I've Had 2 Breast Augmentation Consultations and I'm More Confused Than Ever, Silicone or Saline?

I have breast feed 2 children, youngest one is now 2 years old, now my breasts are shrunken and sagging somewhat. One surgeon suggested a lift and silicone under the muscle going in through the nipple. The other said he would go in under the breast and insert a saline inplant. I have done figure competitions in the past and would like to get back to it. I don't want to have to worry about rippling or noticable scarring. What's best for me. I'm small framed, 5'5", 136lbs, 34 yrs old.

Doctor Answers 23

Confused by differing opinions - Saline vs Silicone

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As for appearance, there is far less rippling with a silicone gel filled implant than with a saline implant. The feel of a breast with a silicone gel impalnt is usually more natural. All this must be taken into consideration with the type of tissue you have. If you are 22 yrs old and have firm moderate B cups to start, you could probably use either and get a great result. If you have had children and suffered post partum atrophy, a silicone gel is usually abetter choice if you want the best possible look and feel to the breast.

That said, as far as a lift, I cannot tell you without an examination of your breasts. There are many women who have been told that they need a lift and they really do not, if you use a breast crease incision and a dual plane approach. 

Stony Brook Plastic Surgeon
4.9 out of 5 stars 244 reviews

Silicone versus saline, general considerations.

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Choosing silicone versus saline implants is based on the physical characteristics of each implant, the breast into which the implant is placed, and the recommended follow up necessary to look for changes in that implant. A few general considerations should be addressed when making this choice:

  1. ALL implants can ripple. Silicone implants tend to be less noticeable than saline implants due to the different viscosities silicone and saline. Regardless, rippling is a factor of the breast tissue and it's thinness. If you have very little breast tissue, you can see rippling with either type of implant.
  2. The breast tissue needs to hide the implant for a "natural" look. Choosing to go over or under the muscle is typically based on the amount of breast tissue you have. For smaller breasted women, under the muscle is usually recommended. However, if you are extremely athletic or concerned about implant distortion from the overlying muscle, a smaller implant placed over the muscle may be a necessary compromise.
  3. Incision placement is a very personal decision, but has some impact on postoperative concerns such as capsular contracture rates. Periareolar (under the nipple) usually involves some dissection of breast gland which can theoretically increase bacterial contamination of the implant and lead to higher capsular contracture rates. However, the incision is well hidden. An inframammary (lower pole of the breast) incision provides excellent visualization of the implant pocket and avoids any gland dissection, it is a more noticeable scar.
  4. Implant monitoring. The FDA recommends an MRI at 3 years, and every 2 years following to identify any ruptures or leaks in these implants. This may or may not be covered by your insurance company. Saline implants do not require any monitoring as a rupture becomes obvious due to deflation of the implant.

As you can see, there are many ways and reasons to choose one implant type over another and one augmentation incision over another. I recommend prioritizing your goals and realizing that some compromise may be necessary. Your surgeon should be able to develop an augmentation surgery plan which best approximates your goals. If you are not happy with the first 2 consultations, seek a third or a fourth before proceeding with surgery.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

Breast Implant Types

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Silicone gel implants look more natural and feel softer with less chance of visible wrinkling.  Studies show silicone implants do not increase the incidence of disease or the chances of developing breast or other cancers. The FDA recommends MRI scans to follow gel implants postop. Saline implants, on the other hand, are less expensive. I can insert a saline implant through a smaller incision and can more easily adjust for minor size discrepancies between each breast during surgery. Implants come in various shapes.  Discuss the pros and cons of each shape with your surgeon.This is probably the most difficult decision woman have to make in the consultation.  Ultimately the final decision is yours.     All the best!  "Dr. Joe"

Silicone or Saline

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In patients who are in their child-bearing years I prefer to use saline over silicone unless they have no breast tissue or specifically desire silicone gel implants. Silicone implants are excellent as well. They are both FDA approved and last 10-15 years. Silcone gel implants are excellent for patients who are past their child-bearing years or that desire these implants. Some patients feel silicone implants are softer and feel more natural.

Rod J. Rohrich, MD
Dallas Plastic Surgeon

Breast Augmentation: Saline vs Silicone, Under vs Over the muscle, Lift vs No Lift

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Breast Augmentation is a very safe and extremely common aesthetic surgery.  No matter what type of cosmetic surgery you have, it is very important that you have a board certified plastic surgeon, and that you and your surgeon develop a surgical plan tailored to your body, goals, and anatomy.  Commonly, following pregnancy and breast feeding, a breast lift in addition to augmentation with an implant can create very aesthetic results with symmetry, shape, size, and sensuality to the breasts.  Silicone implants recreate the most natural feel and look and avoid many of the rippling concerns.  Additionally, augmentation under the muscle can further minimize rippling with a more natural look.  Placing the implant under the muscle should not have any deleterious effects on your pectoral muscles and ability to do figure competitions at an extremely high level.  A detailed consultation with a plastic surgeon you trust and are comfortable with can help develop the perfect surgical plan for an amazing result.

John G. Apostolides, MD, FACS
La Jolla Plastic Surgeon
4.9 out of 5 stars 26 reviews

Silicone or saline implants? Both are FDA cleares as safe.

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Saline implants are firmer and are prone to rippling. Silicone implants are softer, a little bit lighter, and ripple less. If you are thin, then silicone is probably the way to go. At the end of the day, it's your call on deciding what is best for you.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Silicone or Saline implants

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In my own honest opinion I do not believe anyone can tell the difference in the appearance between gel or saline filled implants.  The saline does feel firmer and is more prone to rippling.  If you are very thin then the gel implant would probably be your best option as it will feel more natural and have a less risk of rippling.  In my practice I find that half of my patients are selecting gel and half saline.  It mostly depends on what the individual patient's wishes, concerns and priorities are.  Both are actually wonderful implants.


Gary Hall,MD

Gary Hall, MD (retired)
Kansas City Plastic Surgeon

Saline or Silicone

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 Thank you for your question.

 It is a little difficult to determine which would be best for you without any pictures. As the other doctors have stated, it would be in your benefit to seek an examination with a board certified plastic surgeon. On that note, there are benefits to both types of implants. Silicone implants are known for a more natural look and feel, which has led to them being the more popular choice. However, they do require a MRI screening every two years to check for any leaks. Saline implants are a little less expensive, great for adjusting an asymmetry and if there is a leakage, the saline solution is safely absorbed into the body. There is no need for a MRI for saline implants since it will deflate. I highly recommend doing your research so you can decide
which would be best for you personally.

 Good luck!

 Dr. Sam Speron

Sam Speron, MD
Chicago Plastic Surgeon

Confusion through multiple consultations

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You are confused with 2 recommendations from 2 different plastic surgeons. You can see several more and may obtain additional options - and more confusion; or you may find some general trend. Of course, there potentially can be several ways to accomplish an end in plastic surgery.

Silicone implants definitely provide a more natural result in look and feel and are aesthetically preferred over saline by most patients (essentially all). They also last longer and rarely are associated with rippling. Saline implants above the muscle can be a nightmare and more so with a relatively thin person.

Some photos would help with more specific recommendations.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.7 out of 5 stars 33 reviews

Saline vs Silicone Implants

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It is so wonderful that we have a choice in implants! While many patients have a good result with either implant, there are definitely situations in which I prefer a gel implant. Certainly a patient having a lift and implant is one of them. The gels are lighter, have a more natural feel, and last much longer. They are more expensive, but I think well worth the additional costs.

Ann F. Reilley, MD (retired)
Baton Rouge Plastic Surgeon

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.