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.

The
choice between saline and silicone is one that requires a complex discussion of
all of the advantages and disadvantages of both implants. The issues to
be considered are safety, density, mobility, rippling, rupture rate,
consequences of rupture, detection of rupture, need for follow-up care, cost of
follow-up, appearance, feel, sensation of heaviness, radio-density, mammograms,
and costs, among other things. There are advantages and disadvantages of
both products. The decision will ultimately be up to you based on what is
appropriate for your particular situation. Beautiful results can be
obtained with either implant.

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.

Silicone gel implants are now by far the most common choice of patients seekingbreast augmentation. Considering silicone gel implants look and feel more like a realbreast this is easy to understand. In addition, they practically eliminate the problem of ripplingand visibility sometimes seen with saline filled implants. 

In my practice, there is no question that silicone implants look and feel much more natural in saline implants.  He does however have disadvantages.  Saline implants can rupture more easily and cause a notable visible deformity.  Silicone implants do have a slightly higher risk of capsular contracture. This being said, a majority of patients today choose a silicone implant.there are many different styles,  shapes,  projectionof breast implants today.  This should be part of your discussion with your board certified plastic surgeon.  Thanks for your qyestion, Dr. Pacella

I tell my patients that it's not a question of whether saline or silicone is better, but rather a question of which issues are most important to the patient. Both implant types can produce outstanding results, and almost all of my patients are happy with their surgery regardless of implant type. I end up using silicone about 50% of the time, and saline about 50% of the time. Silicone implants tend to look and feel a little "softer," or less firm and defined than saline implants. A patient who wants the softest, most "natural" look and feel above all else may want to use a silicone implant. There are also reasons why a patient might choose saline. The incision can be a little shorter with saline than silicone, which can be a benefit if the patient wants a peri-areolar incision and she has small areolas. Some patients prefer a firmer implant. Even though the FDA has determined that silicone implants are appropriate to use for cosmetic breast augmentation, after reviewing much data and many large studies, some patients still feel more comfortable or less anxious knowing that a leaking saline implant only releases water, rather than silicone. Finally, saline implants cost less. Every patient needs to weigh what's most important to her among the above issues. The difference between the two also matters more for patients with little breast tissue and fat. Such patients don't have much "padding" or "cushioning" over the implants, so the implants may be a little easier to see and feel than in a patient with thicker breast tissue.

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.

There are quite a few choices when it comes to implant selection asides from selecting the different profiles. Silicone: there are 3 types of different cohesive gels that can be chosen.  There is "responsive, soft touch, cohesive".  The difference between the three is the degree of cross linking there is between the silicone gel molecules.  The responsive gel is  gummy gel, soft touch is gummier and the cohesive is gummiest.  The differences will show with the more cohesive the implant the less rippling, but the more firm the implant will be.  Silicone implants give the most natural feel to the breast when comparing them to saline implants.Saline:  there is the traditional, single lumen implant and now the IDEAL breast implant which is a multi lumen implant with baffles to help decrease the "sloshing" of the saline and give the implant a better feel.  Saline implants can give a natural look as well, however to achieve a natural look, the bag has to be filled less with fluid and now the chances of rippling are greater.  Fill the bag up and decrease the rippling but now you have a harder implant.From a safety standpoint: no difference between the two.  In fact a saline implant has a silicone shell as well.Adjustability:  the one advantage that saline implants have over silicone is the ease of adjustability while in the operating room.  Silicone implants come pre-filled therefore the increments of sizes may at times fall somewhere in between the asymmetry you are trying to fix.  However, with the newer Inspira line of implants, there are more options with sizes when it comes to silicone.Incision Size:  Not much of a difference here if the surgeon uses the Keller Funnel.  With the Keller Funnel a smaller incision can be made when placing silicone implants.Hope that clears things up a bit.