How Are Under Muscle Saline Breast Implants Different from Silicone?

I am looking into having breast implants very soon. I really would like to get silicone because of how much more natural they are, but I am only 19.

I am a 36B-34C and want to be a 36C-34D, so it would not be a huge difference and I already have some breast tissue. If I get saline implants under the muscle, would there be a huge difference with silicone? Would they feel and look natural?

Doctor Answers 20

Saline verses Silicone

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Thank you for your question. There is very little difference between the look and feel of a properly filled saline implant under the muscle and a silicone implant under the muscle. I do 90% saline breast augmentations and have to look at the patients chart to be sure what they have when they return for follow up years later. With the amount of breast tissue you have, they both would work very well. Since you are only 19, you should look for a surgeon who specializes in saline implants to insure the best result. Good luck.

Grand Rapids Plastic Surgeon
5.0 out of 5 stars 72 reviews

Saline or silicone?

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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

Different Feel Same Look

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It is sadly true that because of your age, the FDA will not permit you to have gel implants. However even thought there is a difference in feel, the appearance is the same. In my experience, young woman are extremely happy with saline implants slightly overfilled and placed submuscularly. I suspect you will be too.

Richard Linderman, MD
Indianapolis Plastic Surgeon

You can have a good result with saline breast implants.

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1) We have hundreds of patients with saline breast implants who are very happy.

2) You are a particularly good candidate for saline implants because you have a fair amount of breast tissue, you don't want very large implants (very wise), and they would go under the muscle.

3) But it is also true that, in general, results with silicone implants are somewhat more natural.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Silicone versus saline

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In my opinion, silicone implants provide a more natural feel and appearance that saline breast implants.  Remember that as you age, and if you have children, then you will lose breast tissue.  When this happens, the ripples in the saline implant may become visible with time.

Samer W. Cabbabe, MD, FACS
Saint Louis Plastic Surgeon

Silicone vs Saline

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To start with, the fact that you are 19yo, does not qualify you for silicone implants. That said, there is a lot of debate between the two. If you already have breast tissue and a nice amount of subcutaneous fat, the saline will be just fine. In the right hands, saline looks just as natural as gel. A good doctor will guide you thru your process and help you achieve a wonderful result, as well as tell you if what your asking for doesn't fit your body.

Foad Nahai, MD
Atlanta Plastic Surgeon

Silicone vs Saline

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The debate goes on! You will find opinions on both side of this fence. Some of the facts to keep in mind are that both are safe to your health and FDA approved for use in breast augmentation. The limiting factor is how tight the scar of capsule, that surrounds all implants, gets. Another factor is the amount of breast tissue coverage there is to begin with. I suggest that you seek a few plastiic surgeons, with alot of experience in this field, for advice.

Silicone versus saline implants: which is better?

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Both silicone breast implants and saline breast implants have pros and cons. With you only being 19 and having a fair amount of natural breast tissue, you'll almost certainly get a great result with either silicone or saline implants. The U.S. Food and Drug Administration restricts placement of silicone gel implants in women under the age of 22 years for cosmetic breast augmentation, making saline implants your only real option until then.

If you do decide to wait until you're 22 year old to have surgery, there are some things you should know. Breast implants filled with silicone gel look and feel more like natural breast tissue. Also, particularly in thin patients, silicone breast implants tend to have fewer problems with visible rippling than saline breast implants.

Some bad things about silicone breast implants; breast implants filled with silicone are more expensive. Silicone breast implants are approximately twice the cost of saline breast implants, which is factored into the price of surgery. Also, a breast implant rupture is easy to detect when the implant is filled with saline; the breast tends to deflate rapidly, in the span of a few days. A silicone breast implant ruptures is much more subtle to detect. For that reason, the Food and Drug Administration recommends an MRI to monitor for rupture, the first one 3 years after surgery, and then every 2 years thereafter. This test is expensive and most likely will not be covered by third-party insurers. Lastly, capsular contracture rates, or pathologic scarring around the implant, traditionally were much higher with the older generation of silicone breast implants. This does not seem to be the case with the newer generation of silicone breast implants used, which is largely attributable to a thicker implant shell and thicker, more viscous silicone gel within the implant.

So, what’s better? You'll likely get great results with either silicone or saline, but will be hard-pressed to find a surgeon to put in silicone implants until you're age is 22 years or older.

Hope this helps. Best of luck.

Saline and silicone implants both produce wonderful results

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There are differences in the saline and silicone breast implants which may make one a better choice over the other for certain individuals, however with years of experience with both, we have happy patients and excellent results. In a submuscular position it can be difficult to distinguish between the two, even though when both are seen 'on the table' the silicone appears the natural choice. As you are 19, the saline implant should look great, feel soft and perform very well for many trouble free years. You should not be discouraged from augmentation if you are ready.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Silicone vs Saline Breast Implants

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The muscle provides coverage of the breast implant superiorly and medially. Inferiorly and laterally the only coverage is the patients breast tissue and the skin. So yes over time you wil be able to tell the difference between the feel of saline and silicone breast implants. At the beginning you will likely not be able to tell the difference but once everything settles in you will be able to see there is a difference even if placed under the muscle.

Having said that, you are out of the age range for silicone implants unless you have a congenital deformity of your breasts. If not then at this point I would not worry about silicone as it is not an option for you anyways.

Good luck.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 reviews

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