How do I choose between silicone breast implants and saline breast implants?

Saline implants: the basics

Saline implants remain very popular in my practice, and here’s why: saline implants of a moderate (and in my opinion, appropriate) volume look and feel natural.  The implant sizes I most commonly use blend in nicely with existing breast tissue, and patient satisfaction is high.  In over ten years of experience with saline implants I have not had a single patient return to say “I’m not happy with my saline implants…take them out and put silicone gel implants in their place.” 

Saline implants are inserted uninflated, and they can therefore be placed through a somewhat smaller incision than silicone gel implants.  The peri-areolar, inframammary fold and axillary (underarm) incisions can all be used for saline implants of any volume.  If a saline implant deflates it is apparent almost immediately, as the saline solution is absorbed by the body, so no ‘postoperative monitoring’ for implant rupture is required as with silicone gel implants.  Saline implant deflations are relatively uncommon; I have had only one patient (out of hundreds of patients) return with a deflation in the past six years. 

The primary disadvantage of saline implants is the fact that, in many patients, the edge of the saline implant is palpable under the breast.  This occurs primarily in the lateral aspect of the augmented breast where there is the least amount of breast tissue present to conceal the implant.  It tends to be more of a concern in slender patients with a small volume of natural breast tissue (A or small B cup), as there is less tissue available for implant concealment.  In patients starting with a full B or small C cup breast volume, the possibility of implant ‘edge palpability’ is less of an issue.

There is also a somewhat higher risk of having visible implant folds or ripples with saline implants, although on occasion this problem can occur with silicone gel implants as well.  In patients starting with a small A cup breast volume, I urge them to strongly consider gel implants as there is a much higher likelihood of the implant being visible through the breast skin if a saline implant is used.

First of all, you need to meet with highly qualified American Board of Plastic Surgery certified surgeons.  They will help you understand the differences between saline and silicone implants so you can feel comfortable with your choice.

The implants share the same silicone outer shell and are just filled with a different material.  In your hands, they will feel dramatically different and you will probably like the feel of the gel better.  Once in the body, however, unless you are very thin and have minimal breast tissue, they will feel much less different than in your hands.

If a patient with saline leans forward, they can usually feel subtle wrinkles or ripples along the outer edge of the implant.  If knowing this doesn't bother you, you can be happy with saline. 

The saline implants cost about $1000 less and follow-up of them is easier than gel.  The saline implants are obviously intact if they have not deflated.  The gels require periodic MRI's to detect ruptures and these studies are at the patient's own expense.

The implants look almost the same in patients so this is not a reason to choose one over the other.

The bottom line in my own practice, therefore, is that the patients who choose silicone gel implants do so because they place a high priority on the feel of the implant and the lack of wrinkling or rippling.  The patients who choose saline do so because they feel it is "safer" even though the FDA has blessed the silicone as safe.  The percentages currently are about 75% gel and 25% saline in my office.

One consideration is choice of scar.

I do a lot of transumbilical breast augmentation where the implants are inserted through the belly button, the only scar you are born with, so there are no new scars and certainly nothing visible. Only saline implants can be placed using this approach, however. Silicone implants must be inserted making an incision under the breast, around the nipple, or in the armpit.

The first thing most people don't realize is that both implants have a silicone outer layer. The difference then is what the implant is filled with.

Typically saline implants are about 1000 dollars less then silicone. In my office, I have every breast augmentation patient pick up both implants (even if they have pre-selected one type) so they can feel the difference. Often patients have an instinctual or "gut" reaction to one or the other, and then further discussion and a pro and con review can solidify the decision.

This decision can cause a lot of hand wringing, but remember both will give you fuller, beautiful breasts if the surgery is performed precisely.

Almost all implants have a silicone shell, although polyurethane coating has been used in the past.
Saline implants are filled with saline even though the bag is made of silicone.

Silicone gel-filled implants are filled with liquid silicone gel or cohesive silicone gel. Most surgeons in the U.K use cohesive silicone gel, and since the lifting of the ban in the use of silicone gel-filled implants in the spring of 2007 in the U.S, these implants are now more widely used internationally.

Choice:
Cohesive silicone gel-filled implants have less complications than saline filled implants and produce softer, supple, natural looking breasts.