I see people for a wide variety of plastic surgery requests, but breast surgery is one of the most frequent reasons people visit my office. Breast surgery can take many forms — augmentation (increase in size), reduction, lifts or reconstruction after mastectomy.

During the initial consultation I have with patients, many people are surprised to learn that silicone implants are again an option for breast procedures.

After the implant was pulled from the market by the Food and Drug Administration in the early 1990s, silicone became a “bad word” and was associated with sickness and some diseases in women.

However, after years of research and close review of the product’s usage in Europe and in mastectomy cases (where silicone usage has continued since the ban), the FDA re-approved silicone implants in late 2006. The government body found no linkage between silicone implants and connective tissue or auto-immune diseases in women.

During the period that silicone was unavailable, saline implants became the norm for breast enhancement.

Saline continues to be a popular option for women, but the addition of the silicone implant provides greater choice for individual needs. The two options have different benefits and drawbacks including:

Natural look and feel. Many surgeons and patients believe that silicone implants look and feel more natural than the saline versions. They show less rippling and tend to feel softer. For this reason, when people have had a mastectomy or have very thin breasts (and therefore very little breast tissue to surround the implant), I often recommend silicone.

For people who have thicker breast tissue, saline implants can produce an excellent look and feel as well.

Side effects. If a saline implant ruptures, it’s obvious because the fluid absorbs rapidly and the breast deflates. The saline does not cause any local or systemic problems, but the implant needs to be replaced. The silicone gel is cohesive (like a gummy bear), and if the implant ruptures, then the gel does not tend to leak into the breast. Silicone implants that do rupture into the breast tissue also need to be replaced.

Both types of implants can form capsular contracture (scar tissue around the implant), but silicone tends to do this at a higher rate.

If this tightening around the implant is severe, the capsule and implant need to be removed and replaced. I tell all my patients that implants are not permanent, and replacement during their lifetimes is likely.

Cost. Saline implants are less expensive than silicone.

As part of the FDA’s re-approval of silicone, all women with the implants are recommended to enroll in a study and have regular MRIs to detect any leakage.

With some key differences between saline and silicone, I’m finding that while patients may be surprised by their increase in options, they are certainly happy to have them.

Dr. Todd Willcox is a board-certified plastic and reconstructive surgeon with Samaritan Plastic & Reconstructive Surgery in Corvallis. He can be reached at 541-768-4930.