The decision of whether to use silicone or saline implants is not based on how they look, but how they feel. Saline and silicone implants LOOK the same. If there is enough tissue covering them, they also feel the same. However, if there is only a small amount of tissue between the skin and the implant, the saline one feels more like a water balloon, while the silicone one feels more like natural fat. The only place I have been able to feel a difference is under the breast. This is where the overlying tissue is the thinnest. This is the same with implants placed under the muscle, since the inferior part of the implant is never under the muscle. I have, for years, until the silicone implants were again available, placed saline implants over the muscle in more than 95% of patients. All these looked extremely natural and as good as the silicone ones in the same position.