Silicone breast implants vs. saline: how does one choose the best type of implant?

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.

Silicone gel implants are chosen more often than saline because they feel more natural. They feel more like a breast and are harder to 'detect'.  Monitoring is more complex with silicone. Sometimes a problem with a silicone implant appears with a change in shape, or capsular contracture. Other times, there can be a silent problem detectable only by MRI. The good news is that the FDA has concluded that neither silicone or saline causes systemic disease. Silicone augmentation costs more, approximately $1000 more for both silicone implants than saline. Saline is cheaper, is more palpable, and is easier to monitor. I usually offer both choices, but lean toward silicone for women with small breasts and lean toward saline for large breasts.  This is because women with small breasts are more able to feel the natural feel of silicone gel, and women with large breasts (and smaller implants) are less able to appreciate the difference.  

Both saline and silicone implants can afford patients a natural result if done properly.  One of the most important considerations when undergoing a breast augmentation procedure is expertise of your operating surgeon and the pre-operative discussion between the two of you, which will largely dictate which implant (saline or silicone gel) would work best for your specific case.  Silicone gel implants have become much more popular in recent years as the material is significantly more cohesive, feels much more natural, has a lower chance of rippling and implant folding, and has a longer lifetime expectancy than a saline implant does.  There are pro's and con's to both types of implants, but in my practice about 95% of my patients opt for the new silicone gel implants.  I hope this helps!

Choosing between silicone and saline breast implants is one of the major decisions in breast augmentation. Both implants have advantages. Silicone implants feel more natural, especially in thin patients with small breasts who want to go up more than 2 cup sizes, where most of the breast volume is made up of the implant. Saline implants have less chance of capsular contracture (firmness) because they are filled with a natural saline solution rather than a silicone gel, which breaks down over time into an oil that the body reacts to with inflammation. With saline implants, a leak results in breast volume loss, but it is easy to detect. Detecting a leak in a silicone implant can require an MRI scan (which can be costly), but the breast will not lose volume, so urgent surgery is not required. Saline implants are less expensive and can be placed through a smaller incision, which are minor advantages. From an aesthetic perspective, most patients do well with either type of implant, and so the decision becomes highly individual.

Both implant types are FDA approved. Both the saline and silicone breasts implants are safe. The implant envelope containing either saline or silicone is the same. If the silicone or saline implant ruptures, it needs to be replaced.In my opinion, silicone breast implants feel and look more natural.There are three main differences.1) Saline breast implants have a higher capsular contracture rate than silicone breast implants. 2) If a silicone breast implant ruptures, there is more of an urgency to have it replaced then with the ruptured saline implant.3) The National Cancer in Institute in France found a "clear link" between silicone implants and anaplastic large cell lymphoma (ALCL). This is an exceedingly rare type of cancer. The association is so small that the FDA still finds silicone implants to be safe. In my practice, I still recommend, if indicated, placement of silicone breast implants. 

This is a very common question from patients as they try to decide what implant would be best for them during their breast augmentation.

First of all both implants are safe a will give you a good result. However silicone implants tend to give patients a much more natural appearing breast. Also the silicone implant will give the patient a much softer and natural feeling breast. In patients that are very thin I tend to recommend silicone implants as they are going to feel more of the implant. Patients that are very thin tend to see more rippling with saline implants than with silicone implants.

You should talk to your plastic surgeon about the pros and cons of the two different types of implants.

Thank you for this really important question.  American plastic surgery was forced to use saline breast implants for approximately 15 years while the FDA was evaluating silicone implants.  Therefore, we have had a huge experience with saline implants.  My personal survey indicates almost all Board Certified plastic surgeons prefer silicone to saline. Saline implants ripple because of the flow pattern of salt water vs. silicone.  In an attempt to get rid of this rippling, many plastic surgeons overfilled saline implants which led to a very hard and unattractive looking breast.  Saline implants are filled at the time of surgery, therefore there is a valve, and over time, all valves leak due to scar tissue growing down the self-sealing valve and opening it up.  Silicone implants used today are infinitely better than the ones used prior to 1991.  Rippling is rare, although any implant can ripple, but the thicker the shell, the less rippling that occurs.  As for leakage or rupture, a plastic surgeon in Newport Beach, California, has a YouTube video showing a BMW sedan rolling over a silicone breast implant, and it did not break.  Interestingly enough, the saline implant that the same BMW rolled over did rupture.  Therefore, unless there are FDA regulations prohibiting, I always recommend silicone over saline.

Thank you for your question and doing your homework on RealSelf!  Saline and silicone gel implants are both safe devices and the choice between the two is a very personal one.  Silicone gel implants come in a variety of consistencies and tend to feel more natural beneath your own breast tissue.  There is no right or wrong choice and your board-certified plastic surgeon can partner with you to develop a treatment plan that is best suited to your individual goals, budget, and timeline.  Best wishes on a fantastic result and speedy recovery!

Each implant has its pros and cons, at this time silicone implants are by far the most popular due to their feeling more natural, however they are more expensive. Your best bet is to see a Board Certified Plastic Surgeon who can show you samples of each implant and explain to you the differences. It is a personal decision for you to make but understanding all the differences will help you decide what is best for you! Good luck.

In general, gel breast implants look and feel more natural.  Saline implants are less expensive, and may be somewhat more helpful if there is a significant breast asymmetry that needs to be corrected, because the saline implants can be filled on the OR table within a range of volumes.  There are also different types of implant shapes and projections, as well as different access incisions, including completely away from the breast itself (transaxillary), and different planes of placement within the breast, so it is best to review these details with your surgeon during your consultation.

Ultimately, the answer is...they are different not better or worse but different.Saline vs. Silicone differences include:
-The "feel"- silicone is more natural
-The "look"- silicone is less prone to rippling
-The "cost"- silicone is more expensive
-Access incisions- saline can be placed through a smaller incision as they are empty at the time of placement
-Customization-Silicone implants are pre-filled to a particular volume. Saline can be adjusted on the table within a recommended range.
-Monitoring-Saline implants, if ruptured, will deflate and the saline fill will be absorbed. Silicone implants require surveillance MRI's at 3 years and every 2 years after.
Patients prefer silicone devices for the more natural feel and the decreased incidence of rippling. In my practice most patients will choose a smooth round device over a textured shaped device ("gummy bear"). When placed in the submuscular plane, the aesthetic differences are minimal. The downward pressure by the muscle across the upper pole of the round device forces it to assume a more tear drop appearance. Recent studies have shown that both patients and surgeons have difficulty distinguishing between the 2 implant types post-operatively. Additionally, shaped implants are more costly and have a risk of malrotation.
Finally, although very rare, the few documented cases of BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) have all been in cases of textured devices (shaped form stable or "gummy bear"). Until more data is available many are shifting their practice back to smooth round devices.
With regards to your specific question, choosing is personal. That being said, most patient select silicone for many of the reasons listed above. The Ideal Implant (a new entry to the field- a saline filled implant with internal baffles/supports to give a more silicone like feel) may be another option to consider although this is only available to a few select providers (early adopters/investors).
Your board certified plastic surgeon (ABPS) should be able to help you select an implant type/size that satisfies your goals.