From the Guidelines
Plastic surgeons are increasingly favoring silicone breast implants over saline implants because they provide more natural-looking and feeling results, despite the potential risks of complications like capsular contracture, as supported by the most recent study from 2023 1. The shift towards silicone implants can be attributed to their gel-like consistency, which better mimics natural breast tissue, whereas saline implants can sometimes look and feel less natural, potentially creating rippling or wrinkling that may be visible through the skin. Some key points to consider include:
- Silicone implants have higher patient satisfaction rates, with modern implants being more cohesive ("gummy bear" implants) than earlier generations, reducing concerns about silicone leakage if rupture occurs 1.
- Silicone implants often provide better aesthetic outcomes in patients with minimal natural breast tissue, and while both types carry similar overall complication rates, many surgeons and patients feel the improved cosmetic results of silicone implants outweigh their slightly higher cost and the need for more regular MRI monitoring to detect silent ruptures 1.
- The decision between implant types should always be individualized based on the patient's anatomy, aesthetic goals, and risk tolerance, taking into account the potential risks and benefits of each type of implant, as outlined in the FDA recommendations and ACR Appropriateness Criteria 1.
- It is essential to discuss the risks, considerations, and recommended follow-up with patients, including the possibility of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and the need for regular imaging to detect potential complications 1.
From the Research
Shift from Saline to Silicone Breast Implants
Despite the potential side effects of silicone breast implants, such as capsular contracture, plastic surgeons are shifting towards using these implants over saline ones. The reasons for this shift can be attributed to several factors, including:
- Advances in technology and design of silicone implants, making them safer and more durable [(2,3)]
- Lower risk of rupture and capsular contracture with newer generations of silicone implants [(4,5)]
- Improved biocompatibility of silicone surfaces, reducing the risk of immune reactions and inflammation 6
Potential Side Effects of Silicone Implants
While silicone implants have several advantages, they are not without risks. Some potential side effects include:
- Capsular contracture, a condition where the body forms a thick layer of scar tissue around the implant [(2,3,5,6)]
- Implant rupture, which can lead to further complications and the need for additional surgery [(2,3,4)]
- Systemic symptoms, such as chronic fatigue, arthralgias, and cognitive dysfunction, which have been linked to breast implant illness (BII) 2
Management of Complications
To mitigate the risks associated with silicone implants, plastic surgeons are developing strategies for managing complications, including:
- Early recognition and aggressive treatment of short-term complications, such as hematoma and infection 3
- Use of advanced technologies, such as dual-port expanders and indocyanine green angiography, to prevent and treat complications 3
- Preoperative patient counseling on potential risks and necessary treatments to allow for informed decision-making 3