Silicone Breast Implants Vs. Saline - How to Choose?

Which are better, silicone breast implants or saline breast implants?

Doctor Answers 129

The better breast implant

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If there was truely one implant that is better than the other...there would be only one implant available .  Each implant has its pro's and con's that you must accept.  Silicone feels and looks more natural and ripples less.  Saline feels and looks a little less natural and ripples more. The incision is smaller with saline and bigger with silicone.

If the saline implant ruptures you know because your breast becomes smaller, if silicone ruptures it is called 'silent' because there are typically no signs.  An MRI is recommended to determine if it is ruptured. Saline ruptures more frequently than silicone. I hope this helps.

Depends on your build

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Advantages of saline

  • Less expensive (about $1000 less)
  • Adjustability
  • Shorter scar (my scar is 1" long)
  • No silent ruptures - if they deflate/ rupture, there is no guessing or worrying
  • More volume choices - based on the patients optimal implant diameter and choice of implant size
  • Can be used in women under 22 years of age

Advantages of silicone

  • More natual feeling
  • Less risk of rippling

Generally silicone implants are ideal for the very thin patient with small breasts. In the larger patient with more implant coverage, the advantages of saline outweight the advantages of silicone.

York Jay Yates, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 185 reviews

Saline Breast Implants : The Basics

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Saline implants: the basics
Both Silicone and Saline Implants can look and feel natural. 
In the time since the moratorium was lifted, gel implants have gone from being used in my practice on rare occasion to being used in almost all the breast augmentations I perform. Patient satisfaction has been excellent and I have been very pleased with the performance of the new ‘cohesive’ gel material. However, most of my patients with saline implants, before silicone implants were an option remain please with their breast augmentation surgery and are not interested in "trading" implants
Gel implants are inserted pre-filled and thus require a larger skin incision than is used for saline implants. For this reason the most commonly used incision is one placed in the inframammary fold. The peri-areolar incision is acceptable in patients with a wide areolar diameter, but does not work as well if the areolar diameter is small. An axillary (underarm) incision can be used as well depending on the size of the breast implant
One distinct advantage of gel implants is the fact that in almost all cases the edges and anterior surface of the implant are not palpable, and it is thus very difficult to detect by touch or feel that an implant is present. In many cases it is actually impossible to detect the implant at all. This makes gel implants a very attractive option for women who are quite slender and have a small natural breast volume, as saline implants are usually very easily detected by touch or feel in these patients.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

"Risk" versus "Feel" for the most part

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Silicone gel implants are filled with a "jelly like" silicone substance to which the body reacts more over time. They come filled at one size and are not adjustable in the operating room. Saline implants are more adjustable and this allows better sizing during surgery. Long term capsules (scar formation with hardening) is more commonly a problem with silicone gel implants. The FDA recommendations are that patients with silicone gel implants have breast MRIs every two years to watch them. Insurance usually doesn't cover these and patients rarely get them. The bottom line is that there is likely more long term RISK with silicone gel over your lifetime.

On the other hand silicone gel implants FEEL more natural than saline filled implants particularly when placed "over the muscle." They ripple less when placed under thin soft tissue cover. Early on at least, they look more natural.

Women need to do their research and decide what is most important to them and proceed accordingly. Moderation in sizing with saline implants under the muscle is probably safer.

John P. Di Saia, MD
Orange Plastic Surgeon

Silicone Gel Breast Implants Vs. Saline Implants-How to Choose

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Most women in my Plastic Surgery practice today are choosing the new Silicone Gel Breast Implants.

The most common reasons women choose Silicone Gel Breast Implants are:

  • Natural Feel
  • Less risk of Implant Folds or Ripples
  • No risk of deflation

Saline Breast Implants are also excellent and can give an equally nice result. Risk of deflation and visible folds or ripples are drawbacks. Women choose them because

  • They fear Silicone
  • Want a "natural substance" in their body
  • Somewhat less risk of capsular contracture or fullness

Be sure to discuss this with your Plastic Surgeon who can give you guidance. Check the link below for more information.

In any market in the world, Silicone beats Saline EVERY TIME!

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Just look at the sales figures for SALINE implants vs SILICONE IMPLANTS anywhere in the world where both implant types are legally present for sale.  Silicone out sells Saline implants EVERY TIME.  That means, in mature markets, WOMEN DECIDE TO BUY SILICONE MORE OFTEN.  You can make up your own mind why that might be, but it suggests to me that Silicone implants out sell Saline implants because they are more desirable.  In my 20 plus years of experience,  I was trained in Silicone implants, then had to switch to Saline because of political interference in medicine, then switched back to Silicone implants when they became legal again.  Any patient who had Silicone implants that I had to switch to Saline (because of the law) did NOT like them, and wished they could have their silicone ones back.

 About 10 years ago, I started using the 'anatomic' shaped  implants, the Mentor CPG and the Inamed (now Allergan) 410 devices. These are highly crosslinked silicone implants sometimes called the 'gummy bear' implants because the silicone is solid, not liquid.  These have only one special complication that is not present in other implants- because they are shaped, they can become malpositioned (malrotated).  However, if regular silicone implants can give me a 8 out of 10 star result, these anatomic implants can give me a 10/10 result!  Before using these implants, I had NEVER had a patient return from their family doctor's annual exam where the doctor DID NOT EVEN REALIZE that the patient had implants!  This has now happened many times, and the results from these devices are an order of magnitude better than previous devices.  These devices give a very NATURAL result, where the breasts feel very 'normal' and full.  Unlike the round devices, these do NOT slide up and down in an oversized pocket.  This is called the 'one breast feel' by some, and it means that when squeezing these augmented breasts, the implant does not move around underneath the breast.  It just feels like a firm, youthful, full, normal (real) breast.    I have written several different book chapters on these devices, and they are a bit trickier for surgeon's to use compared to regular round devices.

 The goal of breast augmentation surgery  since the beginning (in 1962) has always been to create a natural feeling breast.  Over the past year, I have been doing Fat Grafting, taking the 'muffin top' fat away from the lower body and putting it into the breast.  This is the ultimate natural breast, since there is NO implant at all.  This is still controversial, but the results have been fantastic.

Claudio DeLorenzi, MD
Toronto Plastic Surgeon

Saline vs. Silicone breast implants

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Both saline and silicone implants will give you a beautiful, natural result.  Silicone implants feel softer and more natural like normal breast tissue.  Saline implants tend to be more firm and ripple more than silicone.  However, if you have a decent amount of natural breast tissue like a B or C cup, the difference between saline and silicone will be much less obvious.  If you are very thin and have no breast tissue, silicone implants will look and feel more natural.  As you can see, there are pros and cons to both types of implants.  Consulting with an experienced board-certified plastic surgeon is essential to the decision making process. 

Patients must educate themselves in the pros and cons of each implant and then decide which they prefer.

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I find that many individuals considering breast augmentation are in the dark about which implant to choose between saline and gel. Most of their uncertainty stems from a lack of knowledge about either implant. I try to give them a list of the pros and cons of each implant. It is then up to each individual to decide between the two.

In my experience there is very little difference in appearance between the two. If you placed a gel implant in one breast and a saline in the other it would be difficult to tell them apart. For those women with little breast tissue seeking augmentation who will not accept a sub-muscular placement the gel does look more natural. In theses cases there would be a risk of visible rippling and wrinkling that would be less likely from the gel versus the saline. Outside of this specific situation there is no visible advantage to one over the other.

The main advantage of the gel is in the way they feel. Most women who have had a saline and switched to a gel would claim the gel felt more like their own breast. The gel implant to the touch appears to mimic the density and consistency of an average breast better then the saline implant. However, this is not to say that the saline implant can't feel quite good as well. I have had many patients with saline implants remark that their physicians after examining their breasts were unaware of the implants' presence. But on average most plastic surgeons and patients would agree that the gel wins the touch test.

The main advantage of the saline implant is in the way its filled. Since it is filled after it is inserted the initially empty implant can be threaded through a small incision. On the average this incision a slightly larger then an inch and therefore produces a small less noticeable scar. Even the smaller gel implants are difficult to insert without, risk of breaking them, through the size incision normally made for saline implants. The more commonly used larger size gels require almost twice the size incision as compared to salines to insure an atraumatic insertion. Therefore the gels generally obligate the patient to a larger telltale scar.then saline. Having said this there is a new product that is designed to assist the surgeon in inserting the gel implant through saline size incisions, I have not as yet tried this device but if it functions as advertised then it would negate the advantage of small scar size presently held by the saline implant.

From a safety standpoint neither implant poses any health risks. They are both approved by the FDA, the governmental watchdog that oversees medical devices. The FDA gave their approval knowing that all implants at some point will break. When the saline implant breaks the salt water is harmlessly absorbed and the breast deflates to its original size. It is visibly obvious to the patient that there is a problem with the implant. When the gel implant breaks the free gel remains in the breast. The breast looks and feels as it did when the implant was intact. In other words, there is no visible or palpable warning that the gel implant is broken. The FDA is recommending that women with gel implants undergo regular MRI exams of their breasts to determine the integrity of the implant. MRI exams are costly and somewhat difficult if you are claustrophobic.

I don't expect most women to follow these recommendations. Is there any major health risks associated with an undiagnosed broken gel implant? The answer is no! However, I have been using gel implants for over 35 years and have encountered many longstanding undiagnosed ruptured gels. In a handful of these cases I found it difficult to remove all the loose gel when replacing the implant. There is really no harm in leaving a small amount of gel behind.

Each patient must weigh this information for themselves and then decide which implant they prefer.

David A. Ross, MD (retired)
Chicago Plastic Surgeon

Silicone and saline implants are both safe for human use...

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Silicone and saline implants are both safe for human use and will achieve your desired results of fuller, more shapely or more symmetric breasts.

The FDA requires that patients be at least 22 years old to have silicone implants, but overall it is ultimately your choice.

  • Saline implants are great for patients who have slight asymmetry in their breasts because it can be corrected with different amounts of saline solution being injected into the implants.
  • Silicone implants have a closer resemblance to natural breast tissue in their consistency and feel.

You should discuss both types of implants with your surgeon and make your decision based on which implant you feel will give you the best result.

Saline or silicone breast implants

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There are pros and cons to each type of implant. Saline implants usually have more rippling, stretch the tissues more, are heavier and feel firmer. Advantages-very simple to replace if they leak. Silicone implants have less rippling, are lighter, feel very natural, and stretch tissues less. Silicone implants require more surgery to remove if they are leaking. In addition, the FDA recommends periodic MRI exams to determine if the implants are leaking; this may or may not be covered by your insurance. Not all patients elect to have MRI screening but you should be aware of the FDA's recommendation.

As far as the firmness of the implant, how the breast will feel with an implant depends on several factors, one of the them is the implant fill material. Other factors are how much breast tissue you have and whether or not you develop a capsular contracture. Most of my patients who had saline implants and switched to silicone preferred the silicone. Hope this helps.

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.