Silicone or saline implants - which is a healthier choice?

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).

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

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—like in your case—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