Silicone or Saline Implants Recommended for Plenty Breast Tissue?

I am pretty much a full 36C with some deflation from breastfeeding, but I have plenty of breast tissue. I am having a hard time choosing between saline and silicone breast implants. They will be placed under the muscle. I am being told that there shouldn't be any difference in how they feel after surgery. I am looking to going back to a 36D. Thanks for the advice!

Doctor Answers 13

Silicone versus saline

In your conidtion, there are no absolute right nor absolute wrong decisions. These are simply options for you. With adequate soft tissue coverage, you can consider saline implants.

I've attached a link to a page below for discussion of the relative risks, alternatives, and benefits

Chicago Plastic Surgeon
4.9 out of 5 stars 81 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.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Saline vs silicone

Remember that as you continue to age, you will likely lose more breast tissue or have the fibrous breast tissue replaced by fatty breast tissue.  As this occurs, the chance of seeing rippling increases.

Samer W. Cabbabe, MD, FACS
Saint Louis Plastic Surgeon
4.9 out of 5 stars 57 reviews

Benefits of Silicone versus Saline Implants

Patients are confused by the choice between silicone and saline implants. In general, silicone implants do not ripple and wrinkle as much as saline implants . The thinner the patient and the smaller the breast, the greater the chance of seeing wrinkles in saline implants. Silicone implants are slightly softer than saline implants; however, the more breast tissue you have , the less evident the difference in softness.

Saline implants are cheaper than silicone ( about half the price ). The FDA strongly recommends that women with silicone implants get MRI's of the breast implants every 2-3 years for the rest of their lives. The MRI looks for "silent " ruptures of the implant that cannot be detected by examination. When a saline implant deflates, you see the difference in size immediately. The cost of MRI's is not covered by insurance and is a lifetime added cost of silicone.

Saline implants can be placed thru small incisions.

Saline implants can be adjusted for size during surgery. This is important for women with asymmetry.

Bottom line: Thin women or women with very small breasts should strongly consider silicone. Women with larger breasts and some fat under the skin can choose either implant.

Richard L. Dolsky, MD (retired)
Philadelphia Plastic Surgeon
5.0 out of 5 stars 4 reviews

How to choose saline vs. silicone implants

This is one of the most common questions my patients ask. There is no right answer for every patient and your consult should provide the pro's and con's of each implant. But in general, as the patient's own natural breast size increases, the advantage of silicone decreases. That is, in patients with more breast tissue, the additional "softness" or feel of silicone is not as great an advantage as it is in smaller cup size patients. Good luck!

Dean Fardo, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 13 reviews

Silicone Gel Breast Implants vs. Saline Implants

In your case with ample breast tissue and a sub-muscular breast implant the consideration of which implant is best is narrowed down to fewer factors.

1. Saline implants are adjustable at the time of surgery and would have an advantage in cases of asymmetry

2. Saline implants can be inserted through a much smaller incision than silicone gel implant

3. In your case there should not be a discernible difference in appearance between saline and silicone gel implants

4. Silicone gel implants are less likely to have rippling

5. Silicone gel implants cost 3 times as much as saline implants

6. Silicone implants are much less likely to leak than saline implants

Once you are aware of the difference, the choice is yours. If you were to ask me, I would recommend saline..

Joel B. Singer, MD
New York Plastic Surgeon
3.4 out of 5 stars 34 reviews

Silicone vs. Saline Implants

Both Silicone and Saline implants are good options for you. IMHO, the key to getting a natural result is camouflaging the implant. Since you already have enough breast tissue, there is enough tissue to "hide" your implant. So you will likely do very well with either implant option.

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 210 reviews

Silicone vs saline implants

The choice of a saline implant or silicone filled implant is yours. Even if you have enough breast tissue to start with, you will feel more natural with silicone implants.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Silicone implants may work better for you

You stated that you have a lot of tissue,but the more important than amount of the tissue is the quality of the skin and thickness of the breast tissue to cover the implant. In general the silicone implants feel better .You can ask your doctor to let you feel a filled saline implant and also a silicone gel implant. This will help you to mke up your mind. Both silicone gel and saline implants will look similar ,but silicone gel will feel better.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 122 reviews

Silicone vs Saline Implants

I feel that most women will get a better result with silicone implants, if they can get past all of the misinformation trial lawyers put forth in the early 1990's. As valid scientific studies have been performed since that time, there is no documented or proven relation between implants and any of the suggested problems. The only drawback for silicone implants is the cost (twice as much as saline).

John Whitt, MD (retired)
Louisville Plastic Surgeon
5.0 out of 5 stars 2 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.