attracted a lot of controversies. Although no clinical studies have ever discovered any reliable connection between silicone implants and various illnesses, in 1992 the FDA and Health Canada restricted the use of silicone implants to women having Breast Reconstruction after breast cancer surgery (Mastectomy).

    Pending further studies, Breast Augmentation procedures were therefore limited to saline implants only. However, in Europe and Asia, the use of silicone implants for cosmetic purposes has never been restricted.

    Mentor and Allergan, the two breast implant manufacturers available in Canada, maintain highest standards of quality in their manufacturing processes. Both manufacturers are also supported by years of extensive clinical research and a comprehensive body of data that supports the safety and reliability of their breast implant products.

    In 2006, the FDA reviewed the research data compiled by Allergan and Mentor and once again approved the use of silicone implants for breast enlargements; Health Canada followed suit. Both manufacturers continue to undertake extensive clinical studies as a commitment to ensuring that every patient has the best outcome with her breast implants.

    Minimal Implant Leakage

    The amount of silicone released through the intact shell of current generation breast implants is minimal and associated with no risk for patients. Implant leakage was determined (by the manufacturer Mentor) to be:

  • Less than 1/1000th the weight of a pin.
  • More than a million fold below established safety limits (based on the results of FDA reviewed studies).
  • More than a hundred-fold below the amount of silicone absorbed from daily exposure to common consumer products containing silicone, such as antiperspirants, skin lotions and hair care products.
  • Unlikely Implant Rupture

    When a silicone breast implant ruptures, it is much harder to detect than a saline implant rupture because the appearance of the breast often remains unchanged, a process known as silent rupture.

    Current generation silicone implants contain a cohesive, gelatin-like silicone gel that is much thicker than saline and is formulated to remain safely and uniformly intact. If any cohesive silicone were to be released, it would leak into the implant capsule only (the scar tissue that surrounds the implant).

    In such a case, if left untreated, the breast may become firmer and misshapen, hard lumps may appear, and changes in sensation (such as tenderness, pain, numbness, tingling or burning) may develop.

    If a patient believes that one of her implants may have ruptured, she should arrange to see Dr. Jugenburg immediately.

    Silent ruptures are normally determined by using ultrasound or MRI scans to screen the breasts. Although routine tests also are recommended every few years; modern breast implants are highly durable and a damaged or ruptured implant is rare.

    In the highly unlikely event that an implant rupture has occurred, an Implant Exchange procedure will need to be performed to remove and replace the ruptured implant.

    FDA Approval

    Before approving the use of silicone breast implants manufactured by Allergan and Mentor, the FDA reviewed an extensive body of clinical data, as well as a wealth of other information, to determine the benefits and risks of silicone implants.

    As conditions of approval, the FDA also required each manufacturer to conduct post-approval studies to characterize the long-term performance and safety of their implants.

    An FDA report on silicone breast implants emphasized that there is no evidence to suggest that silicone gel-filled breast implants cause breast cancer, connective tissue disease or any other illness, and that silicone implants are safe to use.

    It also indicates that breast implant surgery may not be a one-time event, but that sometime during their lifetime 20% of patients will require another procedure. However, there are many reasons as to why additional surgery may be required, such as a patient requesting a size change.

    Furthermore, for Breast Reconstruction (after breast cancer surgery), additional procedures are commonly performed as part of the reconstruction process.

    The key FDA findings on silicone breast implants (manufactured by Mentor) at 10 years after first surgery are:

  • There is a 10% risk of implant rupture in Breast Augmentation patients and a 14% risk in Breast Reconstruction patients.
  • Implants are removed (with or without replacement) in 7% of Breast Augmentation patients and 23% of Breast Reconstruction patients (of which more than half are due to a patient requesting a size change).
  • Reoperation is needed in 20% of Breast Augmentation patients and 38% of Breast Reconstruction patients (including patients requesting a size change and the need for a biopsy).
  • Key complications after Breast Augmentations:

  • Capsular Contracture (implant hardening) – 11% (in our patients 1 – 5%)
  • Additional surgery (for any reason) – 20%
  • Implant removal (with or without replacement) – 7%
  • Cohesive Gel Breast Implants

    Cohesive Gel (silicone) breast implants are the current generation of silicone breast implants. Each implant is filled with a thick, cohesive formulation of silicone that has a consistency more resembling that of a pliable solid than a liquid.

    As a result of this increased density, Cohesive Gel implants have a firmer feel than older liquid silicone implants but are less prone to rippling/wrinkling and the silicone will hold together uniformly in the unlikely event of an implant rupture (i.e., the silicone will not leak out).

    The manufacturer Allergan has a new Inspira® line of Cohesive Gel implants, while the manufacturer Mentor offers MemoryGel® Cohesive implants, both of which are available with different consistencies.

    Mentor MemoryGel® Cohesive IIITM implants and Allergen Natrelle® Style 410 implants have the highest density of the available silicone implants and are generally known as Gummy Bear implants (see below).

    Cohesive gel implants are more expensive than basic saline implants, which results in a higher surgical fee for silicone augmentation procedures. During surgery, Cohesive Gel implants also require a slightly larger incision for insertion than saline implants because they are firmer and therefore more difficult to insert (or squeeze) through a small incision.

    For this reason, insertion is normally performed through an incision in the breast fold (Inframammary), or occasionally through an incision around the areola (Peri-Aerolar). Insertion through an armpit incision (Trans-Axillary) is also possible but is limited to a maximum implant size of 450 cc.

    For further information on Breast Augmentation incisions and scars, please refer here.

    Gummy Bear Breast Implants

    Form-Stable breast implants, which are otherwise known as Gummy Bear implants, offer unique advantages and have been developed to further address patient concerns regarding the leaking of silicone gel.

    Their name is derived from the highly (or ultra) cohesive, form-stable consistency of the silicone formulation used, which resembles that of gummy bear candy. When these implants are cut in half, the silicone gel in each half holds together uniformly and retains its form.

    This type of silicone gel is therefore used in Shaped (Anatomic or Teardrop) implants, which are designed to replicate the look and feel of a natural breast by having a soft touch and a teardrop appearance.

    Once implanted, the breast conforms to the shape of these implants, and irrespective of a woman’s body position, overtime this shape and an upright position is maintained with minimal rippling/wrinkling.

    Other types of implants are subject to the downward force of gravity and adapt to the individual shape of each woman and body position. The main drawback of this form-stability is that Gummy Bear implants feel firmer; however, their density still more closely resembles that of natural breast tissue than saline implants.

    Breast Augmentation is intended to be fully customizable and with the recent Health Canada approval of these highly cohesive silicone gel implants, patients now have more options.

    Yet such variety should not worry or confuse you. During your consultation, Dr. Jugenburg will thoroughly analyze your anatomy, medical history and objectives, and ensure you have a good understanding of all your available options.

    Benefits of Cohesive (Silicone) Gel Breast Implants:

  • All Cohesive Gel implants are FDA and Health Canada approved.
  • Each implant is filled with a thick, cohesive silicone gel formula that holds together uniformly and retains a natural pliability that closely resembles breast tissue.
  • Cohesive Gel implants suffer from less rippling/wrinkling than saline implants and older liquid silicone implants.
  • Ideal for women with very little natural breast tissue or fat.
  • If a Cohesive Gel implant leaks or ruptures, the silicone gel will not be released.
  • Each implant has a set fill volume for predictable results.
  • To ensure best long-term results for all patients, all Cohesive Gel implants are covered (free of charge) by a generous manufacturer warranty and lifetime replacement policy: AllerganConfidencePlusPremier®Warranty and Mentor Premier Advantage Limited Warranty.
  • Benefits of Saline Breast Implants:

  • Saline implants have been FDA and Health Canada approved for many years.
  • Each implant is filled with a sterile salt-water solution similar to the fluid that makes up most of the human body (i.e., it is harmless and compatible with the human body).
  • Saline implants generally have a slightly firmer feel than silicone-filled implants.
  • All saline implants have a flexible fill volume that can be adjusted by Dr. Jugenburg during surgery to meet the needs of each patient and given the best result.
  • Ideal for women with slight breast asymmetries.
  • If a saline implant leaks or ruptures it will be harmless, and since the breast size and shape will noticeably change, it will also be immediately apparent.
  • The insertion of any given saline implant during surgery requires a smaller incision than that required for a similar size of Cohesive Gel implant.
  • Saline implants are cheaper than Cohesive Gel implants, which means the total procedure cost for saline implant augmentation is cheaper for the patient.
  • To ensure best long-term results for all patients, all saline breast implants are covered (free of charge) by a manufacturer warranty and lifetime replacement policy: AllerganConfidencePlus®Warranty and Mentor Standard Advantage Limited Warranty.
  • A variety of similar options are available for both saline and silicone gel implants to meet the individual needs of each woman:

  • An extensive range of base widths (diameters) to suit the body size and shape of each woman.
  • Different implant projection options from low to high profile and an extensive range of sizes to give each woman the look she wants.
  • Two shape options: Round implants or more expensive Shaped implants (Anatomic or Tear drop).
  • Two shell surface options: smooth implants or textured implants.
  • Every woman should also know that whether receiving saline or silicone implants, both types of implants have similar highly durable, elastic and resilient silicone shells that are designed to be highly resistant to rupturing or tearing, and have been thoroughly tested.

    Saline Breast Implants

    Among the many choices that need to be made when planning a Breast Augmentation, choosing between a saline-filled breast implant or a silicone-filled implant is one of the more difficult decisions. Both types of the implant have specific advantages and any number of these factors may influence which option could be more beneficial for you:

  • Your existing breast anatomy
  • The look and feel you desire
  • The placement of the implant above or below the chest muscle
  • The size of the implant
  • The incision used to insert the implant under your breast
  • The information given below is intended to give you an overview of your saline implant options, thereby allowing you to make a more informed decision.To further assist you in the decision-making process, during your Breast Augmentation consultation with Dr. Jugenburg, you will look at and feel various pre-filled implant samples, and try on a range of sizes.

    At the Toronto Cosmetic Surgery Institute, we offer all sizes and shapes of breast implants so that we will be able to create just the look and feel you desire.

    The most important benefit of saline implants is that they are adjustable (their volume can be adjusted during surgery to give you best possible symmetry between the two sides) and since they contain saline, should a leak or rupture occur, saline is 100% natural and gets absorbed by your body without any harm.

    What Are Saline Breast Implants?

    A saline breast implant has a highly durable, elastic silicone shell. This shell is filled with a sterile saline (salt-water) solution that is similar to the fluid that naturally exists in the human body and gives a slightly firmer feel than silicone gel.

    Saline implants are available in a wide variety of shapes, sizes, profiles and surface textures to fit the body, preference and individual needs of every woman.

  • Base width (or diameter) – width on the chest wall; women with narrower chest walls require smaller diameter implants for a proportionate appearance.
  • Size (or projection) – protrusion from the chest wall; a suitable size for any given women will depend on her existing breast anatomy and body proportions.
  • Shape: Round or Shaped (Teardrop or Anatomic) – Round implants can give a natural or fake looking appearance depending on their placement. Teardrop implants are designed to mimic the gentle contours of a natural breast (for Breast Reconstruction).
  • Shell surface: Smooth or Textured – a textured surface for greater tissue adherence, while the smooth surface is less prone to rippling/wrinkling.
  • Further information on your breast implant choices is given here.

    Insertion of Saline Implants

    The silicone shell of each saline implant is inserted into its placement under the breast without fluid (i.e., without being inflated), and filled during surgery through a fill-tube to the predetermined size. The benefit of this is that saline implants can be inserted through a smaller incision than silicone breast implants.

    The size of a saline implant, therefore, does not influence the type of incision that is used to perform the surgery. Unlike silicone implants, any size of a saline implant can be inserted using an incision made in the armpit (Trans-Axillary), thereby completely removing scarring in the breast area. A self-sealing valve then allows the implant to automatically seal itself once the fill-tube has been removed.

    Saline Implant Fill Volume

    Every implant has an optimal volume of saline fill that gives the best balance between either rippling/wrinkling (caused by not enough saline) or becoming too firm (caused by too much saline).

    The difference between an inadequate volume and the optimal volume is small and as little as 10% of the maximum volume for any given implant. All saline implants, therefore, come with an optimal range of fill volumes that have been defined by Vthe manufacturer.

    The Mentor SPECTRUM® saline breast implant is an innovative design that also allows Dr. Jugenburg to make further adjustments to the saline fill volume postoperatively. A small, removable fill tube is left temporarily attached to the implant after surgery.

    The tube is accessible to Dr. Jugenburg by injection through the skin. In a simple procedure, the implant size can, therefore, be adjusted until the desired effect is achieved. Dr. Jugenburg then removes the fill-tube through another routine procedure and a self-sealing valve immediately closes and seals the implant.

    Is Visible Rippling a Problem With Saline Breast Implants?

    To some extent, rippling/wrinkling occurs with every breast implant. Breast implants are soft and natural folds therefore commonly occur in the shell of an implant. This effect only becomes a problem if visible, but is more often felt and not seen (typically along the outer edge of the implant, below the armpit), especially when a woman leans forward. A similar pattern of skin folding occurs in women with naturally larger breasts (i.e., without implants).

    Saline breast implants are more prone to rippling because the liquid saline fill shifts with changes in a woman’s body position, but is more common when saline implants are under-filled. Since under-filling a saline implant also leads to a higher incidence of implant rupture and deflation, it is not normally done.

    Most Plastic Surgeons will fill a saline implant to the upper range of the implant. Rippling is most objectionable when it is visible at the top of the breast. For that reason, placing a saline implant below the chest muscle (pectoralis muscle) can be advantageous, as the thickness of the muscle disguises any folds on the implant’s surface.

    Studies have shown that bringing a saline implant to its optimal fill volume, thereby reducing rippling, also helps to extend the lifespan of an implant. Rippling leads to premature failure by causing increased stress at the folds and wrinkles. Filling to the maximum volume is not over-filling; however, some Plastic Surgeons still use the term in this situation, although it refers to older saline implants that came labelled with a single, set fill volume.

    Over-filling current generation saline implants are not recommended by breast implant manufacturers and may violate an implant’s warranty. Furthermore, if an implant is filled beyond the recommended range, scalloping of the edges of the implant may occur. Scalloping is puckering around the edges of an implant and may cause visible folds on the surface of the implant that has the appearance of rippling but are a separate issue.

    What Happens if Saline Breast Implant Leaks or Ruptures?

    Saline breast implants are capable of rupturing and deflating, which is one of the more notable risks of saline implants. Should a hole or tear develop in the shell of a saline implant, the liquid saline solution will be released and the implant will deflate.

    The speed at which deflation occurs will depend on the size of the defect. When the saline solution is released, it will leak into the body where it will be harmless and absorbed over a period of days; it will not cause any irritation, illness or other unwanted effects. The patient (or Dr. Jugenburg) will be able to identify a leaking or ruptured implant due to the loss of size and shape in the affected breast.

    Saline breast implant leaks are not common, and for any given patient, having it happen once does not mean that patient will have a higher risk of it happening again.

    Rupture and deflation can be caused by a number of different factors, such as physical trauma, general wear and tear, Capsular Contracture (implant hardening), or complications from medical procedures. If a patient believes that her breast may be losing volume, she should arrange to see Dr. Jugenburg as soon as possible.

    All patients not in Toronto can contact the clinic by email and send photos of the affected breast to allow Dr. Jugenburg to make an assessment. Should Dr. Jugenburg determine that a breast implant leak or rupture has occurred, he will discuss treatment options with the patient and try to schedule a quick replacement.

    Although there is no health risk from the deflation of a saline implant, it is preferable to replace the defective implant before the implant has completely deflated and the breast pocket in which the implant is positioned has collapsed. If caught early, the implant capsule, which is the scar tissue that forms around an implant, will still be in its original shape and size.

    However, if the breast pocket is allowed to collapse after an implant has deflated, the implant capsule will shrink and tighten. If this happens, a new space for the replacement implant will need to be created.

    Saline Breast Implant Costs

    Saline implant Breast Augmentation procedures are typically $2000 cheaper than silicone implant procedures due to the differing manufacturing costs of the two types of implants.

    Women who receive silicone implants are also advised to have annual MRI scans after the third year to detect implant ruptures (silent ruptures), which adds further costs. Since saline is harmless and a saline implant ruptures immediately apparent, regular MRI scans are not necessary for women receiving saline implants.

    Benefits of Cohesive (Silicone) Gel Breast Implants:

  • All Cohesive Gel implants are FDA and Health Canada approved.
  • Each implant is filled with a thick, cohesive silicone gel formula that holds together uniformly and retains a natural pliability that closely resembles breast tissue.
  • Cohesive Gel implants suffer from less rippling/wrinkling than saline implants and older liquid silicone implants.
  • Ideal for women with very little natural breast tissue or fat.
  • If a Cohesive Gel implant leaks or ruptures, the silicone gel will not be released.
  • Each implant has a set fill volume for predictable results.
  • To ensure best long-term results for all patients, all Cohesive Gel implants are covered (free of charge) by a generous manufacturer warranty and lifetime replacement policy: AllerganConfidencePlusPremier®Warranty and Mentor Premier Advantage Limited Warranty.
  • Benefits of Saline Breast Implants:

  • Saline implants have been FDA and Health Canada approved for many years.
  • Each implant is filled with a sterile salt-water solution similar to the fluid that makes up most of the human body (i.e., it is harmless and compatible with the human body).
  • Saline implants generally have a slightly firmer feel than silicone-filled implants.
  • All saline implants have a flexible fill volume that can be precisely adjusted by Dr. Jugenburg during surgery to meet the needs of each patient and give the best result.
  • Ideal for women with slight breast asymmetries.
  • If a saline implant leaks or ruptures it will be harmless, and since the breast size and shape will noticeably change, it will also be immediately apparent.
  • The insertion of any given saline implant during surgery requires a smaller incision than that required for a similar size of Cohesive Gel implant.
  • Saline implants are cheaper than Cohesive Gel implants, which means the total procedure cost for saline implant augmentation is cheaper for the patient.
  • To ensure best long-term results for all patients, all saline breast implants are covered (free of charge) by a manufacturer warranty and lifetime replacement policy: AllerganConfidencePlus®Warranty and Mentor Standard Advantage Limited Warranty.
  • A variety of similar options are available for both saline and silicone gel implants to meet the individual needs of each woman:

  • An extensive range of base widths (diameters) to suit the body size and shape of each woman.
  • Different implant projection options from low to high profile and an extensive range of sizes to give each woman the look she wants.
  • Two shape options: Round implants or more expensive Shaped implants (Anatomic or Teardrop).
  • Two shell surface options: smooth implants or textured implants.
  • Every woman should also know that whether receiving saline or silicone implants, both types of implants have similar highly durable, elastic and resilient silicone shells that are designed to be highly resistant to rupturing or tearing, and have been thoroughly tested.