Saline breast implants were added to the armamentarium of plastic surgeons in 1968. It would take years and the removal of the first-generation silicone implants from the market in 1992 for the technology of the saline filled prosthesis to become a viable alternative.
The thickness of the silastic shell was the first problem along with the unnatural feel and the audible “swoosh” reported by women. Eventually, a reliable shell was developed and overfilling of the implants became commonplace to improve the palpable rippling that tends to occur over time due to an evaporation-like effect of the saline solution. This loss of volume causes the shell to collapse thus creating the rippling and is very common. Saline breast implant rippling is often observed around thinner areas of the breast.
The problem with rippling was never corrected and continues to occur with virtually all saline implants as they age. Rippling in saline breast implants is the most common cause for replacing implants for correction (breast augmentation revision).
Today, much more technologically advance silicone breast implants are available with a more natural feel and with improved ability to maintain their shape once placed in the body. These implants come in a variety of anatomical shapes, and projections with at least three different stabilities. The stabilities refer to the implants ability to maintain their breast-like shape in the body. The most “form-stable” made by Allergan’s Natrelle is called the “gummy bear” implant whose feel has been likened to a soft gummy bear candy.
Once a breast implant has resided in its pocket, usually beneath the pectoralis chest muscle for at least six months, the pocket becomes stable and rarely changes over its lifetime unless a capsular contracture occurs (<5%). The loss of saline volume and rippling effect often gives the breast a saggy appearance but doesn’t always indicate the need for a breast lift procedure in conjunction with implant replacement. In most cases, breast implant replacement with the gummy bear implant can fill-up the implant pocket and lift the breast back to a more desirable shape.
The painful part of the first breast augmentation usually results from the creation of space where there previously was none. In a word, making the initial sub-muscular pocket at surgery hurts when filled with a breast implant. Fortunately, once the pocket is made and is satisfactory in shape, taking an implant out and replacing it with a new silicone variety requires very little investment in pain. In fact, it is such an easy recovery that we have called it a “Tylenol recovery.”