Patients must also decide which type of breast implant they want and, once again, there are advantages and disadvantages to both saline and silicone gel devices. Although both devices were initially used in the early 60’s, the silicone gel devices are the implants which have undergone the most change and controversy in the past 40 years. The first generation devices were thick shelled and fairly durable but soon gave way to the second generation devices which had a very thin outer shell and very thin liquid silicone inside. These devices were not originally regulated by the FDA and in the late 80’s came under extensive public scrutiny due to the relatively high rate of rupture which was complicated by the practice of closed capsulotomy common during that era (a process in which the plastic surgeon would squeeze the breast capsule very hard in an attempt to break the patient’s tissue capsule but not rupture the implant inside).
Due to a variety of problems, including mounting public pressure, the FDA ordered all of the silicone gel devices off the market in 1991. Saline devices soon controlled the market and to this day remain a very safe alternative. Some of the disadvantages of the saline devices involve the feel of the saline filled bag. Although your body is 60% salt water, most of this is in your muscles and organs. Your breast tissue is mostly fatty tissue and this is why it has a unique soft feel (although the fat percentage may change over the years and there is a lot of variability amongst patients). The silicone gel feels much more like natural breast tissue because of it’s density and consistency. The current implant market uses the fourth and fifth generation devices which have a thicker outer shell and a thick, viscous inner gel. Although all of the gel breast implants use a cohesive inner silicone gel, some devices use an extremely thick inner gel which is form stable. These devices are called form stable cohesive gel devices (sometimes referred to as “gummy bears”) and are currently not available in the United States outside of specific research studies. It may not be possible to place the form stable cohesive gel devices (gummy bears) through an axillary or umbilical incision. Both plastic surgeons and the implant industry are hopeful the FDA will approve these devices for clinical use sometime in the relatively near future. After a thorough examination of your anatomy and tissues, your plastic surgeon can recommend which device may be a better fit for you. Ultimately, it will be your decision based on the pros and cons of each device and your confidence in that implant.