History of silicone breast implants
Unlike any other device in medical history, silicone breast implants have been the subject of vilification, research, redemption and pardon like no other.
Since Dr. Gerow, my former professor and the inventor of breast implants, started playing with a bag filled with blood while still in training at Baylor College of Medicine in Houston in the early 1960s, breast implants have had a tumultuous and politically charged existence.
Soon after their invention, the first saline-filled breast implants gave way to implants filled with silicone gel. The silicone was softer and had a more “natural feel,” especially as the older saline-filled implants had a particularly thin wall that made them really feel like a “bag of water.”
All through the 1970s and 1980s, silicone breast implants were king. In fact, when I started my residency in Houston in 1990, I had never seen a saline-filled implant used for a cosmetic surgery. At that time, saline breast implants were used as skin expanders in reconstructive surgery. By the time I finished my plastic surgery residency in 1993, there were no silicone breast implants available in the US for cosmetic surgery.
Immune reaction to silicone
A great deal of the trouble that started with silicone breast implants had to do with the notion that silicone caused an immune response in the body that caused the body to attack itself. There are a number of diseases like this and, proportionately, women suffer from them more often than men. Diseases like rheumatoid arthritis and lupus fall into this category. After a decade of research, 4.5 billion dollars in law suits and the bankruptcy of Dow Corning, a major implant manufacturer, it all turned out to be… rubbish. Silicone does not increase your risk of getting one of these immune-modulated diseases. The FDA once again allowed the silicone implants to be used for cosmetic surgery in 2007.
Risks of silicone implants
There are real risks involved with silicone implants. Most of the risks are shared with saline breast implant surgery, but there are risks specific to silicone implants.
Common risks of all breast implants
- Capsular contracture
- Implant mal-position
- Breast numbness
Specific risks of silicone implants
Implant rupture is the most serious complication of silicone breast implant surgery. Saline breast implants can, of course, rupture, but the saline is readily absorbed into the body and the empty implant is easily removed and exchanged.
But look at the photo below to see what happens when a silicone implant ruptures!
The ruptured gel starts to leak all over the breast implant pocket, and if you are lucky it will stay there. In some cases it can escape the pocket and start to migrate around the chest wall, making it impossible to remove.
Removing a ruptured silicone implant is much more complicated than removing a saline implant and requires removing the whole breast capsule; this is called a capsulectomy, and it can take several hours under general anesthesia.
Whereas with a saline implant the loss of volume is immediate and easily seen by all, a silicone implant needs a CT scan or MRI for a diagnosis of an implant rupture. This is an added cost for the patient that recurs every two years.
There is nothing wrong with silicone implants for breast augmentation surgery other than the fact that they require more complicated upkeep and create a bigger scar. As for the feel—I still cannot tell the difference, and like all cosmetic plastic surgeons, I spend all day trying.
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