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Saline Vs Silicone Breast Implants for a More Natural Look?

I'm getting Breast Augmentation in 2 months. I had originally decided on a 320cc silicone implant, but now feel safer going with saline.I contacted my plastic surgeon and it was clear she was trying to dissuade me from going this route. She believes I will be much happier with the look of silicone and stated that she rarely does a saline implant anymore, as almost all of her patients request silicone. Please help me make heads or tails with this decision I need to make. Can a saline implant give a comparable natural look?

Doctor Answers (19)

Silicone versus saline implants


Some of the reasons for visible rippling, which tend to be higher with saline implants include:

1. thin skin and minimal breast tissue with visibility of normal folds
2. moderate profile saline implants are more likely to ripple than high profile saline
3. saline are more likely to ripple than silicone implants
4. over the muscle placement are more likely ot have visible rippling than under the muscle
5. weight loss may make rippling more noticeable
6. involutional breast atrophy after nursing may make rippling more apparent
7. breast ptosis (sag) may make rippling more pronounced
8. capsular contracture with "scrunching" of implant causing folds
9. textured surface causing folds and knuckles
10. partial deflation of implant with collapse and folding
11. underfilling of implant
12. flipping of implant

Chicago Plastic Surgeon
5.0 out of 5 stars 44 reviews

Saline and silicone breast implants will look the same


There has been a general push toward the silicone gel breast implant and a feeling that patients will be 'happier' with the gel. The bare truth is that both work very well and I defy anyone to show a picture of a well performed breast augmentation and be able to tell if the implant is indeed gel or saline. Both will look very natural. The next issue is feel. It is true that the saline breast implant will have a greater tendency to show through a ripple, especially in thin skin, however in place in the breast the saline implant is soft and compressible and has a flow characteristic that makes it satisfactory and natural in most who seek augmentation with an under the muscle approach. The gel implant may feel softer, though it may not. The more cohesive the gel, the stiffer the implant. The extreme is the 'gummy bear' implant where the implant is form stable which flexes or compresses and then resumes its shape. It can look wonderful, though 'natural' it is not. Remember that with each implant there are trade offs, some more acceptable to a patient than others. Take your time to explore, and resist a push to one implant over another until you understand what your choice will mean in the long term.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 29 reviews

The "look" of saline vs gel implants


If you looked at 10 patients with breast implants, half with gel and half saline, you would not be able to tell them apart based on the "look." Each look fine. The only difference is in the "feel." If a saline patient leans way forward, you can typically feel or sometimes even see ripples along the lower outside edge of the implant. If that wouldn't bother you and if you feel "safer" with the saline, go with them! Make sure they are under the muscle.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 49 reviews

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Go for Silicone Breast Implants for a more natural look


If it is a close choice for you, go with SILICONE.

Yes, great results have been achieved with both saline and gel implants.

The advantages of saline are lower cost, ability to be placed through a smaller incision and by being able to put more or less saline in - we can correct minor asymmetries.

The advantages of gel implants are, they are lighter, they ripple less and they feel much more like the real breast tissue.

Good luck.

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 61 reviews

Results can be good for both saline and silicone breast implants


Good results can be had with both. To a large extent the decision of one versus the other depends on the patient's natural breast/chest anatomy. The thin patient with minimal tissue would often do better with the silicone implant in terms of ripples, and a natural feel. Otherwise, saline is acceptable.

Safety is not really a consideration as I feel both are "safe". Deflation is a possibility, and the saline implants go flat. The silicone implant, more involved and hence the need for MRI analysis. Not really a safety issue, but a consideration. All things being equal, go with what you are comfortable with.

Michael A. Marschall, MD
Chicago Plastic Surgeon
4.5 out of 5 stars 4 reviews

Your plastic surgeon is giving you good advice, Silicone gel over saline breast implants


 While almost all patients are happy with saline implants, I feel secure in telling you that silicone gel implants look and feel better and more natural. 

Carl W. 'Rick' Lentz III, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 12 reviews

Saline Vs Silicone Breast Implants for a More Natural Look

Each surgeon has different preferences regarding breast implants based on experience and expertise. We perform a large number of both saline and gel implants. The look between the two implants are extremely comparable. Gel implants do feel more natural. There are other strengths and weaknesses between the two implants.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 18 reviews

Saline vs. Silicone Breast Implants- Does it matter?

When dressed in clothing and looking at patient postoperative photographs, it is difficult to distinguish between saline and silicone. Patients with adequate natural breast volume and good skin quality, both implants may give natural results. The volume or size of the implant plays a greater role in the “more natural look” with smaller implants looking more natural than large implants. I believe the patient should determine the ultimate implant type- saline or silicone after reviewing the best options for them.

Michelle Zweifler, MD
New York Plastic Surgeon
5.0 out of 5 stars 10 reviews

Saline vs. silicone implants


If you have enough tissue sitting on top of the implant, then the appearance will be the same. If you are thin, and have minimal breast tissue, then the concern is that you might have rippling on the side or underneath the breast.

Less likely with silicone.

Gregory Sexton, MD
Columbia Plastic Surgeon
5.0 out of 5 stars 27 reviews

Saline or silicone?

Much of the final “look” achieved after breast augmentation surgery  depends on several factors:
1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.
2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.
3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the press implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.
Sep 16 '11, 4:46am

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 751 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.