Data story · ASPS 2007–2020
Silicone vs Saline:
The Implant Wars
On November 17, 2006, the FDA re-approved silicone gel breast implants after a 14-year restriction. What followed was the fastest consumer preference shift in surgical history — and then the BII movement stalled it.
35%→88%
Silicone share
2007 → 2018
11 yrs
To near-total
dominance
2006
FDA re-approval
after 14-yr ban
In 2007 — the first full year after re-approval — saline still held 65% market share. Surgeons had spent 14 years exclusively placing saline for cosmetic patients. But patient demand was immediate. By 2009, the market was perfectly split: 50/50. By 2018, silicone had reached 88% dominance.
Silicone Saline
No other consumer product in medicine has seen preferences reverse this completely, this fast. A 53-point swing in 11 years, in a product that requires invasive surgery to change.
The speed of the initial shift was extraordinary. Silicone gained 12 percentage points in a single year (2007–2008). By 2009, the market was perfectly split at 50/50. By 2010, silicone had a decisive 60/40 lead. That's a 25-point swing in 36 months.
65% → 88% silicone share
2007 to 2018
35% → 12% saline share
2007 to 2018
The silicone takeover followed a classic S-curve adoption pattern — rapid flip, steady consolidation, then a ceiling.
+25 pts
Phase 1: Rapid Flip
2007–2010
35% → 60% in 3 years
+28 pts
Phase 2: Steady March
2010–2018
60% → 88% in 8 years
−4 pts
Phase 3: The Stall
2019–2020
88% → 84% (BII effect)
The 2013 tipping point: Silicone jumped from 62% to 72% in a single year — a 10-point leap that suggests the remaining saline holdouts (older surgeons, cost-sensitive markets) finally switched.
From 88% in 2018, silicone dropped to 85% in 2019 and 84% in 2020. A 4-point reversal after 11 years of uninterrupted gains. The timing is not coincidental. The "breast implant illness" conversation exploded on social media in 2018–2019. Facebook groups grew from thousands to hundreds of thousands of members.
The FDA acted. A two-day advisory panel on breast implant safety (March 2019), updated safety communications (July 2019), and the Allergan BIOCELL textured implant recall (2020) all landed in this window. Silicone's aura of inevitability was broken.
BII Timeline
2016-17
BII Facebook groups grow rapidly
2018
Peak silicone share: 88%
Mar 2019
FDA two-day advisory hearing
Jul 2019
FDA updated safety communication
2020
Allergan BIOCELL recall (lymphoma)
To appreciate how unusual this shift was, consider other major product preference changes in medicine.
| Market shift | Duration | Magnitude |
| Silicone vs Saline implants | 11 years | 53-pt swing |
| Metal-on-metal to ceramic hip | ~20 years | ~40-pt swing |
| Film to digital X-ray | ~15 years | ~90-pt swing |
| Sutures to surgical staples | ~25 years | ~30-pt swing |
The key difference: Silicone's shift was a pure preference-driven reversal. No major price difference driving it, no technological leap — just patients and surgeons agreeing that one product was clearly better.
1
Silicone won decisively.
From 35% to 88% in 11 years. The remaining 12% saline holdout represents age-restricted patients (under 22), cost-sensitive cases, and safety-conscious choosers.
2
BII broke the streak but didn't reverse it.
The 88% to 84% pullback was small in absolute terms but significant in trajectory. For the first time since 2007, silicone's dominance became a question rather than an inevitability.
3
Surgeon preference drove the shift.
Surgeons overwhelmingly preferred silicone for more natural results, lower rippling rates, and higher patient satisfaction. Once they could legally offer it, they recommended it.
4
The data gap after 2020 is frustrating.
ASPS stopped publishing implant type breakdowns after 2020. We're left guessing whether silicone held at ~84% or continued to erode during the peak BII conversation years.