" Answer: I have some ambivalence about the new gel implants. Although silicone gel implants always have been available for reconstructive purposes, a moratorium from 1990 until 2006 prohibited their use in cosmetic breast surgery. This was because of concerns that they caused a variety of illnesses. Further studies eventually put these fears to rest, but it may take decades to rule out all risks with certainty."

" In November 2006, the FDA lifted the moratorium. This would appear to be reason for plastic surgeons and their patients to celebrate, and a vindication of sorts, but things are not as simple as they might seem."

" The old implants contained a more liquid, runny gel. When these implants leaked or ruptured -- one of the known risks of implants -- the gel could migrate out of the implant pockets. Some associated problems include: contracture or hardening of the breasts, calcium deposits around the implants and lumps in the breasts. The new implants have a more viscous, or cohesive, gel. In some, you can actually cut the implant in half and the gel will not leak out."

" While this can be a plus, the newer implants have some disadvantages. They are not as soft as the old ones and they must be inserted through a longer incision. A saline -- or salt water-filled -- implant can be inserted empty through an inch-long incision and filled inside the breast. A new gel implant requires at least a 3-inch incision."

" Saline and gel implants each have advantages and disadvantages. Before surgery, the gel implants feel more like breast tissue. However, once inserted, the differences are much less obvious and both can produce very natural results. Although saline implants are more likely to leak over time, this is harmless to patients. They can be replaced easily. Gel implants are much more expensive. Because they
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