Silicone vs saline after mastectomy

Women who have breast reconstruction after cancer surgery tend to be happier with the cosmetic results of silicone implants than with saline, a study published online in Cancer suggests.

In 2006, the Food and Drug Administration (FDA) approved widespread use of two brands of silicone gel-filled implants for breast reconstruction and cosmetic breast augmentation.

Surgeons have long held that silicone implants produce better cosmetic results than saline-filled varieties. But it's not been clear what patients think, said Dr Colleen M. McCarthy, a surgeon at Memorial Sloan-Kettering Cancer Centre in New York and the lead researcher.

Dr McCarthy and her colleagues surveyed 672 women who'd undergone breast reconstruction after a mastectomy at one of three centres.

More women take saline

Of the 482 women who completed the study, 306 had received saline implants and 176 silicone implants.

Overall, the researchers found, women with silicone implants had higher scores on a questionnaire designed to gauge patients' satisfaction with the look and feel of their breasts after breast surgery.

The difference in scores didn't indicate that women were unhappy with saline implants. "These women were still very satisfied with saline implants," Dr. McCarthy said.

However, she also pointed out that the difference in satisfaction between the saline and silicone groups was similar in magnitude to the difference between women who had received radiation therapy for their cancer and those who had not.

Women who'd received radiation tended to be less satisfied with their breast reconstruction  which, Dr. McCarthy noted, isn't surprising, given their higher rate of implant-related complications like capsular contracture.

The bottom line for women facing breast reconstruction, according to Dr. McCarthy, is that "it's likely that they'll like the look and feel of silicone implants better."

Still a personal decision

Still, the decision on reconstruction is a personal one. If a woman does decide to go with an implant, then the question is whether she is comfortable with the idea of a silicone implant, Dr. McCarthy said.

Silicone implants can cost twice as much as saline implants, a difference of about $1,000 (about R6,800) per implant.

There are no known significant differences between saline and silicone implants in risks of complications like capsular contracture, breast pain and changes in nipple or breast sensation, according to Dr McCarthy.

Main difference between the two

The main difference, she said, is that, if the implant does rupture, it will be obvious with a saline-filled one because the implant will quickly flatten. The implant shell can then be removed and replaced.

With silicone implants, a rupture in the shell will more often than not be unnoticeable because the device does not "deflate," although the gel can leak into the space surrounding the implant. While evidence suggests that the leaking gel is not connected to serious disease risks, it may eventually lead to scar tissue build up and pain in the breast.

The FDA recommends that women have an MRI every two years, beginning three years after surgery, to detect any ruptures, Dr. McCarthy pointed out.

Women need to consider the need for repeated MRIs, which may not be covered by insurance, in deciding on an implant type.

In addition, the long-term safety of silicone implants is still under scrutiny. In approving the two silicone implants currently on the market, the FDA required that the device makers, Allergan and Mentor, conduct a 10-year post-approval study of about 40,000 silicone-implant recipients to track complication rates and patients' compliance with the MRI recommendations.

Dr. McCarthy said that further innovation in breast implants is still needed. One device now under study is a so-called "gummy bear" implant, a cohesive silicone-gel implant designed to be more resistant to leaks should the shell rupture.

None of the researchers on the current study report any financial conflicts of interest.

(Reuters Health, Amy Norton, November 2010)

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