Silicone or saline? Is there less risk of becoming ill with saline implants?

Question

Is there less risk with saline implants of becoming ill or any other risks associated with breast implants?

Ted Eisenberg, DO, FACOS, FAACS · Answer

There’s an opinion asserted by breast implant manufacturers and by many plastic surgeons that silicone gel breast implants are better than saline breast implants.
In my opinion, “It ain’t necessarily so.”
I’ve performed more than 7,000 breast augmentation surgeries, many of them with saline implants. My patients who chose saline have reported a high degree of satisfaction; it’s been rare for a woman to request that I change her saline implants to silicone.

Silicone gel implants may be stealing the spotlight, but saline breast implants still have much to offer. Here are seven reasons why:
A Natural Feel and Appearance
When you hold a saline implant in one hand and a silicone gel implant in the other, the silicone gel implant feels softer, but that’s not where breast implants will be! When I place breast implants behind the muscle, saline and silicone implants feel the same. In slender women who have very thin skin, less breast tissue, and little or no muscle coverage around the side and underneath their breasts, there’s a higher chance that either implant can be felt in these locations.
Availability
Silicone gel implants are recommended by the FDA and the manufacturers for women 22 and older. Saline implants are available to women ages 18 and up. Although the majority of my patients fall in the latter range, young women who have not developed often tell me that they feel self-conscious when they are on the beach and that they can’t find clothing or swimsuits that fit. They don’t want to wait several years for surgery.
Incision Size
A saline implant, which comes empty, can be folded and placed through a smaller incision. It’s filled after placement. A silicone gel implant comes prefilled and therefore requires a larger incision.
Implant Size
There is a limit to how large an implant can fit behind the chest muscle, and it’s dependent on the width of each breast. A saline implant acts as a tissue expander, which means a woman can sometimes get a slightly larger size than she could with a silicone gel implant. 
Correction of Tuberous Breast Deformity
Saline implants, which are inserted empty and then filled, can expand and correct a constricted breast in a one-stage procedure. Silicone implants, which are prefilled, cannot. My surgical approach to correcting TBD has recently been published online in the American Journal of Cosmetic Surgery.
Implant Rupture
When a saline implant shell breaks, the body safely absorbs the saline (salt water) and it is urinated out. The breast returns to its original size. When a silicone gel implant ruptures, the cohesive gel inside sticks together. Women might not notice a change in breast size. To check silicone gel implants for rupture, the FDA and manufacturers currently recommend that you get an MRI or ultrasound five years after surgery and every 2 years thereafter. This might not be covered by health insurance.
Cost
Silicone gel implants cost about $1000 more per pair than saline implants.
When you are choosing your breasts implants, consider all the facts. Although silicone implants get most of the attention, saline implants produce an equally aesthetic result.

Martin Jugenburg, MD · Answer

There are options to get silicone or saline implants for a breast augmentation.

When a saline implant ruptures you would know as the breast it would appear deflated. Saline implants typically have a smaller incision, as the saline shell is inserted prior to the implant being filled. Saline implants are typically less expensive than silicone. A drawback with saline implants is that they don’t feel as natural as silicone implants do. Another drawback is the rippling that can occur with saline implants.

Silicone implants have a more natural feel when compared to saline. A drawback with silicone implants is that a rupture is difficult to notice. A silicone rupture is typically detected by an ultrasound or MRI. Another drawback of silicone is the incision would be slightly larger to insert the silicone implant.

Both saline and silicone implants have their pros and cons. It is important see a board certified plastic surgeon to determine what is important to you before making the decision.

Kenneth Hughes, MD · Answer

Hello, thanks for your question. I recommend silicone, they develop better results in the future. They are long lasting implants and the shape its better. I recommend you to schedule a consultation with a board certified plastic surgeon.

Daniel Barrett, MD · Answer

Dear Kez3030,
the two main types of implants are silicone and saline. The shell of the implants can be either textured (which reduces capsular contracture) or smooth. A textured implant sometimes requires a larger incision. The shape of the implant can be either round or tear drop shaped (gummy bear). Both have their advantages and disadvantages.
The different types of implant offer different pros and cons. For instance, the pros of silicone implants are that they look and feel more natural and ripple less.
On the other hand, the pros of saline implants are that they do not require as large of an incision as silicone, less expensive, they have less incidence of capsular contracture (scarring around the implant), one can tell immediately if there is a rupture, the size can be slightly adjusted, and they can be used for women less than 22 years of age.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ajay Mahajan, MD, FRCS (Plast) · Answer

There have been extensive studies done on safety of silicone breast implants and an Independent review group in the UK (1998) has found silicone breast implants are not associated with a greater health risk when compared to other surgical implants.

One can have both silicone gel and saline breast implants according to their wishes. However, most patients choose to have silicone gel breast implants as they tend to feel more natural and maintain a better shape. You can have an anatomical or tear drop shaped breast implant or a round breast implant. However, tear drop shaped implants only come in silicone gel fill.

For optimal outcome, please consult a fully qualified plastic surgeon, who has specialist qualification in plastic surgery 'FRCS Plast' after having being trained adequately in the field of plastic surgery, is registered on the 'Specialist register for Plastic surgery' with the General Medical Council and has been considered competent enough to be a member of the 'BAPRAS' (British Association of Plastic Reconstructive and Aesthetic Surgeons) and 'BAAPS' (British Association of Aesthetic Plastic Surgeons) at the least.

Ali Gurlek, MD · Answer

Thank you for your Question. 
there are multiple factors influencing the actual size increase a breast implant will provide other than volume, including:
Implant profile (projection) and base widthImplant shape (i.e., classic round, teardrop shaped, extra upper pole fullness)How much natural breast tissue you haveThe width and contour of your rib cage

Connie Hiers, MD, FACS · Answer

Yes, saline implants have fewer risks because the bag is filled with salt water. However, they feel less soft and less natural. If you have enough tissue to hide the implants, then saline implants are a good choice. If you have minimal tissue, then gel implants would be better. The bag is the same on both gel and saline implants.

Vivek Sivarajan, MBChB · Answer

Hi, thanks for your question. There is still very little evidence to support that silicone implants can make you unwell. Breast implant illness has been studied for decades and no definitive proof has ever been found for its existence.
Saline implants carry their own risks, such as poor look and feel and deflation. Correction of any of these would be far more likely to affect your health than anything do do with silicone.
I would advise you to find a Surgeon you trust, who uses high quality breast implants. A BAAPS surgeon would be a great place to start.
Best of luck

George Orloff, MD, FACS · Answer

There is a misconception that saline is safer than silicone, however studies show that silicone implants are not associated with more health risks than its saline counterpart. The preference between the two comes down to feel and shape. Silicone implants are typically a more natural feel and maintain a better shape. Depending on how you want to look will better determine which way you want to go. There will always be a risk factor when getting implants, so it is best to review the options with a board certified plastic surgeon who specializes in Breast Augmentation to go over what is best for you and your body.

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