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.

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.

I appreciate your question.

The size of implant is dictated by your chest wall measurements.  Once we determine that we can choose the profile based on what you want or need to achieve.

Silicone will give you a fullness at the top (upper pole fullness).

Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion.

Anatomic gummy bear implants might be a good choice to give you volume.

These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.

During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers.

The best way to assess and give true advice would be an in-person exam.

Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Board Certified Plastic Surgeon

#RealSelf100Surgeon

#RealSelfCORESurgeon

Good afternoon!There are many factors involved in choosing a breast implant type- many of which involve your tissue type that can only be ascertained by exam as well as the type of look you are trying to achieve.  In general however, silicone has a more natural feel to the touch than saline.  Depending upon the size implant you are considering in relation to your tissue thickness, silicone can also have a more natural look.  Women looking for that exaggerated fullness at the top of their breast are usually happier with the look of saline implants and are willing to sacrifice the more natural feel that silicone gives for the more "fake" look.  Silicone implants also tend to be more expensive than saline.Your best bet is to have a consult with at least one plastic surgeon certified by the American Board of Plastic Surgery who has a practice devoted primarily to cosmetic surgery of the breast.  It is during this consult that you should be able to hold and feel both types of  implants, perhaps try them on in a bra to get a rough idea about sizing, and discuss the pros and cons of each type of implant.I hope this helps

There are pluses and minuses to both.  Both can give a nice result.  Best to discuss with a board-certified surgeon which one would work best in your case.Saline:-less expensive-no need for additional follow-up ultrasounds or MRI (= low maintenance)-adjustable at time of surgery-higher chance of ripples (10% vs 2% for silicone), especially in slender women-seem to cause more tissue stretch over time-can be used in patients under age 22 (USA)Silicone:-nicer feel, preferred by 85-90% of women-fewer ripple issues-follow-up scans recommended-not adjustable, but available in many different sizes.  Can use two different ones for asymmetry problems.Both:-not associated with breast cancer or autoimmune diseases-have similar capsule rates in modern studies-will eventually require replacement surgery

Thank you for your question. This is a question I get asked quite often. There are pros and cons to each, though in my practice over 95% of patients choose the silicone implants. Saline implants require a smaller incision, they are adjustable and they are roughly $1,000 less expensive. When a patient comes in asking for a more round and augmented look, the saline implant is preferable. Also in some professions, ladies require a smaller incision so it is less noticeable which is possible with saline implants. Silicone gel implants give a more natural look and feel. This is especially the case in someone with very little breast tissue to begin with. There is less rippling and less "implant show". The satisfaction rate is extremely high in my practice with the use of mostly silicone gel implants. Your plastic surgeon will examine you and point out the pros and cons for each individual patient.

Thank you for your question. I suggest you go see a board certified plastic surgeon and discuss your desired results with him.  Your plastic surgeon will give you the best advise and explain to you the perfect implant designed for your body.  Best of luck!Dr Dhaval PatelDouble Board Certified Plastic Surgeon Chicago Hoffman Estates Oak Brook