Which Is More Popular, Saline or Silicone Breast Implant?

Breast augmentation is either performed using saline- or silicone-filled breast implants, devices which not only increase the bust size but also regain the lost volume after childbirth.

In terms of popularity, silicone breast implants are almost outpacing the saline version.  This is not surprising because they provide a more natural result since they are filled with a cohesive gel that is designed to replicate the feel of breast tissue and fat.

The growing popularity of silicone breast implant can be attributed to the FDA’s decision to lift the ban in 2006 after several studies have suggested that there is no link between its use and cancer risk and systemic diseases.

Another reason why silicone implants are more popular than saline is that they are very ideal for women with little tissue and fat in their breasts.  And not surprising, a significant number of patients seeking breast augmentation have this anatomical feature.

On the other hand, saline implants can provide a natural appearance only if there is a moderate to significant amount of tissue and breast plastic surgeons can work with.

Meanwhile, a 2009 survey released by the American Society of Plastic surgeons revealed that 50 percent of breast augmentation patients had chosen silicone implants. 

Right after the lifting of the 16-year ban, silicone implant is gaining on saline version every year.  In 2007, 35 percent of breast implants used in surgery were silicone and they jumped by 47 percent a year after.

Difference Between Saline and Silicone Implants:

* Saline implants are filled with a sterile salt and water solution while the silicone version is filled with a cohesive silicone gel.

* Saline implants are prone to sloshing, which in turn results to higher risk of downward displacement than silicone with the same size.  For this reason, some doctors intentionally overfill the saline implants.

* Silicone implants need longer incision than the saline version, unless they come in a very small size.  By contrast, saline implants require a short surgical cut because they are placed empty inside the breast pocket before they are inflated with a sterile saltwater solution.

* Silicone implants can maintain their volume for years (except if there is a leak or implant failure) unlike the saline ones which have a natural deflation rate of 1 percent every year.

* For patients with a little amount of breast tissue, saline implants often result to unflattering, dome-shaped breasts while the silicone implants can provide a more natural result. 

However, saline and silicone implants provide almost the same aesthetic result for women with moderate to significant amount of breast tissue.

Breast Lift and Different Degrees of Ptosis (Sagging)

Because of the different degrees of breast sagging, plastic surgeons are using various types of mastopexy or what is more commonly referred to as breast lift.  In this way, they can address the problem using the shortest incisions possible.

Most doctors categorize breast sagging in three types: ptosis, empty sac syndrome, and pseudoptosis.

* Ptosis

This is the only condition that warrants breast lift surgery.  This happens when the breasts droop far enough that the nipple is at the same level or has even sagged below the breast crease.  Usually, this is often associated with the lack of volume in the upper poles and cleavage that the bosoms appear elongated.

Ptosis comes in three categories: mild ptosis in which the nipple has dropped to the level of the breast fold; moderate ptosis in which the nipple has dropped beyond the level of breast crease; and advanced ptosis in which the nipple is pointing toward the floor.

Advanced ptosis is often treated with full mastopexy, which is also known as an inverted-T or anchor lift due to the shape of its incisions.  Plastic surgeons create an excision that starts at the base of areola and travels to the breast crease, and then cut out a crescent-shaped amount of skin along the breast crease.

Full mastopexy also involves repositioning the areola complex so it sits in a more youthful position.

On the other hand, mild and moderate ptosis can be corrected with less invasive forms of mastopexy.  For those who need the least amount of correction, the Benelli or donut breast lift is often enough to address the sagging by simply making an incision around the areola complex.

But for those who need a little more correction, the lollipop breast lift or vertical mastopexy is a good option.  This technique involves an incision around the areola and another one that travels to the nipple down to the breast crease, resulting to a lollipop-shaped scar.

* Empty Sac Syndrome

This condition can be treated with breast augmentation surgery alone since the areola and nipple have not yet fallen at the same level or beyond the breast crease.  Implants are enough restore the lost volume associated with aging and pregnancy.

* Pseudoptosis

This condition, like the empty sac syndrome, is best suited for breast augmentation rather than breast lift.  Women with pseudoptosis have breasts that have fullness below the nipple but the upper portion appears somewhat “deflated.”

Film School in China Bans Students Who Had Plastic Surgery

With the growing popularity of plastic surgery in China, a film school has made it clear that anyone who alters his or her appearance will likely be disqualified from the entrance examination.  Officials from the illustrious performance institute of Beijing Film Academy said that “changes in the faces and other body parts might affect the acting of students.”

Even students with tattoos may be disqualified from entrance examination.

Surprisingly, many people think the decision to ban those who had plastic surgery is “fair,” arguing that actors who had “surgical enhancements” are somewhat cheating.

Some people even say that plastic surgery is a fraud.

However, what they fail to realize is that plastic surgery is not all about looking better than others.  For some people, this may be their only way to live a normal life, improve body functions, and repair deformities caused by illness and accidents.  Does it mean individuals who had reconstructive plastic surgery are also banned from the film school?

One student’s parent even said that she agrees with the plastic surgery ban because “what matters is the performance and acting, not how a person looks.”  With this argument, what is the point of excluding those who had “cosmetic enhancements” when their talent is the most important thing rather than their appearance? 

And not to mention the freedom of choice.  The choice to undergo “surgically-assisted beautification.”

Another potential loophole is that how on earth the film school’s officials can determine if someone had surgical enhancements or not?  What kind of criteria they are going to use?  Perhaps it would be too tedious to conduct background check for the sole purpose of determining if a student had plastic surgery or not.

Currently, eyelid surgery is one of the most common cosmetic plastic surgeries in China.  And with 94 percent of the population consisting of Han people who usually lack a prominent eye crease, individuals with this feature may end up being accused of having “surgical enhancements” even if they did not.

The issues surrounding plastic surgery are somewhat analogous to guns.  Guns are neither bad nor good as the situation depends on who will use them.  The same thing is true in cosmetic surgical enhancements. 

But perhaps the plastic surgery ban imposed by the prestigious film school has its own merits.  According to the country’s health ministry, about 70 to 80 percent of those who seek cosmetic surgical enhancements are high school and college students who are too young to understand the ramifications of their decision.

Also, another concern is that teenagers are not yet physically mature to undergo cosmetic plastic surgery.

Breast Augmentation to Treat Hypoplasia

Contrary to popular belief, breast augmentation surgery is not only used to improve the figure; for some women, this procedure is needed to address deformities such as hypoplasia in which one or both breasts never mature properly.

Many women with this condition suffer from emotional pain because the breasts have always been associated with femininity and sensuality.  Fortunately though, most cases can be corrected by breast implant surgery; and because it is performed as a reconstructive procedure, insurance reimbursement is often possible. 

There are many factors which can lead to breast hypoplasia including hormone abnormalities.  If this is the problem, hormone therapy might resolve the condition and allow the breast tissue to develop normally. 

Hypoplasia can also be the result of systemic disorders, which must be addressed immediately while the patient is still young to increase the success rate of the treatment.  And for some, the problem may have originated from the damaged or injured undeveloped breast bud.

In some cases, underdeveloped breasts are caused by anorexia.  By simply addressing this underlying problem, most patients can develop normal breasts right after they regain their normal weight.

As much as possible, doctors treat the underlying problem before they even consider breast augmentation surgery.  However, there are cases in which the patients show no particular reason why their breasts never developed normally; in general, these women are good candidates for plastic surgery.

But even if the underlying problem has been resolved, some patients with hypoplasia will not be able to form a normal breast unless they will undergo breast augmentation.  This is because the delicate breast bud, once damaged at an early age, may never recover and lead to underdeveloped bosom. 

Patients with breast hypoplasia have a chest with a juvenile appearance.  And because of lack of anatomical maturity, the condition will often affect the breastfeeding, although some women have normal or limited mammary function.    

While breast augmentation surgery can correct the aesthetic problem caused by hypoplasia, it cannot help women who have no breastfeeding ability and those who lack sensory responses in their breasts.  But at least the look and feel of their breasts will be normal, helping them to overcome emotional and psychological issues caused by aesthetically immature breasts.  

Because hypoplasia patients lack breast tissue, silicone breast implant is more ideal than the saline version because it can mimic the feel and look of natural breasts.  In addition, choosing this type of implant can reduce the risk of palpable and visible rippling.

Effects of Saline Breast Implants Depend on the Amount of Tissue

As its name suggests, saline breast implant is filled with sterile saltwater; for this reason it provides a less favorable cosmetic outcome for women with little breast tissue and fat.  By contrast, patients with an ample amount of tissue will usually enjoy a more natural result because of the “thicker coverage.”

The reason why women with almost no breast tissue will have unnatural result with saline implants is that there is little coverage.  In fact, the implants will be easily felt through the skin, regardless if these are positioned under or over the muscle, particularly in the lateral side and bottom of the breasts.

And instead of having a teardrop-shaped breast, it would end up being unnaturally round.  So for women with little amount of tissue, silicone breast implants, which are filled with a cohesive gel that mimics the feel of glandular tissue and fat, are the best options for them. 

(However, using teardrop-shaped implants, which are always available in textured surface to prevent them from flipping over, are not advisable for women with a very small breast because of the higher risk of rippling.)

Another concern of using saline implants on women with limited breast tissue is the higher risk of rippling and wrinkling of the shell, which is caused by “lack of coverage.”  This problem may be even aggravated with the use of textured implants with large “graininess.”

On the other hand, patients with moderate to significant amount of glandular tissue—particularly those with firm breasts—will likely enjoy a more natural result with saline implants.  In fact, regardless of the type of implants they would use, it is easier for them to achieve a favorable cosmetic result.

But despite having more amounts of tissue and fat, women should still limit themselves from using large saline implants (filled with more than 500 cubic centimeter or cc) because it can lead to a higher risk of downward displacement than silicone implants with the same size.

Meanwhile, women with a modest amount of tissue will achieve a result somewhere in-between.  They will most likely feel the implant shell through their skin with saline implants, although the shape of their breasts will appear natural as if they have used the silicone version. 

In general, silicone breast implants are still the best option for these patients to achieve a more natural feel.  (When plastic surgeons mention the word “feel,” they are talking about the sensation of the breast as it is being touched by fingers.)

FAQs About Breast Implant Surgery

1.     Question: What kind of implants is used during breast augmentation?

Answer:  Currently, the US Food and Drug Administration only allows silicone- and saline-filled breast implants.  However, there is some speculation that the gummy bear implants (these are filled with a more cohesive type of silicone gel) which are under clinical trial, will be made available to the public in the next few years.

2.     Q:  Which can provide a more natural result?

A: Siliconeimplants are designed to mimic the feel of breast tissue, making them a more popular choice of women these days.

3.     Q:  Any benefits in choosing saline implants over silicone version?

A: Yes.  Patients are not required to undergo MRI screening, a test necessary for those with silicone implants because they are at risk of having silent leak (no visible manifestation that the shell has already ruptured),And in case of rupture, patients with saline implants can immediately see the problem because their breasts will become deflated within hours.

4.     Q:  What is capsular contracture?

A:  This happens when the scar tissue—which naturally forms around any implant—becomes extraordinarily dense that it ends up squeezing the implants.  Fortunately, there are many surgical techniques and post-operative treatments that can minimize the risk of capsular contracture.

5.     Q:  What is the difference between smooth and textured implants?

A:  Smooth implants have a balloon-like surface while textured implants have a rough, somewhat “grainy” exterior.

All teardrop-shaped (or anatomical) implants come in textured surface to prevent it from rotating inside the breast pocket, something which may lead to visible distortion.  On the other hand, round implants often come with smooth exterior because they can rotate without causing any problem.

However, some round implants have rough surface which is said to minimize the risk of capsular contracture.  But this claim has not yet been proven.

6.     Q:  Which can provide more natural breast contour, round or teardrop implants?

A:  Both implants can provide natural appearance as long as with the proper placement.  And contrary to popular belief, round implants do not automatically lead to a dome-shaped, unnatural-looking breast because their shape turn into a teardrop once inside the breast pocket (due to the pull of gravity).

      7.  Q:  How long do breast implants last?

A:  According to a study conducted by the Institute of Medicine, breast implants last an average of 16 years, although their lifespan still depends on many factors such as the patient’s lifestyle, certain features of the body, and type of implant used during the procedure.

Breastfeeding After Augmentation Mammaplasty

One of the most common concerns of patients considering breast augmentation is its effect on breastfeeding.  However, many studies have suggested the surgery does not prevent women from producing milk.

Is It Possible to Breastfeed After Breast Augmentation?

Breast augmentation patients will most likely be able to breastfeed their babies following the surgery, particularly if the incision is made along the breast crease and armpit.  However, a U-shaped incision around the edge of areola may increase the risk of having breastfeeding problems because the technique causes more trauma to the glands, nerves, and ducts.

Can Silicone Implants Contaminate the Milk?

Breast implants do not pose contamination risk to babies; in fact, the milk produced by a woman with siliconeimplants has a significantly less amount of silicone than formula milk.

Potential Problem

Patients should know that breast augmentation does not prevent them from producing milk, although there is a risk of having less sensitive nipples, which in turn may lead to difficulty in breastfeeding.  Fortunately, a study has suggested that five years after breast surgery, most of the damaged nerves have already been repaired by the body, significantly improving the ability to breastfeed.

Why Some Patients Can’t Nurse Their Babies

It’s not about inability to breastfeed, but more on the unwillingness of some women to nurse their babies.  According to a recent study conducted by the American Society of Plastic Surgeons (ASPS), women with breast implants who think that breastfeeding can lead to sagging breasts are less likely to do this successfully.

However, the ASPS said that breastfeeding does not affect the result of breast implant surgery and even highlighted the significant health advantages for both baby and mother.

Solution for Those Experiencing Difficulty in Breastfeeding

Women with breast implants should tell her child’s pediatrician about the surgery; in this way, the doctor can keep a close eye on the baby’s weight and make sure he or she is getting enough milk.

But for patients who had breast augmentation to address hypoplasia or underdeveloped breasts, they may experience trouble producing enough milk.  For these mothers, they are often advised to use pump after each nursing session to stimulate production.  But if this is not enough, they should use formula milk or donor milk.

Should Breast Augmentation Be Postponed?

Some plastic surgeons recommend postponing breast implant surgery for women who are considering having babies since pregnancy may change the appearance of their breasts.