Breast Reconstruction FAQs: Silicone vs. Saline Breast Implants

Patient Expert

Q. I also have to decide on silicone vs. saline. I'd heard silicone gives a better result, but wasn't it banned or something? What's up with that?

A. After 20 years of usage, silicone implants were banned by the F.D.A. in 1992 as being unsafe. One study found that as many as 69% of women with implants experienced ruptures, resulting in the implants becoming hard and painful. Some claimed leaking silicone traveled through their bodies, causing cancer and autoimmune disorders, such as rheumatoid arthritis. A class-action suit by women against several implant manufacturers resulted in settlements in the women's favor, and triggered the withdrawal of the implants from the market. Despite the legal settlement, however, there's no reliable research showing that implants-silicone, or saline-cause immune system disease, or increase cancer risk. And this year, the F.D.A. lifted the ban, claiming silicone implants, while they may still rupture and be painful, are basically safe.

The advantage of silicone implants over saline is that they're softer, hang more naturally (though still not as naturally as reconstruction made from your own body tissue), and assume a more natural shape than saline. The advantage of saline is that, if you're worried about silicone, a ruptured saline implant simply leaks saltwater into your body, not silicone.

So, which should you choose? Sorry, I have no magic answer here. Once again, do your research, make your decision, and don't second-guess yourself. Go forward with confidence that you've done what's best for YOU.

Q. Will an implant interfere with any future mammograms?

A. This is a tricky subject. First, you may not need future mammograms on your implant side; if you're having a total mastectomy, there's no breast tissue left to examine. If you're having a partial mastectomy, then depending on where the implant is placed, it could interfere with the ability of the mammogram to do its job. In addition, the compression necessary to get a clear reading increases the chance of your implant rupturing, which then requires another surgery to remove the implant. Finally, be aware that implants sometimes cause a buildup of scar tissue, which not only can be painful and make the breast change its shape, but can make it difficult to identify any possible tumor.

These possible side effects with implants should definitely be discussed with your surgeon; and if he or she seems at all vague about what effect the implant might have on future cancer detection, see if you can get a better opinion from your oncologist.

In addition, discuss with your surgeon what happens if your implant ruptures or leaks, or whether it has a limited lifespan (and, if so, how long). It's good to thoroughly understand all the possible consequences before you have this surgery done, so that you're not surprised if any "repairs" become necessary down the road.

Previous Reconstruction Q&A: Breast Implants and Tissue Expanders

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