Breast augmentation general questions, silicone or saline?

Hi everyone! I am 20 years old, currently 32B & looking to become a full D. I've DREAMED of having big beautiful full breasts and have decided now is the time! I have a consultation scheduled out here in CO Springs but I'm also new to the area and curious if any of you ladies would recommend Dr.'s in the Denver/Springs area that have given you amazing results? I would love to have silicone but due to the age limit being 22, I suppose saline will work? What are the experiences with saline like?

Doctor Answers 11

Yes, you CAN legally have silicone gel implants under the age of 22!

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Silicone gel implants are FDA-approved medical devices that licensed physicians (should be ABPS-certified plastic surgeons) can legally use in any patient they choose. Use in patients younger than 22 are considered "off label," but off-label use is commonplace in medicine and surgery, and entirely legal.

You will find many plastic surgeons who will tell you that it is "illegal," or prohibited by the FDA, or restricted by our society to use silicone implants in a woman under age 22. It is perfectly legal, ethical, and appropriate for a plastic surgeon to use silicone gel implants in an informed woman under the age of 22 who requests their use. This is considered "off-label" use, and this is not only legal but quite common in medicine and surgery.

For example, I would bet that every surgeon who answers your questions about silicone implants uses Botox for the forehead and other areas of the face besides frown lines and crow's feet, although Botox Cosmetic is FDA-approved ONLY for the treatment of glabellar frown lines (between the eyebrows), and more recently, crow's feet. No other areas are FDA approved, but Botox is used for many areas other than the two FDA approved ones--this is an example of off-label use. Many others exist, and most physicians and surgeons ethically and legally use medications and devices (like silicone implants) off-label.

Perhaps those who claim silicone implants cannot be used in you because you are "too young" or cannot be properly "informed, choose not to understand the comparison, but if a well-educated and properly-informed women chooses to ask me for silicone implants, I am more than happy to use them. I will publicly state I have done so for properly-informed 18-22 year old women who have asked me to do so.

This is not a "new" issue, but many of my colleagues still cling to this inappropriate FDA "age restriction" despite legal age to vote or go to war in the service of our country being age 18. Click on the web reference link below to see where I answered a similar question 4 years ago, when Botox was only FDA-approved for frown lines. Now, it is approved for crow's feet as well, but still you will receive answers saying you "can't" have silicone implants.

Take the time to find an ABPS-certified plastic surgeon who is experienced enough to respect your requests and is willing to provide informed consent and off-label use of your chosen implants. Best wishes! Dr. Tholen

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Breast Augmentation when younger

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Dear jaix3,
It is very important to do your research before deciding on your surgeon, your implant type, and your ultimate size selection. The FDA recommends silicone for patients 22 and older, but this is only because younger patients were not part of the clinical trials that were done when the implants were re-approved in 2008. Each physician can evaluate you and counsel you about which implants may be best for you, as they do for all patients. It is still possible to use silicone "off label" if it is truly best for you and you are fully informed. I have heard that perhaps the warranty from the company might not be honored if using them off label. Younger patients are typically better candidates for saline than older patients because younger breast tissue has a firmer quality and better camouflages the feel of the saline. You will certainly have many sets of implants over your lifetime, so saline "starters" are a reasonable choice for many who would consider switching to silicone after having their children. There is certainly no one right answer or plan for every patient.
Best of luck on your journey and if Denver isn't too far a drive (I have many patients in the Springs) I would be happy to see you.

Stacey Folk, MD
Denver Plastic Surgeon
4.8 out of 5 stars 25 reviews

Saline vs Silicone

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Saline and Silicone, Safety and PerformanceWomen have so far had essentially just two breast implant fill choices: saline or silicone.
Silicone implants have distinct advantages over saline implants in terms of performance: they wrinkle less and conform to a more natural breast shape, and also have a softer feel that is more breast-like. However, silicone implants have gained a reputation—possibly undeserved—for being less safe than saline implants. Despite the fact that there is no known toxicity of silicone gel breast implants, the possibility of a “silent rupture,” undetectable except by MRI, has been enough to make many women opt for saline implants or wait for a better product to come along. The time will be here most likely within a year or so with the advent of the Ideal Implant, the name given to a new design saline hybrid implant. It has the natural feel of silicone and safety of saline.
Saline implants, though providing peace of mind by being perceived as safer than silicone, often do not create a result that seems as natural. Wrinkling, scalloping, a globular shape, and water balloon-like feel, and increased risk of capsular contracture have been the trade-off for peace of mind with breast implants. The Ideal Implant solves many if not all of these concerns.
The Ideal Implant has bothThe Ideal Implant is one of the major technological advances to come along in the past few decades in implant manufacture. Using a novel design with internal baffles, the saline implant is manufactured to achieve a similar feel and performance comparable to a silicone implant. Approximately 95% of both patients and their surgeons expressed satisfaction at the current two-year data point by the FDA. The Ideal Breast Implant is now FDA approved and soon to be released in the US market, hopefully with in the year.

Breast augmentation general questions, silicone or saline?

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Both saline and silicone can give very nice results. However it is particularly important that saline be placed under the chest muscle for more coverage and a better result. See an experienced board certified plastic surgeon with good reviews on Nothing wrong with waiting two years and getting Silicone if that is your preference.

Breast Implants / Breast Augmentation/ Cohesive Gel Implants / Silicone Implants / Revision Breast Surgery

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I appreciate your question.

The size of implant best for you is dictated by your chest wall measurements. Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.

Silicone will give you a fullness at the top (upper pole fullness).
Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion.

Anatomic gummy bear implants might be a good choice to give you volume.
These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.

During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers.

The best way to assess and give true advice would be an in-person exam.
Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

best of luck!

Dr Schwartz
Board Certified Plastic Surgeon
Director-Beverly Hills Breast and Body Institute

Either implant type can deliver beautiful results.

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Choosing the right type and size of implant for your breast augmentation can feel like an overwhelming task, as there are many things to consider.There are pros and cons to both saline and silicone implants, and opting for one over the other can be influenced by such things as your body type and natural anatomy, as well as what kinds of results you are looking for.I suggest clearly communicating your goals with your plastic surgeon by bringing in some photo examples of your "dream look," and from there your plastic surgeon can offer customized guidance on the best implant type and size for you. Good luck!

Silicone or Saline - Silicone vs. Saline Breast Implants

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Both saline and silicone implants are FDA approved for cosmetic breast augmentation in the United States. Clinical trials demonstrate similar infection, failure and re-operation rates. Neither type of implant causes breast cancer. Despite lawsuits, and internet horror stories, medical studies do not link silicone implants to autoimmune disease like lupus, scleroderma or rheumatoid arthritis.
The major difference between saline and silicone implants is how the implants look and feel. In general silicone implants are softer, lighter and will feel more "natural." Saline implants are firmer, rounder and gives a more augmented or fake look. These can be positives or negatives depending upon your goals. The main downside to saline is increased scalloping and rippling, meaning a higher likelihood of seeing (visibility) or feeling (palpability) the implant in thin patients. The only two things that control implant visibility and palpability are the device itself and the amount, and quality, of tissue above the implant hiding it. Therefore, the type of implant selected plays a large role in your result in terms of both look and feel. The vast majority of my patients select silicone implants.
Interestingly, when we refer to silicone or saline, we are talking about the inner fill material. Both saline and silicone implants have the same silicone shell, so the body is exposed to the exact same material for the majority of woman who never experience a failure. Only if the shell was to fail would the breast pocket and capsule be exposed to the fill material. Saline is absorbed and urinated out, silicone gel remains inert, and except in extraordinary cases, stays within the breast pocket.
One factor that should not be considered when considering the difference between saline and silicone breast implants is price. A few hundred dollars is a small difference upfront, for a device you may have for decades. Additionally, both implants carry a lifetime warranty against device failure, but the silicone implant includes a 10-year warranty to help pay some of the surgery fees (up to $3500) should the device fail. To put it simply, both have a lifetime “parts” warranty and silicone includes a 10 year “labor” warranty while that “labor” portion of the warranty is an additional $200 for saline, thereby negating most of the price savings.

Implant size

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The best way to pick implant size is based on your breast and chest width and not the volume. As the implants get bigger, they get wider. When the width of the implant fits the width of your chest, it will look nice and fit your frame. If the implants are too small, you will have a gap between them and they may look too far apart. If they are too wide, they will make you look top heavy as they may be too wide and stick well out past the sides of your chest. There are ways to get a bigger or smaller look.This can be done by picking a different implant profile. The higher the profile, the narrower the base width of the implant. If someone has a very narrow chest and wants to be big, they should consider a higher profile implant. If someone has a broad chest and they do not want to be too big but want to avoid the gap and still have cleavage without projection, they should consider a lower profile implant such as a moderate. There are options in between these such as the moderate plus. I prefer the underarm approach so there is no scar on your breast. The new silicone is the only way to go as far a rippling as the new silicone ripples much less than saline, especially in the larger implants.

Dr Ennis

Lawrence Scott Ennis, MD, FACS
Pensacola Plastic Surgeon
5.0 out of 5 stars 162 reviews

Saline vs Silicone Breast Implants

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There are 4 basic questions that need to be answered when considering breast implant surgery:

  1. What type of implant (saline vs silicone, profile, shaped)
  2. Placement of the implant either above or below the muscle
  3. Incision choice (under the breast, under the nipple, through the armpit or the belly button)
  4. Size of the implant
Of the 4 choices the size selection is the most difficult to determine. Regarding saline vs silicone, here are the advantages and disadvantages of each.

Saline:  Advantages
           1. Less expensive
           2. When it leaks/breaks it is obvious
           3. Can utilize any of the 4 incision choices
           4. Adjustable during the procedure
           5. Incision length shorter, therefore the scar is shorter


           1. When they break or leak they deflate immediately
           2. Ripple and wrinkle more often
           3. Less natural feel (they feel like a water balloon)

Silicone:  Advantages

          1. More natural feel
          2. Less wrinkling and rippling 
          3. If they break they do not deflate immediately


          1. More expensive
          2. Incision length longer
          3. Incision choice limited (either under the nipple or breast)

When silicone breast implants were re introduced on the market in 2006 the FDA recommended that the patients need to be 22 years of age to receive the implants.  This is a random and nonsensical selection by the FDA and we have found the age limit to make no difference.  Any person under the age of 22 can receive the implants as an "off label" use as agreed upon between the patient and the surgeon.  We do this all the time.

Please see a Board Certified Plastic Surgeon who specializes in breast implant surgery to assure the best possible results, Good Luck!

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 83 reviews

Breast augmentation general questions, silicone or saline?

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Thank you for your question. You can achieve very nice results with saline or silicone gel implants; both have their benefits and drawbacks and it would be wise for you to consult a board certified plastic surgeon with experience in both types of implants for an objective evaluation. Many plastic surgeons have a particular bias toward one type of implant or the other, but I believe that is largely based on their own comfort level with a certain type of implant.  I have extensive experience with both types of implants, and ultimately, it is the choice of the patient, and sometimes body type that determines which implant type is best for helping you achieve your goals.   For those who like the natural look and feel of silicone, we have found the IDEAL structured saline implant to be a great alternative.  It has all the benefits of silicone implants but no risk of silent rupture, which is one of the drawbacks of silicone gel implants.  You can check the IDEAL implant website for providers in the Colorado Springs area.  I hope this is helpful.  Best of luck to you. 

Steven L. Ringler, MD, FACS
Grand Rapids Plastic Surgeon
5.0 out of 5 stars 72 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.