Some of the most frequently asked questions I get regarding breast implants are the following: "What is the difference between saline and silicone breast implants?" "Do I have to replace my implants after 10 years?" "Which one is better?" "Which is safer?" "Which do you recommend?"

The answer to these questions is up to each individual woman. For starters, any woman aged younger than 22 years old is only a candidate for saline. There is no hard data to support this age- it is only an arbitrary age that the two main implant manufacturers in the US (Mentor and Allergan), have established in their studies. This age makes no sense to me since you need only be 18 years old to sign an adult informed consent or serve in the military, and be only 21 years old to meet the legal drinking age. But "ce la vie…"

Saline implants are tried and true. They are silicone shells that are then filled intraoperatively with sterile saline during the operation and quite safe. If they deflate, then only sterile saline leaks out into the body and gets absorbed safely into your system. If a deflation occurs, it is like a "flat tire" and you will notice right away and call your plastic surgeon immediately to have a new one placed. Both manufacturers have good standard warranties regarding both their saline and silicone implants. However, the down-sides to saline include a more rigid type of device in that the saline implants seem to "hold their shape"- particularly in the upper pole of the breast more rigidly than do silicone. Saline implants can tend to feel more like "water balloons" and less natural. Some have reported a "sloshing" noice audible and noticeable in high altitudes (such as during skiing trips). I tend to steer away from saline implants in very thin patients- particularly patients who have visible ribs in their upper chest, as saline implants can be much more visible and palpable in this area. Women who have broader chests and a fair amount of their own, native breast and soft-tissue tend to have more natural-appearing results with saline implants. Saline implants are a good choice in women who have significant asymmetry of their breasts, as the implants can be inflated during surgery to more precisely match in volume. Silicone implants have fixed volumes, thus asymmetric breasts may remain overall improved, however remain asymmetric after surgery if silicone implants are chosen. Also, very young patients with a more limited budget who expect to exchange out their implants sometime over the course of their lifetime may be good candidates for saline. Which brings us to the next commonly-asked question…

" Do I have to replace my implants after 10 years?" This 10-year mark is a myth and the real answer is… you only need to exchange your implants if and when you have a problem with them. I have encountered patients who have a problem with their implants after only a short period of time (due to capsular contracture, deflation or desiring a size or site-change) and women who haven’t had a problem with their implants in over 20 years or so. It is recommended by each implant manufacturer that you replace your implants if they become ruptured. I often make the analogy to women patients to think of their new breast implants similarly to a new car. You wouldn’t expect anything to go wrong with the engine of your new car within the first few years. However, after 7 to 10 years of owning your car… the chances that you may have something major go wrong with the car or engine increases greatly. However, you only need to get a new car if either you have a major problem with your old car, or you wish to just get a new and better car. Such is the case with breast implants.

"Which is safer- saline or silicone?" Well, the answer is that both device have proven safe and effective. That is why the FDA has re-approved silicone implants and saline implants remain on the market. The previous belief that silicone implants cause auto-immune disorders and systemic problems has proven untrue in clinical studies. If your silicone implants rupture, there is a chance that the silicone can travel regionally to the level of your axillary lymph nodes (similar to the path that cells travel in breast cancer) and cause silicone granulomas or axillary silicone granulomas. These are typically permanent. Also, women can expect to potentially require an MRI study to adequately diagnose a ruptured silicone implant and/or properly assess their breast tissue for pathology, and therefore must be prepared for this possible eventuality.

"Which do you recommend… saline or silicone implants?" Well, this question is again based on each woman’s preference. If a woman is at all fearful of the potential sequelae of ruptured silicone implants, then saline remains a very safe choice. However, typically women who emphasize a desire for very "natural looking and feeling" breast implants will more likely be more satisfied with silicone devices as their shape and texture mimics actual breast tissue. Thus, I recommend both saline and silicone, and the choice is solely up to the woman choosing her implants.