Which are better, silicone breast implants or saline breast implants?
Many women can achieve a beautiful result with both saline and silicone implants. However, the feel of one's breasts will be more natural feeling with silicone implants in most women, especially those women who have a looser skin envelope such as after nursing or weight loss.
Hello,
Silicone gel implants are filled with a "jelly like" silicone substance to which the body reacts more over time. They come filled at one size and are not adjustable in the operating room. Saline implants are more adjustable and this allows better sizing during surgery. Long term capsules (scar formation with hardening) is more commonly a problem with silicone gel implants. The FDA recommendations are that patients with silicone gel implants have breast MRIs every two years to watch them. Insurance usually doesn't cover these and patients rarely get them. The bottom line is that there is likely more long term RISK with silicone gel over your lifetime.
On the other hand silicone gel implants FEEL more natural than saline filled implants particularly when placed "over the muscle." They ripple less when placed under thin soft tissue cover. Early on at least, they look more natural.
Women need to do their research and decide what is most important to them and proceed accordingly. Moderation in sizing with saline implants under the muscle is probably safer.
Please consult with a Board Certified Plastic Surgeon and don't just depend on our observations because your correct choice of an implant is probably one of the most important decisions you will make. That being said, here goes:
Pros:
Saline: a) small incision for placement; b) ability to make small adjustments, intraoperatively; c) unequivocal detection of implant failure ("flat tire"); d) firm feel; e) cost of implants (roughly 50% of silicone gel); f) greater perkiness.
Silicone: a) feels more natural; b) less tendency for implant palpability, wrinkling or rippling; c) better camouflaging of any rib and/or breast bone abnormalities.
Cons:
Saline: a) potential for lateral pole rippling and wrinkling; b) possibility of firm feel, if overfilled.
Silicone: a) possibility of "silent rupture"; b) FDA recommendation of scheduled MRI screening; c) possiblity of noncoverage of silicone related surgeries by Insurance companies.
Silicone implants do feel more natural than saline implants. However, in my experience, if the patient has adequate breast and soft tissue, the difference is there but minimal. If the patient has very thin skin, then the advantage of silicone is obvious.
Silicone implants also have a better replacement warranty than saline implants. Both Mentor and Inamed (the only FDA approved companies in the U.S.) will pay towards your surgery to replace an implant which has leaked. The companies typically pay more towards your surgery, if silicone implant was used. However, this payment is only done if the implant has leaked within 10 years of your surgery.
The disadvantage of silicone implant is the potential inability to know if the implant has leaked or not. With saline implants, if the implant should leak, the body will absorb the saline (salt water). Therefore, in a day or two, the patient will notice a difference in the shape and size of the breast affected. With silicone implant, the leaked silicone will NOT be absorbed. Therefore, one may or may not be able to detect the leak. Even your surgeon will not be able to detect a leak on physical exam. MRI is currently the most accurate test to detect a silicone implant leak.
I always recommend to my patients requesting silicone implants to perform an MRI of the breasts a few weeks before their 10 year anniversary arrives. As I mentioned previously, the companies will replace the implant free of charge, if the implant has leaked. However, no payment will be made to cover the cost of surgery if the implant has leaked after 10 years. Since silicone implants can fail without any obvious sign, it may be a good idea to obtain an MRI just before 10 years of implantation to make sure a leak has not occur ed.
The other potential disadvantage of silicone implants is the inability to adjust the volume of implant. Silicone implants are pre-filled with the silicone gel and the volume is not adjustable. Therefore, the chance of having more asymmetry, especially in the upper portion of the breast, is higher than with saline implants.
The other disadvantage of silicone implants is the cost. Currently, silicone implants are much more expensive than saline implants. Most surgeons charge an additional $1000-1500 for the use of silicone implants. The price will probably drop as the demand for silicone implants increase. However, I doubt the price will ever be the same as saline implants.
In summary, then, silicone implants feel and look (in patients with thin skin) more natural. On the other hand, they are more expensive, have higher chance of breast asymmetry, and require more "baby-sitting" and perhaps more costly studies in the future.
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