Déjà Vu: Silicone Breast Implants Have A Complicated History, But Are They Safe Now?

This summer, The University of Texas MD Anderson Cancer Center's Plastic Surgery Department released the results of the largest-ever study of women with silicone breast implants. The goal of the study was to evaluate whether the rate of certain autoimmune and other chronic disorders were more common in women with silicone implants than in the general population. Although the study had some weaknesses that made the results somewhat uncertain, there was a strong suggestion that there might indeed be a link between the two.

The History

In the 1990s, silicone implants were highly scrutinized and thought to be the cause of connective tissue disorders. After numerous patient complaints and documented illnesses, they were taken off the market in a historic moratorium that lasted until 2006. When silicone implants came back on the market after being cleared by the authorities, they were indeed new and improved. Better shells, softer gels, and eventually the gummy revolution led to great strides in implant technology. Today, hundreds of thousands of women worldwide have silicone breast implants, and the number grows yearly.

My experience with silicone implants:

When I was in training to become a plastic surgeon, I performed many breast implant procedures—both cosmetic and reconstructive. At the time, there was only one design option for saline implants, which mostly felt like water balloons. It was pretty well-established that silicone, with its soft jelly-like texture and gentle contour, offered a far more natural look and feel. We were taught that these implants should be periodically monitored for rupture, since a ruptured silicone implant often looks and feels no different than one that is intact. But there was not much concern for general wellness in these patients. Plus, the aesthetic benefit seemed to far outweigh the apparent risks or inconvenience of monitoring. When I started my practice, I knew I would focus on breast surgery as a specialty, and I experimented with the different implants available on the market. My patient base evolved into a group of very aware and motivated women, highly active and pressed for time. We talked about silent rupture and routine MRI maintenance, as well as the fact that free silicone was not what anyone wanted in their body. We also discussed the age old question: “Do I have to replace them every ten years even if they feel okay?” There was no easy answer to that question. Still, the silicone almost always won the touch test, and with little evidence that these implants were actually bad for you, that's usually the option we went with.

My perspective has evolved.

In the last few years, I've performed many implant revisions. I've taken out implants anywhere from 5-46 years after placement. With this experience, I've personally witnessed what happens to an implant after all of that time. I've also performed several surgeries on women who had implants described as “clearly ruptured” on MRI, who actually turned out to have no rupture after all. These experiences create a lot of perspective. I no longer tell patients “If they're not bothering you, leave them alone,” as I had been taught. And I no longer expect that the MRI has the answer; I trust my exam and clinical judgment. Plus, I do my best to take my patients’ lifestyle and personal comfort threshold into consideration. I treat the patient, not the problem.

Are silicone implants truly dangerous?

The question of whether or not silicone implants are actually dangerous remains a challenging one to answer. I have had patients tell me that they "just felt better" after removing their implants. I've also heard many stories of vague symptoms emerging after an implant ruptures (and before it gets cleaned up). I have reviewed the data, both on the original moratorium, and on today’s emerging evidence. One would argue that where there’s smoke, there’s fire, but we still don’t have definitive proof of what the problem might be nor how deep it runs. Over the years that I have been personally debating with myself about saline vs. silicone, I always imagined that if there were a saline implant that looked and felt comparable to silicone, it would be very welcome in our community. The Ideal Implant, with a structured multi-chamber design, saline fill, and perky contour, provides that low-maintenance possibility. No MRIs also means less time and money chasing potential implant-related problems. For most of my patients these days, that is the answer. For others, silicone still wins out based on a slight difference in feel. I've always believed that when it comes to making an informed choice, knowing all of your options is key, so I offer everyone both, along with my personal recommendations on a case-by-case basis. Overall, breast implant surgery has an extremely high satisfaction rate, and when done properly, the results can be fantastic. Most patients report feeling “balanced” and “feminine,” in a way little else could provide. But the decision to put something into your body is an important one, and the more information you have, the better. Consider issues like short- and long-term maintenance, possible complications, and the costs of monitoring. Even choices like whether to put the implant above or below the muscle can significantly impact your overall surgical experience, as well as the long-term result. Think about how those issues fit into your lifestyle. Know your options. Everything in life has its trade-offs, and breast surgery is no different.

Where we are now:

As of 2018, we've made great strides in terms of technology. Saline no longer looks different from silicone, and silicone now has multiple levels of cohesion (or gummy-ness) allowing for less leakage even in the case of rupture. But the general “ickyness” factor associated with all of the unknowns, and the fact that we’re still (and again) talking about possible systemic disease or chronic illness associated with silicone implants remains concerning. The truth is that if it were me, I wouldn’t want a ruptured implant in my body. I also wouldn’t expect to keep the same implant over an extended period of time without having some kind of issue with it. And as a woman, I also know that sometimes not feeling well is hard to explain and even harder to prove. Now, over 20 years since the last debacle, we’re still trying to figure out if silicone implants are in fact completely safe. Everything we learned from the last investigation seemed to check out, but with many of the same kinds of complains resurfacing recently, the case seems to be slowly reopening. As a surgeon, I try to keep current with the latest data so I can accurately represent the facts. As a woman, I always consider what I would want someone to tell or offer me if I were the one having the consultation. As a patient, I weigh the risks and benefits of every choice I make, and what it might mean in the future. And as a physician, I have to feel good about what I did for someone today. Medicine is an ever-evolving practice of never-ending discovery, and the breast implant journey appears to be far from over. Image from Dear Sam.  

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