Cohesive Breast Implants or Saline? (photo)

I am 5'3 and 112 lbs. I want to get breast implants but I'm very afraid of using silicone since it can rupture or leak inside my body. Are the new FDA cohesive silicone implants 100% safe from rupture or at least leakage? And if not, would I be able to get saline implants under the muscle without the possibility of seeing ripples on or around my breasts? I wish that I could go with saline implants since I'd feel safer but I'm so afraid of making things worse (i.e. ripples).

Doctor Answers 9

Solid silicone implants don't leak

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While today's silicone gel implants can rupture, because the gel is so "cohesive," meaning it "sticks together," it will not run or leak like a liquid.  It will behave more like the inside of a marshmallow, and just like a marshmallow won't pour out when you cut into it, neither will a gel implant.  Furthermore, multiple, multiple studies have shown that even when a gel implant ruptures and the gel contacts the tissues, there have been no systemic health risks like disease or sickness.  On the other hand, saline implants rupture and leak more frequently than gel, and they also ripple and tend to be more palpable.  Thus, I am statistically much more likely to return to the operating room for problems or dissatisfaction with saline implants than gel.  Another thing to consider when selecting an implant is whether to use a shaped or round implant.  If you are considering cohesive gel implants, and you do not wish to have a round and prominent upper contour to your breast, a shaped implant can be used to avoid too much projection at the top of the breast.  Such shaped implants are really not an option when using saline.

San Diego Plastic Surgeon

Breast implants saline vs. silicone and rippling

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All of your concerns are valid and cannot be fully addressed in this format. You will need to consult with plastic surgeons face to face before making any decisions.

Your options which you already know are under vs. over the muscle and saline vs. silicone. You need to also consider surgical approaches i.e. nipple, breast crease or armpit incisions.

Every option has its own pros and cons. Saline can be placed through smaller incisions, rupture is usually obvious, are cheaper etc. but do not feel as natural and have higher incidences of visible rippling. Silicone feels more natural and has less risk of visible rippling but need a larger skin incision especially the highly cohesive ones. There is no way to guarantee that there would be absolutely no leakage or rupture of a silicone implant (highly cohesive or not).

It sounds like you are more inclined towards saline but are worried about possible rippling. This is less likely if the implants are placed under the muscles but you would always have some rippling in the lower outer quadrant where the muscle does not cover them and if you cannot see rippling you would be able to feel it.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Silicone vs saline

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Form stable cohesive gel implants are the norm rather than the exception in Australia and are safe. The advantage that they have over saline implants is that you can augment the natural form of a breast rather than enlarging it without consideration for correct form and symmetry. 


Hope this helps


Saline solution Breast Implants VS   cohesive gel Silicone breast implants

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Today the gold standard in breast augmentation surgery is the use of cohesive gel  silicone implants.  Saline solution implants  trend  into the disappearance or  total disuse.  Saline solution implants have no advantage over implants of  silicone gel, saline solution implants have not  lowers risk of  reported complications than cohesive gel silicone   implant, however cohesive gel silicone implants have some advantages. Let me explain:
1) saline solution implants have a covering of silicone implants like cohesive silicone gel, saline solution implants are largely affected by the force of gravity and this effect contributes to a greater propensity to produce the content is scroll down and the upper pole of the breast is empty, however this effect is smaller in cohesive gel implants and breast have a full upper pole and therefore a more attractive neckline,
2) saline solution implants with or without rupture could leakage  and thus can reduce its volume and to deflate, that does not happen in cohesive gel silicone  implants  which even  breaked   its content remains attached and circumscribed to  the  same pocket  and within the capsule formed by the body to isolate it, thus  there is not spill or dissemination of silicone
3) both type  of implants can be placed equally  in the plane  submammary or retro muscle, that will depend on the texture of each patient
4) has not been demonstrated in any studies that implants have a higher incidence of both capsular contracture or  breast cancer risk relating  to the filling type (cohesive gel or saline solution)
5) the silicone gel implants are more stable in terms of form therefore better preserved breast form over time and less effect of fall or ptosis
6) The rippling is not related to the filling of implants but with the thickness of the tissue on which it is implanted then the patient with little or thin  breast tissue are favored with the placement of implants in the retro muscle space thereby decreases the risk of rippling and ptosis
In the case of the patient presented in the picture who is apparently a young patient with little breast tissue and small areolas, I recommend the use of cohesive gel  silicone implants  extra high profile (they are safe and have stood the test of time) in the retro muscle space  to reduce or avoid the risk of rippling.
Regarding the way of placement will depend on the experience and preference of the surgeon also of the election of the patient but could be used periareolar via, axillary route  or  mammary fold , each of these surgical approaches have advantages and disadvantages which should be discussed between physician and patient..
In terms of volume to place will depend on the wishes of the patient (discussed with  her doctor) and the approach chosen but I  recommend implants with smaller base than the base of the breast.

Jose Luis Acosta Collado,MD
Dominican Plastic Surgeon

Jose Luis Acosta Collado, MD
Dominican Republic Plastic Surgeon

Saline implants

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The cohesive gel implant has a low leakage rate but an implant is not made today that does not occasionally leak. Many women have saline implants that are placed   in the subpectoral space and do not show rippling. You need to have a consultation to evaluate the natural breat tissue you have to cover the implant.

Ronald Iverson, MD
Pleasanton Plastic Surgeon

Silicone Breast Implants are Very Safe

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In comparing the two implants you need to determine what you want. If you desire a more natural feel with less rippling, then silicone is the best choice. Both implants are very safe, and in fact, the leak rate of silicone implants is lower than saline implants. If a silicone implant ruptures then the gel is most likely held within the capsule and the implant would just need to be removed. In a saline implant the size would decrease on a daily basis. I advise you to sleep on it and determine what YOU really want in implants.

Itzhak Nir, MD, FACS
West Palm Beach Plastic Surgeon
4.9 out of 5 stars 41 reviews

Cohesive Breast Implants or Saline?

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       The form stable implants are less likely to rupture and have less rippling.  However, saline does have its benefits.  If you have saline placed, placement under the muscle will be imperative.  Remember that all implants have the ability to thin tissues over time and that the implant and its contours will become more visable.  Kenneth Hughes, MD Los Angeles, CA

Cohesive Breast Implants or Saline? (photo)

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If you need 100% guarantees, think death and taxes, not surgery. No implants are 100% free from leak. All saline implants have ripples to some extent. 

Every patient having any medical intervention is balancing benefits with risks. Risks are always present, and ideally they are overwhelmed by the potential benefits. 

Best bet for you will be a consultation with a plastic surgeon. RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S. Thank you for your question, best wishes

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Saline and silicone filled gel implants are options for most patients.

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First of all ruptured silicone gel implants of any kind do not leak all over the body. The capsule forms around the prosthesis contains all silicone. The picture demonstrates a modest amount of breast tissue but enough to cover irregularities one would see the saline implant provided the patient does not want to be too large in the implants are placed under the muscle.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 41 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.