Will I Get Same Look with Silicone As Saline?

Can the same "look" that I am hoping for be achieved in either saline OR silicone? I am wondering because I read of some people who feel that saline looks very round and fake and silicone does not. IS that the case? or does it all depend om anatomy and implant style (moderate or HP) or size (cc)? My BOARD CERTIFIED PS.. with multipal hospital privelages.. has chosen for me 375- 425 cc mod plus mentor silicone gel. final decision will be made in O.R.

Doctor Answers 11

For many years we were using saline implants exclusively for breast augmentation, and the results

were beautiful and very natural looking.  Although silicone implants are slightly softer and more natural feeling than saline implants, the look is very similar.  In women who have a fair amount of their own breast tissue, and want an augmentation, saline can be a very good choice, especially when placed under the pectoralis muscle.  In these women, the results are very similar and there is nothing wrong with spending half as much for the implants, as saline implants are significantly less expensive than silicone gel implants.   For women starting with little breast tissue and tight skin, or for those women who choose to have the implant placed above the muscle, silicone is a more natural choice.  As with most issues in cosmetic surgery, there is simply no right answer for everyone, and you need to consult with a surgeon is is familiar and comfortable with multiple techniques.

Mount Kisco Plastic Surgeon
5.0 out of 5 stars 2 reviews

Saline or silicone?

Thank you for the question. Unfortunately, it is a tough question to answer briefly.

Much of the final “look” achieved after breast augmentation surgery  depends on several factors:

1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.

2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.

3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.

On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.

Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants. 

On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.

4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" means different things to different people and therefore prove unhelpful.

Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the press implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Silicone Implants Give Better Results

Although many women get very nice results with saline implants, silicone implants are more likely to give a nice natural result.  The density of the silicone is closer to that of breast tissue.  You are also less likely to have noticeable rippling with silicone.  I recommend silicone to all patients, but some continue to select saline based on either fear or cost (the cost for silicone is roughly twice that for saline).

John Whitt, MD (retired)
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

Silicone breast Implants vs Saline breast implants

One very important issue to consider is implant palpability, i.e. whether you can feel the implant or not when you - or someone else - feels your breast. Both silicone gel and saline implants are soft and generally breast-like. Most surgeons and patients agree, however, that silicone gel breast implants tend to feel more natural than saline breast implants. Because saline is non-viscous, it tends to allow the edges of the implant to collapse and this makes the implant edges more easily palpable. This will be quite obvious to you when you examine samples of saline and silicone gel implants during your consultation.

The degree to which this difference is significant varies a great deal with regard to two factors: the amount of breast tissue that exists prior to augmentation, and the size of the implant that is used. A silicone gel implant's more natural feel will be much more important to patients who are slender and who fit in an A cup bra preoperatively, as they have less subcutaneous soft tissue and breast tissue to conceal the implant. In such a patient a saline implant is usually very easy to feel through the skin, and may even be visible externally - especially in the lateral aspect of the augmented breast where the tissue covering the implants is the thinnest. The difference in feel between saline and gel implants will be less noticeable to a patient who is more full-figured and whose pre-operative bra size is a full B or especially a C cup, and in some fuller-figured patients saline implants may be undetectable by palpation (meaning they feel completely natural). Saline implant palpability is primarily a matter, therefore, of how much natural tissue there is to disguise the implant.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

What is the difference in appearance between silicone and saline implants?

Silicone implants have a soft gel that blends in very well with breast tissue.  They are much more natural in appearance in thin patients with small breasts.  Saline implants are more round and firm than silicone.  Both implants will look nice with women with some soft tissue coverage.  The saline implants may have some wrinkling especially in the outer, lower part of the breast where the muscle doesn't cover the implant. 

I think that the size decision should be made prior to surgery.  All of the information that is needed (eg. shape and size of a woman's breast, her goals and expectations, implant sizing) can be obtained with careful measurements and discussion prior to surgery. 

Both implants are good and there are many happy patients with silicone and with saline.  Silicone is 'higher maintenance' meaning more work will be needed for follow-up and the diagnosis of a rupture.  Remember that whatever implant that you chose, it will not last your lifetime and will need to monitored for a rupture and eventually need to be replaced.

Elizabeth S. Harris, MD
San Antonio Plastic Surgeon
4.9 out of 5 stars 20 reviews

Silicone in general is the "cadillac" implant

in general, silicone will look better (more real) in many women. in some women, the difference is much more evident than others.  women with very little of their own breast tissue, as well as those who are quite thin (ribs show) should strongly consider silicone implants rather than saline. for women with good soft tissue coverage and at least a modest amount of their own breast tissue, this decision is less critical and they will get a nice improvement with either choice.

Bruce K. Barach, MD
Schenectady Plastic Surgeon
4.6 out of 5 stars 13 reviews

Comparing look of silicone gel versus saline breast implants for augmentation

    * I find that a well selected implant placed behind the good skin and muscle coverage can look fantastic, regardless of the implant type.
    * When large implants are used-- ones that are wider than the natural diameter of the breast, there is more potential for implant visibility. In theses cases gel implants have an advantage in both appearance and feel.
    * For most patients, however, an outstanding result can be achieved with either.  In fact, saline implants can have a real benefit over silicone in terms of incision size.
    * Because saline implants can be inserted partially filled and the filled completely once in place, they can be inserted though a tiny incision.  I often use a areola border incision that is virtually invisible.  A silicone gel implant comes pre-filled and cannot be adjusted, so it requires a much larger incision, typically under the breast.
    * All these factors are taken into account when selecting the correct implant for each patient.  That is why it is best to seek out a highly credentialed (ASPS member) and experienced surgeon who can help you choose the optimal surgical approach and implant.

Michael Suzman, MD
New York Plastic Surgeon
4.8 out of 5 stars 28 reviews

Silicone and saline look the same when surgery is done well . . . but then there's the "feel," ripples, and possible deflation!

My breast augmentation career started well before the silicone implant restrictions (1991-2006), so I have used silicone gel implants both before (older generation of silicone implants) and after (present generation of cohesive silicone gel implants) a long period of mostly saline implants for primary cosmetic augmentation.

A well-performed augmentation will look great with either type of implant, though rippling can be visible and disfiguring, both below and above the muscle, with saline implants. A proper amount of "overfilling" can help to minimize rippling, as can submuscular placement, but too much over fill can make them feel overly firm. Too little fill and they feel mushy and "water-balloon-ish." Then there is the potential for saline implant deflation requiring re-operation, at which time I almost always recommend switching to silicone gel for both breasts, rather than simply replacing the deflated saline implant with a new saline implant. (If they felt the same, it wouldn't matter, but the silicone always feel better!)

EVERY patient I have done this for uniformly like the look (same or better) and the feel (always better--more soft and breast-like rather than "water-balloon-ish") that their new silicone gel implants give over their "old" saline implants. Every one of my office nurses who have had saline implants at one time or another have ALL switched to silicone, and uniformly like them better! That should tell you something.

The "hard" feel, or round fake look is commonly due to capsular contracture, which is caused more by bleeding and bacterial contamination than by choice of implant. In other words, careful surgery will yield a lesser likelihood of capsular contracture (regardless of implant) than a "sloppy" or bloody operation. The same goes for above or below the muscle--it's much more about technique than about position or implant type, even though identical careful technique will have more capsular contractures above the muscle (below the breast-- where bacteria from the ducts literally "bathe" the implant in bacteria) than below the muscle, where there are fewer potential sites for contamination. So it's not really about implant choice as much as it is about surgeon choice!

So  if you have carefully chosen your surgeon and have seen plenty of photographs that support his techniques and surgical practices, just choose silicone as your surgeon has suggested--every patient may know one or two or even a few women with saline implants who have good results. THIS DOES NOT MEAN YOU SHOULD CHOOSE SALINE IMPLANTS!

Of course, getting good results with saline implants is what I strived for in my patients between 1991 and 2006. But if you compared 100 saline patients and 100 silicone patients, you would immediately see that the silicone patients have better appearance, feel, and no risk of leakage and deflation compared to their saline counterparts. All the other risks--infection, capsular contracture, malposition, wrong size, etc. can occur with either choice, and are more dependent on surgeon and his/her technique and practices rather than implant choice. But with identical technique and position, your surgeon already knows (and has told you via his recommendation) that silicone offers the BEST choice for you! Follow that advice!

Good luck and best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Will I Get Same Look with Silicone As Saline? Answer:

I think this is a needed discussion with every doctor and patient considering implants. You can achieve a very natural result with both but it really depends on the soft tissue covering a woman has and the size of implant she has chosen. For my patients 5’7” 105lb…. silicone. For others 5’4” 145lb. probably saline. And for those in between..depends on how big! Do you have breast tissue already? Can you see more than 1 rib on the side? Lean runner body? All factors that can make a difference.

John J. Corey, MD
Phoenix Plastic Surgeon
4.6 out of 5 stars 44 reviews

Saline vs. Silicone

As a general rule I believe you get a better result with the silicone  implant.  They tend to be more " breast-like"  since they're filled with a very dense gel versus saline which are basically filled with water.  The silicone implants also tend to ripple less, and give a more pleasing shape.  The difference between the two is more obvious in the thinner woman who has less breast tissue to cover the implant.  In a heavier breast it is more difficult to tell the difference between the two. 

Robert M. Jensen, MD
Medford Plastic Surgeon
4.8 out of 5 stars 40 reviews

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.