I'm going with saline implants, but I feel that I see more people with silicon. Did I make the wrong decision?

Question

I am going with saline implants because I was super pleased with the doctor I chose, my surgery is still 2 months away but I am getting nervous because I feel as though way more people are doing silicone! I like the fact that saline is safer and can be placed through the armpit but a lot of amazing results I see on here are silicone so its making me second guess, did I make the wrong decision? Look wise what is the biggest difference??

Richard H. Tholen, MD, FACS · Answer

Fact: Silicone implants (present-generation ones by any manufacturer) cannot "leak"--they are all cohesive silicone gel "solids" of differing degrees of cohesivity. Fact: Silicone implants have been the most studied implants in the medical device marketplace, and are safe. They do not have any association with autoimmune disorders, arthritis, lupus, scleroderma, or so-called human adjuvant diseases.Fact: Therefore, saline implants are NOT "safer." Another operation to replace a leaking implant or one whose rippling you find intolerable is another whole set of (minimal, but present) real risks!Fact; Via static photos, you cannot tell the difference between a great result with saline implants and a great result with silicone implants. Click on the web reference link below and see lots of examples of both. Saline implant rippling is seen when bending over, and can be felt. This never to rarely (always less) occurs with cohesive silicone implants. Silicone feels more natural, and not just a little better!Fact: Going through the armpit means armpit bacteria can contaminate (saline OR silicone) implants (even if a Keller Funnel is used), and therefore increases your risk of capsular contracture (CC). NOT an "advantage" of saline implants. Is avoiding a crease scar that is usually minimally visible worth an axillary incision that can still be visible with sleeveless tops, swimwear, or arms raised? Plus a higher risk of CC?Fact: There are very real and scientifically-proven reasons most surgeons and most patients choose cohesive silicone implants, and the rate is about 85% silicone, 15% saline. Saline does carry a bigger profit margin . . . could THIS be a reason why some surgeons promote saline implants?Fact: the majority of us that prefer cohesive silicone implants do so with full awareness of the pros and cons of saline, since we were "forced" by the FDA to use them for primary cosmetic augmentation between 1992 and 2006. Once they returned to the elective, first-time breast augmentation marketplace, the majority of us returned to mostly silicone implants. We still offer saline implants, but don't really recommend them since silicone are "better" by most criteria, and preferred by most patients!Go to the link below and see how saline and silicone look. No difference. Ask 87 women how they feel, and even many of the saline-implanted women will feel great. But some of the saline won't, and way less of the silicone feel anything different from wonderful.Then, please read my Comprehensive Guide to Breast Augmentation by clicking on my about page and scrolling down to the Articles section. Listen to your gut! Feel the Force, Madison! Best wishes! Dr. Tholen

Donovan Rosas, MD · Answer

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. 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 an increased risk of rotation.
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.
Your board certified plastic surgeon (ABPS) should be able to help you select an implant type/size that satisfies your goals.

Ted Eisenberg, DO, FACOS, FAACS · Answer

When the implant is placed in a dual plane (partly behind the chest muscle at the top and partly behind the breast on the bottom), there is NO difference look wise. See for yourself. Only 1 of the 20 pictures posted in the link below is silicone. Bet you can’t determine which one. Hope this information is helpful and reassuring. Enjoy your saline implants with no regrets. Dr. Ted EisenbergBoard-Certified Plastic Surgeon and Author

Christopher W. Chase, MD · Answer

Have you heard of and/or considered the "Ideal Implant"?The "Ideal Implant" is a saline-filled breast I mplant with two saline chambers and internal structure that gives the implant a "feel" that is much closer to silicone than traditional saline implants.The "Ideal Implant" was designed for those people who have concerns about silicone leakage (saline is absorbed by the body) and want to be able to tell if the implant has leaked, if that should occur (the implant goes flat), while having the feel of natural breast tissue as much as possible.Not all plastic surgeons are using this implant yet.  If interested, you may find more information on the implant and the doctors who use it on the Ideal Implant website.

Kenneth Hughes, MD · Answer

This does not have to be a stressful decision. There is not a right or wrong answer. I perform all 4 approaches to breast augmentation and use every type of implant.  I think that there are better choices for certain types of anatomy and better approaches for certain anatomical considerations.  The plastic surgeon should be able to help you sort this out in an efficient manner in 5 minutes or less.  Go back and review the pros and cons with your plastic surgeon; you still have almost two months to make a final decision.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Ira H. Rex III, MD · Answer

Both types of implants can give excellent results. If you are not having any specific problems with your implants, then go ahead and enjoy them and do not regret your decision. In most cases, the implants will give a very similar appearance.

Robert Cohen, MD · Answer

Silicone implants are softer, more natural looking and feeling, and overall are higher quality than saline implants.  They also ripple less and cause less "wear and tear" on the tissue because they don't cause a water hammer effect.  There are a tremendous range of shapes, sizes, levels of cohesiveness, and shell types with silicone implants, so they can be customized to each patient's needs, and they are no less "safe" than saline implants.  If anything, they are safer with regards to their long term effect on the tissues.  Transaxillary approaches are shown to have much higher capsular contracture rates than inframammary incisions, so I would recommend that you reconsider the approach for implant placement as well.  If you liked your surgeon, I imagine he or she would be able to do silicone through an inframammary approach, so maybe just have another discussion to make sure you are fully comfortable with the pros and cons of the final plan.  Good luck!

Donn M. Hickman, MD · Answer

I also prefer saline over silicone. It is surgeon preference. This is still quite controversial. The single most issue is when a saline implant ruptures, you know immediately, and there is a compelling change in appearance. While it is not dangerous nor do you need immediately surgery, this can be disquieting. It prompts the patient to seek replacement sooner and with some understandable anxiety and financial commitment. Yet in properly screened and selected patients, using an under muscle approach or dual plane approach, the results are comparable for saline and silicone, except in the very thin person who goes very large. In that case, silicone can be considered an advantage. We have patients returning just since 2010 who have saline implants in place 12 to 25 years having but one operation only.  No capsulectomies, extensive revisions for silicone rupture and gel spread, and no multiple mammograms or MRIs for silicone gel issues. I do think I performed vastly fewer procedures for implant hardness and scarring in saline augmented patients.  Again, it is usually the very slender patient with a full C or D cup and beyond, that are inclined to scarify more easily.  Each implant fill has its issues, but I can say I am more inclined to stay with saline.  The unhappy patients have a rupture early than anticipated, or have more than one in a short period. I do think the saline implants having a broad fill range allow the surgeon some latitude for minor adjustments especially when a lift is performed at the same time.  When we use saline in place of silicone in those unfortunate patients who have had numerous procedures for scar tissue, they again, seem to do better. Also, I prefer the areolar scar, as the underneath scar required for any silicone gel augmentations can be vexing.  I have been faced with more problems from from the inframammary scar when performing revisions, especially from outside referrals, since that scar can indent and widen more than an areolar scar.   Each implant, and each method of approach has its tradeofffs. Finally, I prefer smooth shell implants as I do not think texturing adds any advantages except to prevent shaped implants from rotating. I think the round saline implants at different projections can solve most anatomic concerns when a formal lift is not needed.  Textured implants can add a new set of issues, and when a silicone gel augmented patient gets a rupture, it may go unnoticed for years. Even if diagnosed, I have found that a number of patients wish nothing to be done, since they are still happy with the shape and softness. I cannot get through to these patients that ruptured silicone gel implants need to be removed and replaced. That is why I stay with saline. I do not have to worry about silicone floating around where it should not be. I do believe for the sudden saline rupture issue in the average patient, that is a daunting dilemma for the patient and surgeon.  Expense for secondary silicone gel implant surgery may also far surpass that for secondary saline implant surgery.   These are personal perspectives and subjective to debate and discussion by all surgeons who use their judgment and clinical experience to determine what breast augmentation protocol they use.

James A. Hoffman, MD · Answer

Hopefully you did not choose saline because that is all your surgeon offered. Do your research, see 2 or 3 Plastic Surgeons and understand and feel the difference. Decide what is best for you, not just what your surgeon offers. For patients with very little breast tissue to start, silicone is a much more natural feel and movement. Saline can give a beautiful result if you have at least  small B cup of breast tissue to start. The incision in the fold for silicone is very short and barely noticeable in the shadow of a larger breast.  Evaluate all your options, you still have time to be sure you are making the best decision. Best Wishes

Jack Peterson, MD · Answer

It is important that you use a board certified plastic surgeon and are comfortable with your choice of surgeon. You can check on the website of the American Board of Medical SpecialtiesLet me say that silicone is by far the more popular product on the market now. You do not need to be concerned with safety. Please watch my video explaining the safety of gel implants.That said, the reasons  more people choose silicone is because they have lower rupture rates, better warranty, feel more natural, can be placed on multiple planes for surgery as needed for a specific patients. Saline implants feel less real and have a higher rate of rippling and visibility issues.The only reasons I can see for saline are 1) somewhat less expensive and 2) a slightly smaller incision or  if you want a armpit or belly button placement, saline is your only choice . Otherwise, they are an old technology

I'm going with saline implants, but I feel that I see more people with silicon. Did I make the wrong decision?

Answers (16)

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