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This is Dr. Salzberg with insights and perspective for you on the use and safety of silicone breast implants:

There’s been much discussion surrounding use and safety of silicone breast implants over the years, and the information can certainly be confusing! Are they safe? Do they rupture and how can you tell? Do silicone implants increase your risk for autoimmune diseases? Do they need to be replaced at some point? How do they feel? So many questions, and frankly the answers aren’t always straightforward.

I would like to take a minute to provide some concise and accurate information so that women feel more confident in the decisions they make when having breast surgery involving the use of implants, whether cosmetic or reconstructive.

Much of the confusion over silicone implant safety stems from when FDA ordered manufacturers to take them off the market in 1992 and required additional research by unbiased plastic surgeons to make sure that leaking silicone implants were not causing autoimmune disorders like lupus, scleroderma, fibromyalgia or rheumatoid arthritis. During this time, breast cancer patients were allowed to receive silicone implants for post-mastectomy reconstructive surgery and research protocols. After 14 years of research, the experts concluded that there was NO causative relationship between ruptured implants and these autoimmune disorders. The use of silicone implants for breast reconstruction and cosmetic purposes was re-instated by the FDA in 2006.

Silicone implants are overall very safe, and in fact have been improved since returning to the market. The outside shell is more stable and less likely to rupture, and the internal silicone is in a more stable form. “Memory gel” implants, as well as “form stable”(also known as “gummy bear”) implants, offer silicone that is more cohesive and less viscous i.e., it will not “run out” of the implant even in the unlikely case of a rupture.

As far as mammography and breast follow-up, radiologists are very accustomed to reading mammograms for women with implants. Many times an additional view of a breast is requested, but surveillance for breast cancer should generally not be a problem with silicone implants. Additionally, many implants are placed behind the pectoralis muscle, so the implant is in a completely different tissue plane that the actual breast tissue. Even when implants are placed sub-glandularly (on top of the pectoralis muscle), they are behind the breast tissue and easily differentiated on mammography.

Silicone implants are also unlikely to rupture. The companies state that it is reasonable to expect to change your implants within 10—12 years, but as long as they remain soft, don’t change shape, become hard or cause any discomfort, we leave them alone. In fact, we have lots of patients at our practice that have had the same implants for 20+ years before needing them replaced. Activities of daily living — even kids or dogs jumping on you — won’t rupture implants, and they can even take the underwater pressure of scuba diving without damage!

So how do you tell if the implant is ruptured and needs to be replaced? Some women will be made aware when it’s seen on their yearly mammogram. We usually counsel patients on their options and then they decide if they would like them replaced. If the breasts are soft and the patient is not having any symptoms, they do not have to replace their implants. They may simply choose to do so if the patient has had her implants for a while or desires a change in shape or size.

Another scenario is a patient who has had implants for 10+ years and tells us that over the last 6 months or so she’s noticed one breast feels slightly firmer and may sit a little higher than the other. This is an indication that the implant may have ruptured and her body is reacting by tightening the tissue around the implant. Ultrasound and/or MRI can confirm, and if necessary the implants can be replaced in a simple outpatient procedure. There is no reason to have a yearly MRI or any routine testing on your implants – we just recommend you see your surgeon yearly for a quick check up.

What’s the difference between silicone and saline implants? Saline tends to feel firm like a water balloon and is more likely to show contour irregularities like rippling, while silicone feels soft like real breast tissue and is less likely to ripple.

It’s important to have any of your concerns properly addressed by your plastic surgeon when deciding on the use of an implant in breast surgery, but hopefully this gives you some background knowledge and a foundation from which to focus your questions and discussion.

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