Chances of Add'l Surgery Within 5 Years - Silicone Vs Saline? I Am Having Surgery Soon.

Info on Mentor silicone implants scared me. I don't want repeated surgeries (I understand risks and complication factors). In general, if surgery goes well and recovery is normal, what are changes for repeated surgery within 5 years and does it make any difference if it is saline or silicone? Mine will be under the muscle. THX !

Doctor Answers 9

Silicone vs. saline implants: chances of revisional surgery

Revisional surgery can be needed for a number of reasons including patient dissatisfaction with shape/size, capsular contracture, infection etc. Capsular contracture rate depends on implant factors (surface of the implant - smooth or textured), early problems such as bleeding or subclinical infection and position of implant (under the muscle or just under the gland tissue). So to answer your question, the content of the implant does not directly influence the rate of revisional surgery. However the content is important in other ways such as the feel of the implant and the length of the incision.

Lastly, just for your information, silicone implants have been shown to be perfectly safe all over the world and even saline implants have a silicone coating.

Birmingham Plastic Surgeon
4.8 out of 5 stars 32 reviews

Need for implant revision

The implant revision rate stated by implants manufacturers is unsettling for many patients but patients need to really accept  that the revision rate is substantial.  Many, many revisions are done because patients want a really good result to be even better or they want a different size.  In these cases, revision was not really "necessary".  All of these "unnecessary" revision cases are thrown in with reivison done for more serious reasons such as malposition or major asymmetry or capsular contracture. 

Thank being said, no woman should have breast augmentation unless she is willing to accept the fact that she made need a revision. 

Lisa Lynn Sowder, M.D.

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 73 reviews

What are the chances of needing surgery within five years after breast implants.

I know the statistics are frightening.These are general statistics. If you find an experienced and competent plastic surgeon the risks of re-operation is nowhere near those statistics. Most re operations are due to implants being too big for the patients frame and tissues. There is no question that the larger the implant is the more there are chances of complications. Patients come in asking for a certain size implant because their girl friend had that size. I examine them carefully and give them a narrow range of sizes to chose from depending on the physical findings. If they don't agree with my recommendation I will not proceed with the surgery. By adhering to these principles I keep my re-operation rate to a minimum.

Farhad Rafizadeh, MD
Morristown Plastic Surgeon
4.9 out of 5 stars 48 reviews

FDA information is MEANT to "scare" you!

Please realize that the FDA-mandated booklet is meant to outline every possible complication that has EVER been reported in conjunction with breast implants.

Never mind that the present (5th) generation of silicone gel implants is the safest, most-studied medical device in the FDA's history. These implants are cohesive and cannot leak or rupture; the older silicone implants were associated with leakage, higher capsular contracture rates, and re-operations, but now I believe that saline implants (which the media and many doctors have repeatedly taught us are "safer" than those "maybe bad" silicone gel implants) actually have a HIGHER rate of re-operation than silicone implants. Saline implants are more susceptible to rippling (particularly if underfilled), and eventual shell failure, leakage, and deflation, which ALWAYS requires re-operation for a new implant. Skillfully-placed silicone gel implants have very little or no  rippling, feel softer and more natural, cannot leak or rupture, and have no higher tendency for capsular contracture than their saline cousins.

Most re-operations are for size change, not for problems such as capsular contracture, infection, malposition, or leakage. Surgeons who do only a few dozen of these operations a year, or surgeons who are not ABPS-certified plastic surgeons have a higher rate of complications and re-operations. (Just read the questions about breast implants on this site if you think that every surgeon is well-versed in this procedure!)

To put things in perspective, if you read the FDA package insert about aspirin, you would be scared about anaphylaxis, Stevens-Johnson syndrome, gastric bleeding or ulceration, colon bleeding, and a host of other "possible" (but unlikely) reactions to the common Bayer aspirin.

I have been performing breast augmentation for 26 years, including my two years of plastic surgery training at the Mayo Clinic. I perform several hundred breast surgeries each year and have done so for many years. Breast augmentation has been the most common operation in my practice for the past seven years, and in the nation for the past three years. I can attest that my re-operation rate is well below 10% for ANY reason, and the majority, despite careful discussion, is still about size change (usually larger).

I would suggest that you take the FDA booklet warnings with a truckload of salt, and trust your surgeon's recommendations. If you don't have a good feeling about him or her, get other opinions until you get that feeling of satisfaction and confidence in your choice. I would highly recommend silicone gel implants (either manufacturer's implants are cohesive and very similar); saline are truly "second-class" but work fine for those who choose them. Every one of my nursing staff who had saline implants has had them exchanged for silicone, just to give you an idea about the "inside" information recommendation! Read the link below for much more information! Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Probably not within 5 years


As you are starting to look into the risks and benefits of breast implants, you are finding that different implants have different problems that can arise. Five years is early for either implant type to have a very high possibility of having these problems though unless you go quite large on your implants or have them put in by an inexperienced surgeon.

Silicone implants have a higher possibility of having reaction issues and breast hardening, but this tends to happen over 10 years or more. The saline-filed implants can feel less natural especially in women with less tissue and can rupture over the 10-20 year interval usually.


Best Regards,


John Di Saia MD



John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 27 reviews

Depends on your breast shape and tissue

In general the rate of revision breast surgery is around 20% nationwide for straight augmentation and 40% for augmentation/lift. These are published data and your surgeon may have higher or Lower rate. The long term reoperation rate is 100% after 10-12 years.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 124 reviews

Complication after Breast Augmentation?

Thank you for the question.

Although it is not possible to give you precise statistics for a five-year reoperation rate,  my best estimate would be somewhere between 10 to 15% chance. Chances will very depending on your choice of surgeon (as well as other variables);  be careful with this selection.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,498 reviews

Risk of revisions after breast augmentation

Assuming that surgery and recovery go well, as is almost always the case, the main reason for needing revision surgery in the first few years would be for capsular contracture.  This is estimated to occur in perhaps 9-10% of women, and most commonly seems to occur in the first year, although it can occur after that.  Most other complications that require revision can be avoided by going to a good and careful surgeon and by being sure that your expectations regarding size and contour are communicated to that surgeon, who takes the time to understand those expectations and to educate you if your expectations are unrealistic or cannot be met.  There are additional problems that can occur that are related to unusual healing (poor scars, "drop out" from pockets that stretch too much despite careful surgical pocket dissection, etc.) but these are relatively rare.  Need for revisions seem to be a bit higher with saline implants due to a somewhat higher risk of implant "drop out" than with silicone gel implants, to the higher risk of visible and certainly palpable implant wrinkling that can occur in thinner patients and that can lead to patient dissatisfaction, and to a somewhat higher risk of implant deflation with saline implants.

Robert M. Grenley, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 87 reviews

Silicone vs Saline

Our happiest patients are the ones that have their saline implants removed from behind the muscle and silicone implants placed behing the fascia, infront of the muscle.  Silicone is lighter than saline, has more shock absorbability and also feels more natural.

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

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.