Are saline implants really that different feeling than silicone?

Question

I know many women say that saline implants feel harder to the touch and feel like they have water balloons on their chest. I feel safer getting saline implants though, but want them to look and feel as natural as possible. Is silicone the way to go or will I get the natural feeling results I want with saline too?

Austin Hayes, MD · Answer

Silicone implants feel more natural and have not been shown to cause any autoimmune issues. Your comfort with the procedure is a major concern, so make sure you hear all of the pros and cons of saline and silicone implants so that you can move forward with confidence.

Gerald Minniti, MD, FACS · Answer

Hello,
Are you a science denier? Do you believe in 'alternate facts'? The answer is yes if you think silicone gel implants are not safe or less safe than saline implants. Millions of women for many decades have gotten silicone gel implants and have not been at higher risk for illnesses like auto immune disease, fibromyalgia, or chronic fatigue syndrome. Scientific studies involving hundreds of thousands of women over decades have evaluated silicone gel implant safety and concluded they are safe. Silicone gel implants are more durable, higher performing, and less traumatic to your natural tissues. More than 90% of women in the US get them today.  Be bold and be a part of the modern world! Go visit a few ABPS certified/ASAPS member surgeons who specialize in breast surgery. Oh, and insist on an inframammary incision to minimize the risk of the most common complication of breast augmentation, capsular contracture. Best of luck!

Jed H. Horowitz, MD, FACS · Answer

Saline implants vs Silicone implants :  Which is the Ideal Implant?We rarely use traditional saline implants unless the patient requests a TUBA procedure.Other wise we will tell our undecided patients the benefit of the Ideal Structured saline implant The IDEAL IMPLANT® is essentially a structured double-lumen saline implant similar to a balloon within a balloon, complete with an inner and outer shell that not only supports the shape but also gives the implant a more natural feel. Depending on the size of the implants, in the outer  lumens are one to three baffle shells, which float within the saline of the outer lumen to make the saline feel more viscous similar to silicone. The internal structure of IDEAL IMPLANT Structured Breast Implant also controls the sloshing movement of the saline solution seen in other saline implants, making it feel less like water and behave more like natural breasts would.
 
AM I A CANDIDATE FOR IDEAL STRUCTURED BREAST IMPLANT® ?
An IDEAL Structured Breast IMPLANT® candidate is someone who likes the natural feel of silicone implants but also wants the benefits and peace of mind of a saline implant. The candidate should be over the age of 18 but not currently pregnant, breastfeeding, or with an active infection anywhere within the body. Patients with existing cancer or pre-cancer who have not received adequate treatment, as well as patients with bleeding disorders or poor overall health, may not be good candidates for the implants.  Candidates for breast implants have a choice of 3 main incision sites which are underneath the fold of the breast, through the areola, or the armpit. The insertion site for the IDEAL IMPLANT® can be made in any of these places.
 
RECOVERY AND DOWNTIME OF THE IDEAL STRUCTURED BREAST IMPLANT®
The recovery after having an IDEAL IMPLANT®   breast augmentation is comparable to traditional breast implant surgeries. The patient will be sore but is expected to be ambulatory and maintain some arm movement throughout the day to help reduce complications. There will also be a potential for bruising and some swelling after the implant procedure. The downtime really depends on the work and other related activities of the patient. A patient who has a physically demanding job may need four to six weeks off after the procedure but a patient who sits at a desk might only need less than a week off from work. Patients should not do any heavy lifting or physical exercise until they are cleared to do so by their doctor.
 
RESULTS OF IDEAL STRUCTURED BREAST IMPLANT®  
The IDEAL Structured Breast IMPLANT® has a 5.7% five year capsular contracture rate which is lower than saline or silicone implants. A 5-year clinical test was conducted to determine the effectiveness of IDEAL IMPLANT. The test results showed that the IDEAL Structured Breast Implant had a lower rate of infection, deflation, and wrinkling compared to saline or silicone implants.  In general, a woman with breast implants will likely have an improved look over a person without breast implants. When breast tissue is stretched or sagging due to aging or pregnancy, the breast loses some volume on top. An implant maintains the volume on top which can be a plus for a woman after pregnancy.   
 
LIMITATIONS AND RISKS OF IDEAL STRUCTURED BREAST IMPLANT®
Because  saline implants have only one lumen, it can be rolled up like a cigar and then placed through a tunnel starting from an incision in the  belly button and filled with saline once inside the breast. The IDEAL Structured Breast Implant ® procedure is limited in that respect because it has two lumens and small baffle shells. However, the incision is slightly smaller and hence there is less scarring than the silicone gel implant since it can be filled inside of the body rather than outside like silicone implants. As the IDEAL IMPLANT® has only been recently released for general use by the FDA, they are limited in some of the very small and very large size selections for the moment, but the most common sizes are readily available.  The manufacturer is currently working on producing a wider array of implant sizes once the demand is sufficient.
The IDEAL IMPLANT is subject to the same risks as standard saline implants. The implant could rupture but since it is saline, the body will safely absorb it just like drinking a glass of water.  If a silicone implant ruptures, the patient usually cannot see or feel a difference. With the IDEAL Structured Breast Implant ®, there are no expensive tests to check for leaks since a patient can see the deflation immediately in a mirror.  With any ruptured implant, the patient will need a follow-up procedure in order to replace the damaged implant. There is a warranty against rupture by the manufacturer that covers this problem.
Although the rate of capsular contracture is lower with this type of implant, it is still a risk. The scar tissue can build up and press against the implant causing it to become firm, too high, and even cause discomfort while the capsule pushes the implant upwards on the chest wall. 
 
AVAILABLE TO TRAINED PROFESSIONALS ONLY
At a safeguard to patients, the IDEAL Structured Breast Implant® is only sold to board-certified or board-eligible plastic surgeons certified by the American Board of Plastic Surgery. A patient looking to have this procedure done can be assured that their surgeon has been properly trained to perform the procedure. Limiting the distribution of IDEAL IMPLANT® to knowledgeable and well trained surgeons is an effort to minimize the risk of botched implants and complications.
 Top TEN reasons to choose the IDEAL IMPLANT
Natural , youthful look and feelLOWEST rupture rateLOWEST capsular contracture rate·      Board Certified Plastic Surgeons ONlY !!
·      NEWEST Implant Technology Available
·      Revision less likely and less often: low maintenance
·      No “silent rupture “
·      Implant revision is easier, quicker and less expensive
·      Warranty: $2400 for surgery and implants
·      Highest implant strength

Urmen Desai, MD, MPH, FACS · Answer

This depends on hoe much breast tissue you have to begin with which will cover the implant.  I recommend silicone for a more natural feeling. I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified Beverly Hills Plastic Surgeon

Daniel Barrett, MD · Answer

Dear Jessica52386,The pros of silicone implants are that they look and feel more natural and ripple less. 
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.Breast implant type and size selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion of the pros and cons of the various types and sizes. But the decision will always start and end with the patient. Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Donovan Rosas, MD · Answer

While both implant types are safe, patients tend to prefer silicone implants due to the lower incidence of rippling as well as the qualitative feel ("more natural"). The "feel" is difficult to define. Saline implants tend to have a more tense "feel." This is due to the fact that they are usually over filled in order to mitigate the risk of rippling (think of an under inflated balloon vs. a maximally inflated balloon). But the "feel" is subjective and will vary from one patient to another. What one may deem "unnatural" will vary.However, the ultimate result is dependent upon the starting point. A patient with adequate breast tissue to camouflage the device will likely achieve a reasonable result from either option.As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Tim Sayed, MD, MBA, FACS · Answer

You might want to consider the Ideal Implant device - it costs more but was designed explicitly for patients with your same kinds of concerns. Disclosure: I am an investor in the Ideal Implant company but only invested because I believe in the technology and am one of few surgeons who are offering this new device. Saline and silicone implants, along with this newer Ideal Implant (a type of saline implant designed to feel like a silicone device), are all FDA-approved breast implants in the US. Patients have a variety of choices when deciding on implant size, style, manufacturer, profile, etc. Here is a simple list of pros and cons of various implant choices:
Saline Implants
Saline implants are introduced deflated and filled with sterile salt water in the operating room. For this reason, they can often be placed through slightly shorter incisions, though it really depends on the pocket size and the ability of the surgeon to safely create the pocket through the planned incision approach.Saline implants may feel slightly firmer to the touch when the breast is handled; this is because the water in the bag is less compressible than silicone and the shell can feel stiffer when the water is compressed, like a water balloon. Some patients want this firmer, stiffer look and feel, whereas others think this is less natural.Saline implants can leak and if they do, the fluid will typically come out of the device and it will deflate, requiring replacement.Some surgeons believe saline implants are more likely to ripple, causing unusual waviness to the breast.Leaking saline fluid is harmless in the absence of infection, so some patients prefer this for piece of mind.Any patient who is a candidate for breast augmentation can have saline implants without age restriction.Saline implants generally cost a little less than silicone implants.Sometimes patients can detect sloshing of fluid in the implants, which may be annoying.Silicone Implants
Silicone implants generally are preferred by most plastic surgeons because they tend to feel more like natural breasts. There is a “give” when a silicone implant is squeezed, which can make the implant harder to detect inside the breast.Silicone implants are now manufactured with a next generation silicone gel that is more cohesive, which means the implants are unlikely to spill out silicone if the shell loses its integrity. This is one of the main issues that originally led to problems with the older generation silicone implants. The newer generation are often referred to as “gummy bear” implants because the consistency of the gel is more uniform and less likely to liquefy.A leaking silicone implant may not result in symptoms, as the gel stays together better and usually remains inside the capsule of the implant. In uncommon cases, silicone can leak out and cause a local reaction of painful hardening or swelling.If a silicone implant is shown to be leaking on mammogram or MRI, plastic surgeons usually recommend replacing it to reduce the risk of inflammatory reactions, and also for patient piece of mind.The FDA recommends an MRI after silicone breast augmentation every few years after surgery as a matter of surveillance in order to continue to gather long-term data, and also because the rare implant that leaks may not show symptoms.The FDA recommends that only patients 22 and older have silicone implants.Silicone implants cost more to manufacture and test so they cost more to put in.Sometimes the incision needs to be larger, especially if very big implants are being put in, since the silicone is already pre-filled in the implant.Ideal Implant
The Ideal Implant is a brand name of a new, FDA-approved saline implant that is designed with internal chambers to “slosh” around less, giving more of a silicone feel to the device.These implants are very new and are not yet mass marketed and mass produced, which means they cost more.Long-term data is not yet available on leak rates but early data is very encouraging, and these implants share the benefit of saline implants in terms of just containing salt water in the event of a leak.The procedure may take a little longer because the device has to be filled a little differently from the regular saline implants.Not many surgeons have much experience with this type of implant yet, but more and more are starting to use them.Incision size can be around the same size as regular saline implants.

Milind K. Ambe, MD · Answer

Thank you for your question.  In general most women would agree that silicone feels softer (and usually looks more natural).  That being said it really also depends on how much natural breast tissue you have.  The more of your own tissue you have, the less important above information is.  You can still have a natural look to saline implants as long as you have enough of your own breast tissue and the pocket is made the right way.  Best of luck to you

Johnson C. Lee, MD · Answer

From the general responses of my patients who have switched between implant materials, they feel that the silicone implants feel more natural. The current generation of silicone implants are extremely safe and there are hundreds of scientific research publications evaluating the safety of silicone implants. It is best to have an in-office examination to determine the ideal implant type for your body and so you can feel saline and silicone implant samples for yourself. Hope this helps!

Johnson C. Lee, MD Plastic Surgery

Johnson C. Lee, MD Plastic Surgery

Tom J. Pousti, MD · Answer

Good question. Much of the final look and feel 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. In other words, if a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
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 or D cup” etc
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. Summary: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as discussed above. Working together you will come up with a good plan to achieve your goals.  
Best wishes.

Are saline implants really that different feeling than silicone?

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