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Patients weigh in on silicone gel vs. saline breast implants
Online survey compares implant device satisfaction

Heather Kent

Vancouver, British Columbia -- Results from an online survey of the experiences of women with breast implants suggest that overall, silicone gel implants are somewhat comparable to saline implants--although for natural feel, silicone scored higher.

According to C.B. Boswell, M.D., a practitioner in St. Louis and one of the study's authors, women with both types of implants expressed high levels of satisfaction with their procedures. The studies were funded by the Aesthetic Surgery Education and Research Foundation and were carried from 2001 to 2002 in all U.S. states and most Canadian provinces.


The primary online breast augmentation survey of women with and without implants was posted on for six months. Some 2,273 women with implants and 1,736 without implants responded to the 177-question survey. The responses of the women who had received implants were compared with those of women considering the procedure.

Variables studied included why women undertook the procedure, satisfaction with body image, breast pain, prevalence of pregnancy and nursing, smoking and drinking frequency, reasons for revision surgery, association of certain diseases with silicone gel implants and demographics.

Nearly 14 percent of the women had gel implants and 86 percent had saline implants.

"Women with saline implants were much more likely to say that augmentation with saline implants completely met their expectations--51 percent of the saline group versus 41 percent of the gel group, on a 1-to-4 scale," reports Dr. Boswell. "However, the statistical difference disappeared when we looked at the top two groups (mostly and completely satisfied--88 percent for saline and 85 percent for gel). Another way that we looked at patient satisfaction was to see if patients would recommend augmentation to their friends and family. Overwhelmingly, patients would recommend breast augmentation (95 percent of saline and 90 percent of silicone gel implant recipients).

Some 13 percent of the respondents had undergone at least one revision surgery, and women who changed their initial saline implant for a gel implant expressed much higher satisfaction on all measures than the gel-to-saline group.

There was no significant difference in breast pain frequency in the two groups.

Tactile marks

"The area where the silicone breast implant was substantially better than the saline-filled implant was when the patients rated the feel of the breast," Dr. Boswell notes. On a 1-to-5 scale, with 5 representing a natural feel to the breast, gel implants were significantly more likely to achieve this level. The same response also occurred with the level 4 ranking.

Pain, discomfort

Another group of 1,700 women who had never had breast augmentation were compared with a gel implant group who were about 10 years older, on joint pain, muscle aches and weakness, fatigue, dry eyes and mouth, and numbness and tingling.

"What is really interesting is that the group of women who had never had any implants--1,700 women--were much more symptomatic than the implanted group. And this was statistically significant in all nine symptoms that were compared," Dr. Boswell says.

In the augmented group, joint pain, joint swelling, muscle aches and dry eyes were all more prevalent in the pre-augmentation phase than post-operatively. Joint pain, joint swelling, muscle aches and fatigue occurred twice as often in the gel group as in the saline implant group.

The women were also asked, in an open-ended question, what they thought caused the symptoms they had reported. Of 378 respondents, only 14 with saline implants and two with gel implants attributed the symptoms to their implants. Others gave reasons such as injuries, fatigue, job stress and medications as possible causes.


The researchers also investigated diseases associated anecdotally with silicone gel implants.

As the gel implants were almost five years old, as compared with the saline implants that were approximately one year old, the data needs to be interpreted with caution, advises Dr. Boswell.

The following diseases were considered:

rheumatoid arthritis




Sjogren's syndrome


Although women with gel implants showed a higher association with rheumatoid arthritis, osteoarthritis and fibromyalgia compared to the women who had never had implants, there was no statistical difference between the two groups of implant recipients.

"What this suggests is the gel implants probably do not cause these diseases, as has been suggested, nor do they cause physical symptoms that have been associated with gel implants," says Dr. Boswell.

Reoperation data were difficult to compare, because 25 percent of the women changed their implant type, some as many as four times, says Dr. Boswell; 36 reoperations were in the saline group and 24 in the silicone group.

The 56-question online follow-up survey for women with implants received 1,350 respondents.

"The group of women with gel implants was much more likely to be denied health insurance. We do not definitely know why the patients were denied insurance, but it is our impression that it is due to the litigation associated with silicone gel implants," Dr. Boswell notes. This was the case for 25 percent of the gel group.

The survey found that informed consent occurred more often in the saline group, which probably reflects their more recent surgery, compared with the gel group; 45 percent of the women missed follow-up appointments with their doctors because they were not having any problems. However, if they were experiencing problems, they usually did return to their doctor, says Dr, Boswell.

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