Breast Implants are all make of a silicone shell (bag) and filled with either saline (salt water) or silicone gel. The silicone shell can be smooth, textured or coated. Different manufacturers use their own method to texture the surface and claim superiority over other implants. However, the evidence to support textured surface in reducing capsular contracture (hardening) is not conclusive. The only surface which is proven to significantly reduce capsular contracture is the polyurethane coating which reduces the risk to less than 1% compared to15% for textured surface implants.

Old silicone breast implants contained liquid silicone which was very soft but had a major problem in the amount of unbound (free) silicone. This allowed the free silicone to leak out (bleed) through the shell. It is this free silicone which causes capsular contracture as the body tries to protect itself against the silicone. Modern silicone implants use a cohesive gel which has virtually no free silicone. So there is almost no silicone leak and thus the risk of encapsulation is markedly reduced. The state of the art implants use a form stable cohesive silicone gel which is like a jelly. It is soft but keeps its shape, allowing the use in teardrop or anatomical implants. Saline implants are filled with salt water. These feel very soft and there is no risk of silicone leaking, but the saline does leak over time resulting in slow deflation of the implant. This unfortunately means that most saline implants will need to be replaced necessitating another operation with its inherent risks.

My goal with breast implant surgery is to do the right operation on the right patient and only do it once. It should not be an absolute that all implants will need to be replaced. Modern surgery with modern implants should avoid future surgery.