Breast augmentation, also commonly referred to as augmentation mammaplasty, is one of the most commonly performed aesthetic surgical procedures by plastic surgeons, with over 400,000 procedures performed annually in the United States alone. The FDA has recognized two types of breast implants for safe and effective use in breast augmentation or reconstruction procedures: saline-filled breast implants and silicone-filled breast implants.
Saline implants
Saline-filled breast implants have a silicone elastomeric shell and are filled with sterile liquid saline. These implants can either come pre-filled or can be filled following placement within the patient's chest. They have been approved by the FDA for women ages 18 and older seeking a breast augmentation and for women of any age seeking breast reconstruction.
Silicone implants
Silicone breast implants also have a silicone elastomeric shell but are filled with a viscous silicone gel. These implants come pre-filled, which require them to be inserted into the body through a larger port. They have been approved by the FDA for women ages 21 and older seeking breast augmentation and for women of all ages seeking breast reconstruction.
Pros of Saline
Because saline-filled implants can either come pre-filled or be filled after implantation, this leads to a less invasive procedure, reduced scarring and a faster recovery time. Additionally, in the event of implant rupture---a known complication with both types of breast implants---a patient is more likely able to identify the rupture due to loss of shape and size of the implant.
Cons of Saline
Saline implants have higher rupture due to the increased shearing forces on the shell. Additionally, recipients of saline implants require replacement sooner than do recipients of silicone implants. They also tend to appear rounder and do not have the characteristic sloping, giving them a least natural appearance.
Pros of Silicone
While being an object of investigation prior to their 2006 FDA re-approval, silicone breast implants offer the recipient a more realistic-looking breast. Additionally, they have lower rates of rupture and a lower short-term replacement rate. They have also undergone several improvements since the initial model, including the development of a textured outer shell which helps to reduce the risk of capsular contracture, as well as a more highly crosslinked silicone gel---also known as the "gummy bear" implant---which results in more natural appearing breasts, decreased likelihood of complications in the event of rupture and reduced rates of replacement in comparison to other silicone models.
Cons of Silicone
According to Biomaterials Science: An Introduction to Materials in Medicine, prior to 2006, silicone breast implants were under investigation for their potential link to autoimmune diseases, but they received FDA clearance as there was not enough evidence to support a connection. While these implants have been determined as be safe, they are slightly firmer, require a larger incision in the skin for insertion due to the requirement of filling prior to implantation and are more costly. Also, silicone breast implant ruptures often can go unnoticed, thus it is recommended that recipients of silicone breast implants get an MRI on the breasts every other year to ensure that the implant has maintained its integrity. In the event that a rupture does occur, a patient can experience lumps around the implant, change of shape/size of implant and pain, burning or hardening of the breast.
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