Breast Implants Birmingham
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Silicone vs. Saline
While the FDA has declared silicone gel implants “safe” for sale to the general public, there are a number of pros and cons with both silicone and saline, which patients need to understand. First of all, patients seeking answers in the arena should be wary about web sites that have advice on them by non-scientists or people who are non-professionals in the plastic surgery field. The best advice concerning the relative safety and advantages and disadvantages of any implant is best obtained from those professionals which clearly understand the scientific relevancy of all issues associated with the implants. I will briefly summarize these issues in this paragraph but patients should familiarize themselves with other sites where they can find out more information on this, including the website for the American Society of Aesthetic Plastic Surgery, the American Society of Plastic Surgery, as well as manufacturer websites Allergan and Mentor. In addition to saline and silicone there are new innovative implants that will be coming on the market within the next year or two. One of these is called the Ideal implant, which actually is a saline implant that is dual lumen and has the looks and feel of a silicone implant in many ways. Trials for this new implant, which Dr. Core will be participating, will be underway sometime within the next year. In addition, there are now silicone implants that are “form stable”, which have been used fairly extensively in countries outside the United States due to more relaxed regulatory practices by the federal agencies involved. The jury is still out on form stable implants; however, we still have excellent choices with our cohesive gel silicone implants which have served us well already.
In regards to saline, these implants have been the primary implant that we have used in our augmentation practice over the last 12 years. Patient has been extremely high and the minimal access endoscopic technique can be used to have the scar in a remote location. As long as patients have adequate tissue coverage over this implant, it has been a highly reliable and successful procedure, which has enhanced the lives of hundreds of women that have come to our practice for endoscopic breast augmentation.
The disadvantages of saline implants occur when one starts to have large implants and a small amount of tissue coverage. In these cases, the edges of the implant can be seen rippling. The implant can feel firm and the edge of the implant will actually “pop” as you push it back and forth with a thin tissue around the edges of the implant pocket. In these cases we have been successful converting these patients to smooth silicone gel implants which have alleviated most of these problems. Leakage from a saline implant has been estimated to be approximately one per one-hundred implants per calendar year. This estimate is actually likely somewhat high since I have over 1,000 patients with saline implants throughout the southeast and we only replace an average of 1.5 implants per year. In addition, when a saline implant leaks, it is an event which is not in any way of medical risk to the patient. The material that leaks out of the implant is sterile saline, which is the same material that is included in an IV that a patient receives during surgery, so there is absolutely no risk of any health problems when the implant leaks. However, the implant will have to be changed, which can be done easily through the same endoscopic incision using sedation and local anesthesia as long as there is not a modification of the implant pocket and needs to be performed at the same time.
In regards to silicone implants, most people feel that the advantage of these implants is that they are somewhat more aesthetic, especially in slim patients in that they have more of a natural feel, they are not quite as firm as the saline implants we have now, and they seem to have less rippling and in addition are slightly lighter per unit volume than a saline implant. Therefore, larger silicone gel implants are lighter than larger saline implants. In addition, a silicone implant up to 325-cc’s can be placed through endoscopic incision in the axilla without a problem; however, sizes above 325-cc’s are easier to place them through inframammary incision, which is in the fold underneath breasts slightly on the lower portion of the breast so that when one raises their arms, the incision is not visible below a swimsuit bra.
The residual concern about silicone implants primarily relates to the media hysteria that occurred in the early 90’s about possible medical conditions, which could occur secondary to silicone gel being placed in one’s body. For the most part, these medical issues have been resolved to the extent that the FDA now feels that placement of silicone gel implants is safe and that there is an extremely low risk of developing other medical problems such as autoimmune disease. However, silicone gel implants do still have a slightly higher rate of capsular contracture where the natural scar that forms around the breast implant after surgery can start to squeeze down on the implant and make the implant appear firm. In actuality, the implant is not firm; it is just under pressure by the scar capsule that is now putting the implant under pressure. This is akin to placing a towel around a water balloon, which feels soft as long as you don’t squeeze on it but when you start squeezing on the towel the water balloon will appear very firm. The capsular contracture rate for silicone implant however is much lower than it used to be. Back in the 1980’ and 90’s the contracture rate for silicone implants was quite high, some people stated as high as 30 to 50 percent. However, due to the advent of cohesive gel now as opposed to liquid silicone gel in these implants, the capsule rate has dropped to somewhere in the range to 3 to 5 percent. Saline implant capsular contracture rates are somewhere in the neighborhood of 1 to 3 percent. In addition, with silicone implants when there is a leak the gel, which is now cohesive, does not bleed out of the implant shell as the old liquid silicone did; therefore, there is no risk of the gel traveling to other places in your body are remotely outside the breast pocket.
In addition to the above advantages, silicone can be placed in front of the muscle easier than saline implant because it requires less tissue coverage than a saline implant. For this reason, this implant may be more appropriate in cases of droopy breasts (ptosis) or in patients who do not want any deformity when they flex their muscles, such as women who are into fitness and/or body building. Silicone has certain advantages over saline. The primary disadvantage would be the residual concern from the health issues of the early 90’s and issues with the FDA, as well as the inability to place the implant through very small incisions.
Form stable silicone implants as well as the Ideal saline implants should be forthcoming within the next year or two. However, delaying one’s own personal sense of enhancement and gratification on waiting for these implants is something that should not be considered since experience has shown us that sometimes the FDA may take many years to approve an implant style and therefore the window of opportunity could actually pass waiting on a government agency like the FDA.
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If you have any questions or if you would like to schedule a consultation to talk more about breast implants, please contact our office today.