Breast augmentation surgery is one of the oldest cosmetic plastic surgeries. Even though the principles and methods of breast augmentation surgery have not changed apparently, but the improvement of the two prosthesises, which are inserted into breast has been continuously developing. From the earliest filling water bag to silicone liquid-filled, to the latest well-known silicone gel-filed breast implants; the various products make people dazzled. However, could you really understand the difference between these alternative materials no matter you have listened to the explanation from your doctor or have searched the information on the Internet? Do you completely understand the effects and the possible problems causing once this implant material is placed into your body? The above topics which are often discussed by many people does not seem to correlate with the surgery at all, but it is important to understand as well as consider carefully about the solemn issues before making a decision for breast augmentation surgery.

Actually, the so-called water bag and silicone implant are both coved by a layer of thin silicone compound. The only difference between them is the filling material. The thickness as well as the material of the outer bag influences the durability of the outer bag which is the most important factor for implant. Nowadays, the famous- brand manufactures significantly enhance the outer bag in order to prevent any possible rupture or leakage of the outer bag after a considerable period of time. On the other hand, the consumers would feel harder with the stiff thicker outer bag, sometimes, they could even touch the edge or fold as well. As regarding to the filling materials, water bag is filled with normal saline water by the surgeon during the operation. The amount of water filled depends on the size of bag, which only allows a standard capacity of less or more 10~15cc water to be filled by the surgeon to reshape and adjust the aesthetic appearance of breast. What we all know as silicon gel, which was improved to the cohesive gel form these years, is a type of silicon. The silicon gel is not easy to break or leak which could avoid filling the body or being absorbed by the body. However, many doctors worry about the difficulty of post surgery tracking as the characteristic of silicon gel is that it will remain its solid state even after it ruptures. Until now, FDA doesn’t approve silicon gel-filled breast implants; our government also prohibits this material in the market. Regarding when it will get the approval is still uncertain, some say probably at the end of this year, but who knows!

Regardless with the authorization for silicon gel, let’s discuss about what side effects that may occur on the human body? I, the author, must explain firstly that it is 100% safe for both the water bag and silicon when there is no leakage or rupture on the outer bag. The question is even though manufacturers claim their products will last forever and there is no need to remove it later on, the implant still has different durability that depends on the individual’s condition. Furthermore, surgeons can’t guarantee the filling bags will last for over 20 or even 30 years without any natural leakage or breakage caused by external pressure. Therefore, as long as the potential possibilities and worries exist, the safety for the filling material must be confronted and explored. Regardless with the authorization for silicon gel, let’s discuss about what side effects that may occur on the human body? I, the author, must explain firstly that it is 100% safe for both the water bag and silicon when there is no leakage or rupture on the outer bag. The question is even though manufacturers claim their products will last forever and there is no need to remove it later on, the implant still has different durability that depends on the individual’s condition. Furthermore, surgeons can’t guarantee the filling bags will last for over 20 or even 30 years without any natural leakage or breakage caused by external pressure. Therefore, as long as the potential possibilities and worries exist, the safety for the filling material must be confronted and explored. The filling material in the water bag is saline water which is compatible with the human body; it will be absorbed by human body once the water bag ruptures. Besides, the patients will be warmed by the rapidly shrinking breast, and replaced a brand new water bag by their surgeon without any problem. For the silicon, the problem is more complicated, since the gel character makes it maintain the fundamental shape without shrinking, even though we press it hard. It is an improved material; however, it actually influences the self-examination for detecting the problems of leakage and rupture. In other words, you won’t perceive it when the silicon bag begins to leak; you don’t even feel any abnormalities until the surgeon detect the problem. According to my experience, many patients are then aware of the problems after the silicone has been leaking for years. I have some cases that the patients had a broken silicone implant for 10 years, more than half of the silicone was absorbed by their body, and the remaining silicone turned to dark yellow after contacted with the body tissues for a long time. In addition it appeared calcified spots and sclerosis in their aponeurotic fascia. Although there is lack of evidences that silicone would cause cancer or induce mutation, but retaining silicone in human body for a long period of time will lead to topical Siliconoma, the calcification which influences breast cancer screening or causes some normal symptoms such as headache, arthritis, etc. The worst, it may induce the systemic autoimmune diseases. Besides, it is difficult to remove the leaking silicon out of body completely; many doctors therefore adopt a more conservative attitude towards silicone breast implants.

Since silicon is not 100% safe, then why so many women are still eager to undergo silicon implants? Putting it into simple terms, the filling density of silicon is much higher than saline water. When touched, the feeling is comparable to the real breasts and skin tissues. Also, it can prevent formation of water ripple or the sound of water created by traditional saline water bags. With regards to the smaller and skinner Asian women, using silicon can prevent from being embarrassed or situated in a difficult position when found out that a breast augmentation was done. However it is not all accurate. If massages are not done frequently after silicon implant, the chance for the edge of the bag to be felt is still possible. In addition the filling of the silicon is built in, thus it is more bouncy and flexible (some may say more resilient) than water bags. However, after being implanted into the body, some people may feel that it is harder or unable to sway easily. Conversely, water bags will feel softer as it is made with water, and it is able to fluctuate more. Therefore, both materials have its pros and cons, I can only summarize briefly below what type of material is suitable for what type of patients groups.

Patients suitable for saline water bag implants:
1. Implanted via under the pectoralis major muscle
2. Average weight person or have thick subcutaneous tissue
3. Safety is your first priority
4. The required breast size is not very big
5. Possibility for breast feeding after pregnancy in the future
6. High risk profession, such as extreme sports, car racing, horse racing, kick boxing etc...
7. With a family history of autoimmune disease
8. Concerned about being discovered a breast implant has been done due to an obvious scaring

Patients suitable for silicon gel implants:
1. Implant via under Mammary Gland (under fascia)
2. Too skinny or thin subcutaneous tissue
3. Priority is for surgery not being discovered
4. The required breast size is too big
5. Breast reconstruction after mastectomy
6. Able to co-operate with the surgeon to have a check up each year

According to the brief classification above, generally you can understand what kind of implant material is most suitable for you, but it is still recommended to follow your surgeon’s professional suggestion. Also there are some suspicious concepts regarding these materials, I would also like to take this opportunity to explain and correct the miss understanding as well.

1. Silicon gel implant has fewer chances for capsular contracture?
This is wrong, because no matter if it is silicon or saline, the material of the bag is all the same, and capsular contracture can only be overcome by daily massages. It has nothing to do with the material of the implant fillings.

2. Will silicon implants look more natural?
This point is also not necessarily true. It depends on the space and the flexibility of your own skin tissues and also its thickness. The biggest advantage of silicon gel is that its density is quite similar to actual breast tissues; therefore it is not easy to distinguish or discover the range of the bag.

3. Silicon implants are more likely to form a water drop shape
This point is wrong as silicon gel and water bags will all drop downward because of weigh. Both will form the shape of water drops but the only difference is whether the lower breast tissues has enough loosen space for the breasts to drop downwards. Thus, after surgery massages and constraining the upper bra band are very important. Especially for patients that have the implant under the pectoralis major muscle need to massage more frequently, this will help having water drop shape breasts. Thus, material of the implants has nothing to do with effecting the formation of water shape breast.

4. The edge or fold of the bag cannot be detected with silicon implants?
This point is for sure because the density of silicone is very similar to human breast tissue, therefore, it is hard to feel the folds of the bag or detect from the two sides of the breasts. But this is directly related with the post surgery massages. If massage is done well enough and properly then bag edges will not be touched, if done improperly, then the bag edges of silicon implants could possibly be seen.

5. The breast is more bouncy with silicon implants?
It is actually the opposite. Once the saline sways, the water bag will easily sways as well, this causes the breast to bounce. On the contrary, silicon implants gives a harder feeling. However, whether the breast will bounce or not, it still depends on the space and post surgery massages. Material is just one of the reasons.

Generally I would recommend females with silicon gel implant to get an ultrasonic breast check ups at least once every year to confirm the entirety of the implant bag. Whether there is a rupture of leakage in the outer bag or not, everything can be clearly seen with ultrasound. This process does not cost you much time or money; it is actually the most convenient tracking method that everyone should use. Once signs of leakage are discovered, it should be removed as soon as possible. Besides, younger patients should not get silicon implants as prolonged usage will increase the possibilities of leakage in the future. Especially for patients who have their implants under the aponeurotic fascia or under the mammary gland needs to be very cautious with tracking. Otherwise any leakage occurs, the neighboring mammary gland could possibly absorb the silicon. This is harmful to breast feeding process in the future.

The current breast augmentation techniques are so advanced already that breasts can be shaped so naturally which makes it hard to differentiate it from real. In some cases not even cosmetic surgeons can tell which is which just by looking at it with bare eyes. Therefore, the material that is being implanted should not be the main concern anymore. Instead patients should consider carefully about its safety standards and durability of the material being implanted. After rational thoughts about your requirements, then discuss with the surgeon. Surgeon should communicate and explain sincerely with patients based on surgeon’s professional understandings instead of influencing patients on decision making. Only this way, both parties, surgeon and the patient, can be satisfied. Furthermore, before silicone gel-filed breast implants can be legally used, any surgeon performing this type of surgery and patients getting this implant will both be held responsibilities for any legal issues. If you are concerned about post caring process and risks of your breasts then saline water bag is the safest and the best one to choose.