"There is certainly a role for silicone gel implants," Friedman says. "However, there are definite disadvantages relative to saline."
He says that since silicone implants are pre-filled -- unlike their saline counterparts, which are "pumped up" only once they are in the body -- the surgeon must make a longer incision to put them in.
Silicone implants are also about $1,000 more expensive, and their risk of capsular contracture -- a condition in which scar tissue around the implant makes the breast hard and misshapen -- is higher.
And on top of these considerations, some surgeons simply prefer saline.
"There are doctors who have always embraced saline implants, even when silicone was available years ago," Antell says. "We will not be discarding saline implants just because silicone has been approved."
He adds, however, that silicone is still an important addition to the range of options available to patients.
"The important thing is that there are more options available so that the informed patient can now make her own choice," Antell says. "Some will choose saline, and some will choose silicone."
Plastic surgery experts also say that the women who do choose silicone may not hold up their end of the deal with regard to strict screening regimens prescribed by the FDA.
One of the conditions that came attached to the approval of silicone implants is that manufacturers must conduct studies and follow-up of a projected 40,000 women over the next 10 years.
Part of this follow-up involves periodic magnetic resonance imaging (MRI) scans intended to detect the signs of implant rupture. Yet, Friedman says it is unrealistic to believe that every woman who gets silicone implants will actually get the prescribed scans every three years.
"Who will pay for this $1,000-or-more test?" Friedman asks. "Certainly not the FDA, the implant manufacturers, the plastic surgeons or the patients' insurance companies.
"Ultimately, this expense will fall upon the patients, most of whom will simply decline to undergo MRI."
"Most surgeons consider the FDA's recommendations of repeated MRI's unnecessary and onerous (and expensive)," says Dr. Brent Moelleken, assistant clinical professor of plastic surgery at the UCLA School of Medicine and a surgeon in private practice in Beverly Hills.
And Kawamoto says the monitoring guidelines imposed by the FDA make it significantly more difficult to get silicone implants now than it was before the moratorium.
"It is more difficult because they are more expensive and require more acknowledgment, and hence more paperwork, for the patient," he says, adding that all patients wanting silicone implants must also read a 60-page list of risks and considerations.
"Isn't 60 pages excessive?" he asks. "I guess not for governmental projects and legal disclaimers."
While some women continue to worry about the risks of silicone implants, surgeons say that all implants carry certain risks. Kawamoto says he stopped inserting breast implants altogether in 1982 because of the problems he saw associated with them.
Still, he says, some patients will still opt for the implants.
"The FDA has stressed that the implants are not totally safe," Kawamoto says. "Neither is buying and driving a car, which costs more, is more problematic and doesn't last as long as implants."
And many surgeons remain optimistic that more women are coming around to the idea of silicone once again.
"Women are less concerned overall about the safety of silicone gel implants now that numerous studies have not shown there to be a link between health problems and silicone gel implants," says Dr. Brent Moelleken, assistant clinical professor of plastic surgery at the UCLA School of Medicine and surgeon in private practice in Beverly Hills.
"Women nowadays tend to be better informed and don't rely on a single sensationalistic news story before making a decision."