Silicone or saline implants - which is a healthier choice?

Question

I am trying to decide between saline and silicone. I have had both and both have ruptured. Because I now have silicone, and the rupture is causing nerve pain and traveling to my lymph-nodes, I need to get it removed. I would like to get them replaced and am trying to research which is better.

John L. Burns Jr., MD · Answer

The vast majority of implants placed today are silicone due to the more natural look and feel.  If you are looking for a "healthier" implant you might consider Motiva.  The Motiva implant has a silk surface which is more biocompatible:  less inflammation around the implant and lower risk of capsular contracture.

Caner Kacmaz, MD · Answer

As a surgeon, I prefer silicone implants. Saline implants are mostly round and full in appearance, and firm to the touch. Silicone implants on the other hand, have more natural feel and resemble natural breast tissue when it comes to the shape and texture. Silicone implants also last longer than the saline implants.

Donovan Rosas, MD · Answer

Prospective breast augmentation patients face a number of decisions in the peri-operative period: implant size, implant position, access incision etc. Implant type i.e. "Saline vs Silicone" is among the most common. The short answer is that both are safe and reasonable options. However, in reality the choice is not simply a binary one.  There are many options and each has so-called strengths and weaknesses.

Following the FDA moratorium on the use of silicone gel filled breast in 1992, “cohesive gel implants” were introduced to the market. How do these devices differ from their predecessors? The silicone gel of a cohesive gel implant is firmer (via the addition of proprietary cross-linker). The greater the cross-linking the firmer the device will feel. The result is a filling that doesn’t leak when the shell is compromised in the way that a traditional liquid does. This quality is best illustrated when cutting a device in half…it doesn’t yield a gooey mess but instead two stable halves.

Saline implants are yet another safe option. The most obvious difference is in the fill. Saline implants are initially empty and ultimately filled on the OR table after insertion. This fact spotlights some of the advantages of the device. They are placed empty through smaller incisions. Fill volumes can be customized because they are not pre-filled offering a measure of flexibility (however, it is important to note that under-filled implants are more prone to rippling and subsequently more prone to failure as the crease becomes a physical weak point in the shell). Additionally from a technical perspective a device failure is easier to detect as a leaking implant will simply deflate over time and the saline will be absorbed by the body. This mitigates the need for surveillance MRI in the case of silicone devices which behave differently.

In general, traditional silicone implants are preferred over saline implants by many patients and surgeons for their more natural feel. and lower propensity for rippling. As when making decisions about any form of surgery, patients should have an in-depth consultation with their board certified plastic surgeon before selecting the type of implant to use. While form stable anatomic implants are newer, they may not be suitable for all patients.

In summary, both are safe. Silicone gels are preferred for their aesthetics. For those that prefer saline, it is usually a function of the ease of rupture diagnosis and subsequent removal.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Daniel Barrett, MD · Answer

Dear Exquisite720586,

there have been numerous studies on the safety and efficacy of silicone breast implants. The FDA has approved them to be safe and breast augmentation is the most common cosmetic surgical procedure performed in the United States every year. Implants are much different than they used to be with rigorous testing and cohesive gel. I can't tell you how happy my breast augmentation patients have been with their implants.

I would recommend a consult with a plastic surgeon to go over all of your concerns. Saline implants are also a perfectly good option if you are still concerned and are less expensive.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Erman Ak, MD · Answer

Sorry to hear about your experience with ruptures. If silicone has caused nerve pain and lymph node involvement, removing the current implants and capsule is the right first step.
In terms of replacement options, Saline implants may be a better choice in your case. If they rupture, the body absorbs the saline naturally, and the issue is immediately noticeable. Unlike Silicone implants that tend to feel more natural and maintain shape better, but when they rupture, it can be silent and&mdash;like in your case&mdash;lead to complications if not caught early.
Ultimately, it’s important to get a consultation in order to get the most suitable recommendation based on your medical history and personal goals.
Best, Erman AK, MDPlastic, Reconstructive & Aesthetic Surgeon

Anshu Gupta, MD · Answer

Thank you for your question. Overall, both saline and silicone implants are considered safe and effective options, with each having its own advantages. However, since you've experienced ruptures with both types, it's important to evaluate the underlying factors contributing to these issues, such as implant placement, tissue support, or other individual factors.
In cases like yours, my preference would lean toward saline implants. The main reason is that with saline, there’s no risk of foreign material leaking into your body. Saline is simply sterile salt water, and if a rupture occurs, your body absorbs it harmlessly within minutes.
That said, modern silicone implants&mdash;often called "gummy bear" implants&mdash;have improved safety features. The cohesive gel they’re made from is designed to stay intact even in the event of a rupture, meaning the silicone typically doesn’t migrate into tissues or lymph nodes.
Ultimately, the best option will depend on your specific circumstances, and a detailed consultation can help us determine what will work best for you moving forward.

Ira H. Rex III, MD · Answer

There is no right or wrong answer to this, but I might recommend using a saline implant since you already have been found to have silicone outside the implant.  Very little silicone leaks from the implant unless a rupture is present, and if you have another rupture, it might be more difficult to determine whether any silicone outside of the implant is new.

Ted Eisenberg, DO, FACOS, FAACS · Answer

In June 2020, Dr. Eric Swanson published the ﬁrst scientiﬁc study comparing saline and silicone breast implants through ultrasound examination and outcome surveys. He concluded that both implants produced similar degrees of palpable and visible rippling. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Gary M. Horndeski, MD · Answer

Unfortunately, you have not provided photographs or told us your bra size. However, if you have had both saline and silicone and both sets have ruptured, then you may want to consider a different approach. An alternative is fat transfers and another is a breast lift.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Camille Cash, MD · Answer

There are pros and cons to both silicone and saline implants.  You can review them both to decide which is for you.  Both are FDA approved and considered safe.  I've included a video that goes over both types to help you with your research.  Be sure to discuss your options with a board certified plastic surgeon who can go into more detail with you.

Silicone or saline implants - which is a healthier choice?

Answers (14)

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