As I have learned, recovery from FBC comes in stages (tsunami waves may be a more appropriate description for me). The next step on my FBC journey is surgery to exchange my expanders to implants. I’ve been avoiding this surgery for, well, as long as I possibly could. Now, however, it’s time to deal and deal again I/we will.
Why have I been in avoidance mode you ask? Well I believe that it is related to the muscle memory developed from my double mastectomy and reconstruction during which I initially had non-existent pain management which extended my recovery and delayed starting chemotherapy. See what I mean about avoidance?
After doing a lot of research & talking with many doctors & surveying lots of women who have had this procedure done, I’m still feeling indecisive. Indecisiveness is not how I usually roll, which is making me a tad edgy. I think that the indecisive edginess goes right back to the aforementioned nasty muscle memory. The bottom line is that I just don’t want to go through another surgery. However, as we say to our daughter a/k/a Sweetly Six, “It’s not a choice.”
The surgery is on February 21st and I need to decide whether to have saline implants or silicone (gummy) implants.
Below is some of the research that I have compiled to help me navigate this confusing maze.
Implants are named according to what fills them. In other words, saline implants are filled with saline (sterile saltwater), and silicone implants are filled with liquid silicone gel, which has the consistency of molasses.
Regardless of what breast implants are filled with, they all have a solid silicone shell. Solid silicone, or silastic, has been implanted in millions of people in pacemakers, artificial joints, heart valves, penile implants, and artificial lenses for the eye. Solid silicone is a very different substance than silicone gel, which fills silicone gel implants.
It is helpful for me to think of breast implants as being similar to balloons. A balloon may be filled with water, helium, or air, but has the same pliable plastic outer layer regardless of what is placed inside.
Silicone Gel Implants: Pros and Cons
The advantage of silicone gel implants is primarily aesthetic: they look and feel so soft and natural that they typically cannot be distinguished from breasts without implants. They also have a lower rate of rippling and wrinkling. Also, because silicone is lighter than saline, the risk of downward displacement due to gravity is lower. In other words, they don’t droop as much.
There are disadvantages of silicone gel breast implants. They impose a higher cost (by about $900- $1000) and a longer scar. The longer scar is necessary as silicone gel implants are pre-filled by the manufacturer, so they must be able to fit through the incision. In general, larger implants require longer scars. This doesn’t really pertain to me because my scar is as big as it could get and I’m definitely NOT going with large implants (Silver Lining – sort of).
Also, the risk of capsular contracture ( an abnormal response of the immune system to foreign materials in the human body) may be slightly higher with silicone.
Finally, silicone gel implants might rupture “silently”, such that there is no outward evidence that a rupture has occurred. Physical exam by a plastic surgeon will identify only 30% of ruptures, whereas MRI will identify about 90% of ruptures, so women with silicone gel breast implants may have to get MRI scans. The FDA recommends routine MRIs for women with silicone breast implants, but this is not consistent with all plastic surgeons.
Gummy Bear Implants
The two main silicone gel implant manufacturers (Mentor & Allergan) tout that their silicone gel breast implants are made with cohesive silicone gel. Being cohesive, the gel supposedly has a tendency to stay together rather than disband in the event of a rupture. They have been likened to Gummy Bears, the soft candy that feels as though it is filled with liquid, but which has contents that do not run out if cut open.
There are varying degrees of cohesiveness in the silicone gel implants. Type I are the least cohesive and are used to make round silicone gel implants. Types II and III are referred to as Gummy Bear Implants and considered to be more cohesive meaning that they hold the shape into which they were molded. As such, they tend to feel more like natural breast tissue while offering great breast shape. Currently these implants are being tested across the United States in clinical studies. They are not yet widely available for use.
Saline Implants: Pros and Cons
A key advantage of saline breast implants is the filling itself. Very similar to natural body fluids, saline is easily and harmlessly absorbed by the body should an implant rupture. And since the implant deflates, it’s easy to tell when a rupture has occurred and replacement is needed.
Saline implants are filled after placement into the breast pocket. This generally provides the patient with a slightly smaller incision and scar compared with pre-filled implants. In addition, because the implants can be filled with different amounts of saline once placed, our surgeons are able to precisely tailor the size of each implant in an effort to avoid breast asymmetry.
Finally, the cost is lower (by about $900-$1000 per pair of implants), and there is no need for MRI, as silent rupture is not a concern. If a saline implant shell ruptures, the saline generally leaks out and is absorbed by the body within a day or so, resulting in an obviously smaller breast.
Disadvantages of saline implants are mainly cosmetic. Women are far more likely to report being unhappy with the way saline implants look, as they occasionally result in rippling and wrinkling. Some women believe this implant type does not feel like natural breast tissue, and occasionally patients complain of being able to hear “sloshing” of the solution inside the implant. A cosmetic as well as functional concern is increased saline implant deflation rates over time. Deflation requires surgical correction, though if deflation occurs, saline is harmlessly absorbed by the body and poses no health risk.
This is exactly how my expanders feel (& have felt since the original surgery). And the Silver Lining is that I’m completely used to it. Another Silver Lining to the “stiffness” is that I don’t have to wear a bra, which is awfully nice, I have to say.
Another disadvantage to large saline implants is that they have a higher rate of downward displacement than silicone, as they are simply heavier than their silicone counterparts. Now, I don’t know if I would have that issue since I’m not going for the large ones. Hmmmm….
The Bottom Line
By all accounts, the best way to decide whether to have silicone or saline implants is to first decide which issue or issues are most important to you. For example, if it is most important to look and feel natural, then choose silicone. I have to say that it’s awfully interesting to contemplate feeling “natural” now. Is feeling “natural” possible after having both breasts removed and knowing that whatever I choose will be an unnatural material? Perplexing to me.
If you instead want lower cost, shorter scar, lower rate of capsular contracture, and no need for MRI, then choose saline.
I’m leaning toward saline based on the aforementioned as well as my plastic surgeon’s description of both: “total safety of saline filled implants versus a (maybe) more natural ‘feel’ of silicone gel.” If I have learned one thing during the past year, it’s that Murphy’s law is absolute with me, which is why I’m now heading toward saline.
For those of you in a similar position of having to choose, first of all, I’m sorry. FBC. Secondly, in addition to considering the advantages and disadvantages of both kinds of implants, it is also important to realize that the best plastic surgeon to advise you is the one who has access to BOTH the silicone gel and the gummy bear implant–making sure that he/she has no set allegience to either. It’s just one of those things that, unfortunately, you have to ask. Silver Lining: now you KNOW to ask it!
Now it’s time for some more Silver Linings:
- Writing this post (& articulating pros and cons of my options) helped me move forward in my decision-making process.
- This is the LAST surgical step for me.
- Though I will have general anesthesia for the surgery, I will not have to spend the night in the hospital.
- By all accounts, recovery from this surgery will not be as bad as the original surgery. YAH!
- Though I will have to suspend all workouts for 4-6 weeks, I’ll have more time to focus on writing!
I’d love to hear your thoughts, opinions and about your experiences!