PURPOSE: Breast cancer is the most common malignancy among women in North America and Europe with incidence rates exceeding 90 cases per 100,000 years.  This presents with a lifetime risk of 1 in 8. Greater than 30% of women still receive a mastectomy for treatment of breast cancer and if this is improperly reconstructed, it may leave the patient with a poor body image.  Surgical options and results are largely dependent on the extent of surgical intervention involved in the mastectomy, the state of the opposite breast, the condition of the overlying skin, the quality of the retained muscle, the availability of donor tissues and the ability to endure a long surgery and/or post-operative course.  Implantation of a prosthesis is the most frequent of the reconstruction techniques.
Implant reconstruction is based on a two staged procedure, initiated by placement of a tissue expander, followed by replacement with a permanent implant.  Both silicone and saline implants have been approved for placement in the postmastectomy reconstruction patients.  There remains a paucity of data comparing outcomes of saline and silicone implants in women after breast reconstruction.  A single surgeon's experience with expander/implant breast reconstruction provides an opportunity to critically evaluate these outcomes in a uniformly treated patient population

METHOD: A retrospective IRB approved chart review was performed on 132 patients following breast reconstruction for mastectomy defect using permanent saline or silicone implants. All procedures were performed by the senior author at Wake Forest University Baptist Medical Center, between 1986-2006.  Complications and re-operative events were identified in the immediate and long term follow up period after placement of the initial implant. A complication is defined as any of the following: rupture of implant, hematoma or bleeding, infection, clinically evident seroma, chronic pain, extrusion, leakage, nipple-areolar necrosis, and wound dehiscence.  The rate of capsular contraction and the need for re-operation for capsular contraction was also noted.  This study compares the difference between saline implants and silicone implants.  In addition, patient satisfaction was analyzed between the two groups. 
RESULTS: Data was collected on 132 patients and a total of 199 reconstructed breasts. 118 breasts were reconstructed with silicone prosthesis versus 193 with saline prosthesis.  The overall complication rate for saline prosthesis was 16.5%, while for silicone prosthesis it was 8.5%.  Rates for capsular contraction were : 16 % (saline) versus 13 (silicone) % ;  infection rates were 5 (saline) % versus 1.6 (silicone) %; rupture rates were 2 (saline)% versus 3 (silicone) % ; re-operation rates 39 % versus 22%.  No statistical difference was noted between saline versus silicone except the rates of re-operation.   
CONCLUSION: Tissue expander/ implant reconstruction remains a valuable option yielding high-quality aesthetic results. 

Our study confirmed previous experiences with the overall high rate of re-operations with tissue expander/ implant reconstruction
It also noted that there is no marked difference between saline and silicone implants in the reconstructed breast based on their complication profile.  Therefore, either saline or silicone can be used with a similar complication profile