In a past blog on breast implants, I discussed the different implant manufacturers. In this blog, I’ll discuss the different options for filling implants.

Implants consist of two components – the implant shell and the implant fill material.  Simply, the shell is a container for the fill. The shell is constructed of a silicone type material, is elastic, and will be discussed in detail in another blog. The fill material is either saline (sterile salt water) or silicone gel. Implants can be roughly categorized as saline or gel, based on the fill material.

Saline Implants

Saline implants are provided to the surgeon as an empty shell. A fill tube is attached to the shell and the implant is inserted empty. Once in place, the surgeon injects saline through a fill tube. Once the implant is filled, the tube is removed. There is a valve in the shell that accepts the fill tube, and this valve seals automatically when the fill tube is removed.

Saline implants have a fill range so that minor adjustments in size can be made once the implant is in place – the range is generally about 10%, say 300cc to 330cc.  Also, since saline implants are placed deflated, then inflated, they can be placed through very small incisions. Saline implants have a firmer feel than gel implants and a greater tendency to ripple which can be felt through the skin in thin, smaller breasted women.  Saline implants generally last 10-15 years and then need to be replaced due to leakage.  When they leak, the saline is absorbed by your body and represents no health risk.  Replacement is simple but is performed in an operating room.

Saline implants are less expensive then gel implants and the risk of capsular contracture is lower.  There is no age restriction on the use of saline implants.

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Gel Implants

Gel implants are provided to the surgeon as a filled implant and therefore require a longer incision to insert. The gel can be thinner or thicker (more or less cohesive) depending on the specific model of implant chosen.

Gel implants since 2006 are all cohesive, meaning the gel is designed to stick together as a single mass and not ooze away, even if the shell fails.  The thickest gels can be molded into a specific form (teardrop) and will maintain that shape – they are called Form Stable (sometimes called “Gummy Bear” implants.)  As cohesive gel implants are relatively new the lifespan is not yet known.  I anticipate that they will last, on average, 20-25 years or longer.

Gel implants are softer than saline implants and have less tendency to ripple. Gel implants are more expensive than saline, but as they last much longer, are less expensive in the long run. Capsular contracture risk is higher than saline. Gel implants can only be used in women 22 or older, based on FDA restrictions.

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Gel implants are much more popular than saline, but saline implants definitely have a place.  The safety profile, other than the risk of capsular contracture, is the same for gel and saline.  No studies have compared the impact of saline vs gel on breastfeeding but the general consensus is that neither impact breastfeeding babies.

In future blogs, I’ll discuss other implant characteristics.