When patients ask me whether saline or silicone gel breast implants would be better for them, the first thing I check is their age. The FDA has mandated that all women under the age of 22 have saline implants placed for elective cosmetic augmentations. This constitutes the only circumstance when a patient would not have a choice.
In general, the thinner a woman is, the more likely that I will recommend gel over a saline because saline implants are more likely to show rippling, even when placed under the pectoral muscle. Remember that an implant placed under the muscle is actually only covered by the muscle in its upper half. The bottom part of the implant lies immediately under the skin and breast tissue. The triangular shape of the muscle requires the bottom half of the muscle to be divided in order to create a space for the implant. It is more important for the upper half of the implant to be covered by muscle since open collars and necklines expose this portion.
If an implant is to be placed over the muscle, I almost always recommend a gel implant; under the muscle, either implant works well.
Some patients express concern about gel implants and a possible relation to rheumatoid arthritis or other autoimmune disorders. Recently, a number of studies with at least 10 years of follow-up, done by physicians with no vested interest in the outcome of the study (rheumatologists), have found no correlation between silicone breast implants and autoimmune disorders. The current implants are made of a cohesive gel that tends to keep its shape. I have cut one of these implants in half and seen the gel behave like gelatin. If you squeeze on it, it bulges but draws back together when you stop squeezing.
The FDA recommends that patients with gel implants should have screening MRIs done every three years to check for the integrity of the shell. If a tear is identified, both the FDA and the implant manufacturers ask that the implant be replaced. Occasionally, it may be difficult to determine if an abnormality in the image is a tear or not. Some may ask why replace any implant, regardless of shell integrity, if it is doing its job and not causing any problem, particularly since the new gel is cohesive? Suffice it to say that both the FDA and the manufacturers are explicit on this point. They want them replaced. Saline implants leave no question as to their status. When the shell fails, it will deflate and will need to be removed and replaced. Patients should take these facts into consideration when choosing their implants.
During your initial consultation, we will discuss the best implant options to help you achieve your needs. If you feel that all of your questions were answered, we will proceed with designing a customized breast augmentation treatment plan.