Would Saline Be a Good Choice for Us with Very Little Breast Tissue?

I am a very petite 27 year old at 4' 11" and 90 lbs. I'm looking into breast augmentation, but I'm having a difficult time deciding if it's right for me. I am currently a 32AAA (34A before kids), therefore, I have very little breast tissue. I'm wanting a very natural look, but am a little hesitant going with silicone. I don't want to go much more than 250cc (mod plus). Would saline be a good option for me? I'm also worried about rippling with saline. I know it happens, but how common is it? Thx!

Doctor Answers 18

Saline implants with very little breast tissue

Saline implants are likely to create some rippling if you have thin tissues. Placing the implants under the muscle is not a complete solution, because the muscle does not cover the lower outer portion of your breasts. Over time, you will likely feel and see ripples/ wrinkles there if you have very thin tissues. If you want to reduce ripples/ wrinkles and get a very natural look and feel, you should consider silicone. If you are concerned about rupture with silicone implants, you could consider the Allergan Style 410 cohesive "gummy bear" implants. They may have less ability to rupture because the gel is very thick (like a gummy bear). The thicker gel also reduces ripples. The anatomic shape lends itself to a natural result. Currently, these are only available to plastic surgeons participating in the FDA study. Hopefully, they will be approved soon.


Best wishes,


Michael Vennemeyer, MD

Southlake Plastic Surgeon
5.0 out of 5 stars 48 reviews

Implant Selection Process

If you have very little breast tissue, you are going to be more prone to rippling.  I would recommend discussing silicone.  In order to make an accurate size recommendation, I would need to assess your chest wall and breast mound measurements and characteristics.  Unfortunately, there is not a general rule of thumb or objective criteria to implant selection.

Your plastic surgeon will perform several measurements of your chest wall and breast anatomy and determine a range of implants that both fit your chest wall and reach your desired goals.
The next step is to try on this range of implants in the office with your doctor.   The key to this success is showing your surgeon the body proportion you desire with a bra sizer and allowing your surgeon to guide you to the right implant.   It will be much easier to communicate in implant cc's than cup size when determining the appropriate implant for you.
I wish you a safe recovery and fantastic result.
Dr. Gill

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 86 reviews

Best alternative for minimal scar is Breast Augmentation with Mini Ultimate Breast Lift

For patients with very little breast tissue I always recommend silicone gel implants.  They look and feel more natural.  The best position is underneath the muscle.  This provides additional padding to conceal the implant and produces a normal feel.  If you are size 32 each 100 cc of implant will correspond to 1 cup size change.  A 250 cc implant will take you up 2 1/2 cup sizes.  Since you had pregnancies, you have stretched skin and volume loss and you may benefit from a simultaneous lift.  This can be done through a circumareola approach leaving only a scar around your areoa.  With this technique, you can lift your breast tissue higher and more medial, which will give you more projection with a smaller implant.  I recommend you consider a new procedure called Breast Augmentation with Mini Ultimate Breast Lift.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 223 reviews

Saline breast implants are not a good choice for patients with very little breast tissue.

Saline breast implants are not a good choice for patients with very little breast tissue for several reasons.  

In patients who have very little breast tissue a sub-muscular breast implant pocket is often used inorder to better disguise the implant, which still can frequently create noticeable breast implant rippling on the upper area of the implant augmented breast.

Also, unlike gel breast implants which are softer and more natural feeling, saline breast implants feel firm and may make a sloshing sound.

For these reasons silicone gel implants are preferred, especially for woman with very little breast tissue.

Fredrick A. Valauri, MD
New York Plastic Surgeon

Saline vs. Silicone implant in woman with very little breast tissue

In situation where a woman has very little breast tissue and seeking larger breast augmentation, I would recommend silicone gel breast implant over saline implant because of the rippling issues more commonly associated with saline implant. Typically the rippling is most prominent at inferior and lateral breast areas. The larger the implant that you select the more likely you will experience rippling. There are other options available to decrease the risks of rippling such as using autologous fat grafting or using acellular dermal matrix (Strattice) graft to minimize rippling. Please discuss with your plastic surgeon regarding this important selection and possible treatment options.


Stewart Wang, MD FACS, Wang Plastic Surgery

Stewart Wang, MD, FACS
Los Angeles Plastic Surgeon
4.6 out of 5 stars 28 reviews

Saline-filled vs. silicone gel-filled breast implants

Here's how I view it -- opinion and experience. 

If a saline-filled breast implant is sized properly, filled properly, and placed properly behind the pectoralis muscle, it should look just like a silicone gel-filled implant but it won't feel like one. Most visible rippling can be avoided by proper sizing, fill, and positioning, but if you can feel the implant in the lower and lateral part of the breast where the muscle doesn't cover, then it will feel ripply. 

Silicone gel-filled breast implants only advantage is that they feel like tissue regardless of how much tissue cover is over them. Their major disadvantage is that currently there is no simple way to know if they have failed and need to be replaced. There is no evidence to support that it harms you if they fail but it would be nice to have a simple test for it (saline-filled implants don't need a test as it's obvious when they fail). The minor drawbacks to gel-filled implants is cost, incision size, and inability to adjust the volume. 

I give patients the choice on this one as it depends on how much they value the various advantages and disadvantages. I can get an equal result in terms of looks with either. 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

Silicone versus saline implants

 Silicone and saline implants will both give you the same look in terms of the results of the breast augmentation but silicone will definitely feel much more natural and softer.  Since your biggest concern is that of rippling I believe silicone would be the best implant for you as you'll be less likely to feel rippling or the give of the implant which is sometimes interpreted as rippling. 

William J. Hedden, MD
Birmingham Plastic Surgeon
4.8 out of 5 stars 317 reviews

Saline implants and rippling

Based on your height and weight, there is a good chance that you will feel rippling with saline implants.  The rippling would be felt even if the implants are under the muscle because the muscle does not cover the implants completely.  Silicone implants would be a better choice to minimize this problem.

Michelle Hardaway, MD
Farmington Plastic Surgeon
4.8 out of 5 stars 110 reviews

Saline v Silicone Implants

Silicone implants look and feel better in a woman with small amounts of breast tissue cover.  The silicone breast implant has been exhaustively studied and has a very high safety profile.  I would encourage you to do your homework about the safety of silicone so that you can feel confident in your choice.

Mary Lee Peters, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 114 reviews

Breast augmentation in petitie patients

In someone with your measurements I would prefer using silicone implants under the muscle.  Silicone implants will look and feel more natural than saline in someone with minimal breast tissue.  I prefer to use silicone in thin patients however sometimes the goal is to have as large as an implant as possible and in those cases saline works better.  Good luck with your surgery.  You no doubt will find breast augmentation to have a positive impact in your life.  

Jason E. Leedy, MD
Cleveland Plastic Surgeon
5.0 out of 5 stars 126 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.