This is one of the most common issues I discuss with patients at consultation. I always offer both types of implants, but most of my patients these days are selecting the silicone gel implants, and we have been very happy with the results. I think the main reason patients like the silicone gel is because of the natural look and feel of the implants. Saline implants can tend to feel "stiffer" or more like "plastic," and they can tend to have visible or palpable rippling associated with them more commonly. Another issue is rupture rate, and although we will never know the true long term rupture rate of either type of implant, we do know from 3 year studies that have been done that saline implants rupture/leak about twice as commonly as silicone gel. The currently used gel implants are more like a solid, and if you cut them open, they would behave like a marshmallow, thus the gel does not leak or flow like a liquid. There have been no studies to show any increased health risk associated with gel implants over saline, and this includes capsule contracture. The older silicone gel implants were associated with higher rates of capsule contracture, but the new gel implants have not.
One comment to make about silicone gel implant rupture and MRI scans to detect silicone implant rupture is that although MRI is the "gold standard" right now for detecting implant rupture, it is not perfect, and there is a certain number of "false positive" results that will occur, meaning the scan will show a rupture when there really is none. Perhaps a more important question to ask is what happens if a silicone gel implant ruptures. To date, we have no evidence that this leads to any health problems, although I think it is possible that such things like increased chance for capsule contracture can occur. For this reason I recommend to my patients that we remove silicone implants that are known or suspected to be ruptured, but it certainly is not a medical emergency.
This is a very personal choice, and it depends on a lot of factors such as your body and tissue thickness, your preferences for appearance and feel of the breasts, your comfort with silicone gel, and your budget. Do your research and then have a detailed discussion about the issue with your plastic surgeon as this is an important decision and you want to be sure you are comfortable with your choice before entering the operating room.
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