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.