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Benefits of Silicone over Saline Breast Implants?

I went for a consultation with a surgeon for a breast augmentation and he recommended silicone implants over saline. When I asked him why, he said that silicone would feel more natural.

He also mentioned that I would need to get a mammogram every 2 years to check for leaks. To me this seems very inconvenient, not to mention the expense to have to do this every 2 years. Is there another reason a surgeon would prefer silicone that he didn’t mention to me? And what are some pro's and con's of having silicone versus saline?

Doctor Answers (6)

Benefits of Silicone over Saline Breast Implants?

+2
When seeing patients in consultation for breast augmentation, I individualize my recommendations when it comes to the type of breast implant that will most likely achieve the patient's goals, with the least risk of complications.  In order to provide this type of advice, the patient's physical examination  and very careful communication of her goals are necessary. In my practice, I find the use of  computer imaging and goal pictures very helpful. You will find,  that without posting your pictures and your goal pictures, that online consultants will not be able to be of much specific/meaningful help to you.
The type of implant used may  determine the final outcome achieved after breast augmentation surgery, 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 are implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
Generally speaking, patients should be aware that more important than any technical detail (such as type of implant, placement of incisions...) will be their careful selection of plastic surgeon;  I think that this selection will be the most important factor when it comes to the outcome of the procedure performed.
I hope this, and the attached link, helps.


San Diego Plastic Surgeon
5.0 out of 5 stars 759 reviews

Saline or silicone is an important decision

+2

This question comes up very frequently and can be a difficult decision for both surgeons and for patients. Some surgeons are very flexible in the implant offering and some strongly believe in one implant over another. Whenever this question comes up the opinions will diverge as there is no consensus.

The saline breast implant is made of a silicone rubber elastomer which makes up the shell or outer covering. The implant is placed empty and then filled therefore they can be placed through a very small incision around the nipple, under the arm, or in the fold under the breast. The implant will wear over time and the saline fill will leak, perhaps over ten to fifteen years after which the implant is easily replaced. In a submuscular position the saline implant has a very low capsule contracture rate and produces a soft and natural feeling augmentation. The relative softness as compared to a silicone implant is not all that different in the breast. The relative drawback to the saline implant is the tendency to have a fold or ripple along the lower edge or side of the breast which is not as commonly seen with a silicone gel implant. The advantages remain the small incision, lower cost, no need for special testing to detect leaks, and the implant can be worn until it wears out with little risk, and one more; saline has a lower capsule contracture rate (firmness).

The silicone gel implant is also made of a silicone rubber elastomer with a coating to lessen the gel leakage. The implant is filled and therefore placed with a larger incision, usually in the fold under the breast.. This implant too will wear over time and the leak will cause the implant to become tender and the capsule may begin to draw in increasing the firmness of the implant. The volume will not change like the saline implant. The implant will last as long as the saline implant, however as there is no warning of the leak, the FDA recommends an MRI study after three years to check the implant and regularly thereafter. This study is not a mammogram and probably not covered by most insurance. The implants are soft and look well and have less ripple than the saline implant. The firmness or capsule contracture rate is higher than with the saline implant, and unless removed before a leak occurs all will become firm over time. If the implant leaks, it is more difficult to replace, often requiring removal of the capsule around the implant as well.

There are some patients who will do better with a gel implant, for example if the implant is very large, over say 550cc, and there are other considerations as well. My bias is that if a patient will look well with a saline implant it is a safe place to start. Both are very good and it will take you time to consider your comfort level to feel out which is best for you. I hope you can find a surgeon who can spend the time to consider both options.

Best of luck,

peterejohnsonmd

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

Silicone vs Saline Breast implants is debatable

+1

Silicone Gel Implants

Pros

  • Feels more natural at first
  • Don't tend to leak and deflate

Cons

  • Gel leaks into breast requiring MRIs every 3 years
  • Gel can encourage breast hardening more than saline

Saline Implants

Pros

  • Don't require MRIs every 3 years
  • Stay softer over the long term - less hardening

Cons

  • Need to put them under the muscle to decrease rippling
  • Easier to feel than silicone implants
  • When they leak, they deflate requiring surgery to replace them.

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 23 reviews

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A Question of Degrees

+1

Hi there-

I think that to some extent the results of breast augmentation will depend on the breasts you are starting with-- in other words, if you have a fair amount of breast tissue already, the chances of being just as happy with saline as you might have been with silicone are pretty high. If, on the other hand, you do not have very much of your own tissue to camouflage the implant, then the chances of ending up unhappy with saline, either because you can see that it's an implant, or because you can feel the implant easily through the skin, are much higher.

The silicone implant is the gold standard in most of the world because it gives a reliably natural look and feel to the breast. The downsides are that it is a bit more expensive, and the FDA does recommend occasional MRI exams to prevent undetected implant rupture.

Armando Soto, MD, FACS
Orlando Plastic Surgeon
5.0 out of 5 stars 105 reviews

Saline vs Silicone Gel Breast Impants

+1

When I decide which type of implant to recommend for my patients, I always take multiple factors into account. First of all, the patient's figure is very important. For a woman who is very thin with very little breast or fatty tissue to help cushion the appearance of the implant, I tend to like the new cohesive silicone gels.

Saline implants can develop rippling, which are more likely to be felt and possibly seen in a very slim woman. In order to minimize the ripple effect it is important to overfill the saline implants, which make them feel firmer to the touch than silicone gels. However, although they initially feel softer, the silicone gel implants historically have a higher risk of developing capsular contracture than saline implants over time.

Ongoing monitoring throughout a woman's lifetime is important , and monitoring of the silicone gel implants is more expensive. Manufacturers recommend that women with silicone gel implants get an MRI of the breasts every 3 years. This is a fairly costly exam and generally will not be covered by insurance. Mammography after age 35 is important for all women (with or without implants), but a mammogram will not yield a clear picture of the status of the silicone gel implants. If compliance with MRI testing is going to cause problems for my patient, I tend to advise sticking with the tried and true saline implants.

Pamela B. Rosen, MD
Coral Springs Plastic Surgeon
3.0 out of 5 stars 2 reviews

Excellent question

+1

Each type of implant has advantages and disadvantages, just like a car or cell phone. You have to decide what is important for your to have (i.e. naturalness) and what you can't tolerate (i.e. rippling) and what you might be able to tolerate (i.e. firmness). The advantage of silicone is mainly that is feels softer and more natural if it is working the way it is intended. That is the only real reason it is one the market. If sailne felt natural, silicone would probably go by the way of Beta-Max. The real uncertainly is "if". Silicone doesn't work the way it is intended when it gets hard due to capsular contacture (higher frequency than saline), when it leaks (probalby higher rate than saline), or if it gets outside the capsule (much moe difficult to remove than saline).

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 8 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.