Silicone breast implants — once heavily restricted due to uncertainty over possible health effects — have returned to popularity in the several years since the restrictions were lifted.
In 2007, saline implants were used in 65 percent of breast augmentations, with silicone implants accounting for the remaining 35 percent, data from the American Society of Plastic Surgeons shows.
By last year, that dominance reversed. Silicone breast implants were used 62 percent of the time, with saline implants used in the other 38 percent.
From 1992 until 2006, the U.S. Food and Drug Administration sharply restricted the use of silicone implants for cosmetic procedures to allow time for additional studies on the effects of silicone in the body.
“There is almost nothing as well tested at this point,” said Dr. Gary Brownstein, a spokesman for the American Society of Plastic Surgeons whose practice is in Cherry Hill. “It doesn’t appear there are issues with it.”
Silicone implants were always allowed for breast reconstruction in cases where there was insufficient tissue to use saline (essentially salt water) implants. After finding silicone implants were safe and effective, the FDA removed its restrictions on their cosmetic use as well in 2006.
As their popularity has rebounded, silicone implants have continued to evolve, from changes in the shell to firmer and more cohesive material inside.
Doctors in the region who perform cosmetic breast augmentation vary in their approach to silicone vs. saline implants, from fully informing patients and letting them decide, to strongly encouraging them to restrict themselves to saline implants.
The differences show more time, and more procedures, will be needed before a possible consensus develops in the medical community on the uses of the different breast implants.
Dr. Ira Trocki, a plastic surgeon and principal of the Trocki Kouli Cosmetic Surgery Center in Northfield, said his practice offers both types of implants, including the latest cohesive gel silicone models that can be cut in half and the gel remains in place.
“We’re seeing that generally people say a silicone implant has a more natural feel to it,” Trocki said. “Most people who are shown saline and silicone implants, by feel and touch they’ll choose the silicone implant.”
He noted that silicone is commonly used in many types of medical implants, not just breast augmentations, is used as a coating on intravenous needles, and is commonly found on nonstick cooking pans. “I suspect we eat a lot of silicone,” he said.
The adjacent body tissue does react at the microscopic level to silicone implants, he said, but that’s true as well for saline implants, which also use shells made of silicone.
After informing patients of the differences and merits of the implants, and giving recommendations on how they can work for them, some choose saline implants, said Trocki, of Margate.
“Probably 60 to 70 percent choose silicone,” he said.
Dr. David Rayfield, a plastic surgeon who practices at Feldman-Rayfield Cosmetic Surgery in Linwood, performs augmentations with both types of implants, but strongly recommends saline ones to patients.
“After I present to patients my opinion and recommendation, I put in one silicone out of 30 implant procedures,” said Rayfield, of Linwood. “They generally choose to have saline after I tell them what I think are the pros and cons.”
The biggest problem with silicone implants, he said, is what’s called “capsular contracture,” the hardening and/or scarring of the thin lining the body forms around the implant.
“It seems clear that the rate of capsular contracture in silicone is higher than in saline implants,” Rayfield said, despite the fact that both types of implants have silicone shells.
“We presume it’s gel bleed as they call it, the molecules inside the shell leaking out around it,” he said.
He estimated the rate of capsular contracture among his patients at about 1 in 100.
“In patients who already have had silicone implants who haven’t had capsular contracture, we’ll put new ones in if they want,” he said.
Rayfield acknowledged that silicone implants have their advantages too.
“Silicone implants feel a little more natural, and in thin-skinned patients with little tissue to hide the implant, saline implants can have a little rippling of the skin, which is less of a problem with silicone. That’s a big selling point,” he said.
Dr. Kirk Brandow, of Philadelphia, who cosmetic surgery practice includes an office in Somers Point, also recommends saline implants and doesn’t think the FDA should have removed its restrictions on silicone implants.
“I do not believe silicone implants should ever be re-approved for primary breast augmentation because the complications rate is significantly higher than that of saline implants,” Brandow said.
“I believe the silicone can create an allergic reaction in many patients that is difficult to diagnose,” he said.
Breast augmentation is the single most popular cosmetic surgical procedure, with 286,274 performed in 2012 out of a total of 1.6 million cosmetic surgical procedures, according to data from the American Society of Plastic Surgeons. (Rhinoplasty, or nose shaping, was second with 242,684 procedures.)
Brownstein, speaking for the society, said all patients should understand that no implant — silicone or saline — “can serve for a lifetime. All eventually are going to break” and need to be replaced or removed.
With saline implants, a break is obvious since the saline solution is absorbed by the body and the breast deflates, he said. With silicone implants, MRIs are recommended after three years to determine if leakage is occurring.
Brownstein said the new form stable and cohesive implants seem to offer the significant advantage of maintaining their shape and the procedure’s results over time.
Other than recommending that patients use the resources of the American Society of Plastic Surgeons to find a qualified plastic surgeon, the society doesn’t have a position on silicone vs. saline implants, Brownstein said.
“The more tools you have in your tool chest, the better work you can do,” he said. “I think saline implants are great and silicone gel implants are great. I can’t make a wrong choice. Just make the choice for yourself.”
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