Saline Vs. Silicone. I Like the Upper Pole That Overfilled Saline Provides. What Should I Do? (photo)

I thought I was set on silicone but while looking at before/after pictures I noticed I like the longer term upper pole that overfilled saline tends to provide. My PS recommended 500 cc HP silicone implants to give me the look I want (perky DD) but as I look at 1+ year out after pictures they tend to settle into a natural position. I want to keep upper pole! I worry about the durability of saline though... Are my goals realistic? Is silicone still an option?

Doctor Answers 10

Saline v silicone

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either saline or silicone will offer you the fullness you are looking for especially with 500 cc's.  There are many factors which influence the decision to go with saline over silicone, such as the cost, feel, future maintenance, and risks. Since you have a fair amount of your own breast tissue to cover the implants, however, I would recommend saline. You will get a nice result and saline tend to be trouble free and worry free over the long term, in my opinion.

San Diego Plastic Surgeon
5.0 out of 5 stars 29 reviews

Overfilled Saline, Upper Pole Does Not Last

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Your photograph shows that your breasts are low and you would benefit from a lift.  There is a new technique called The Mini Ultimate Breast Lift, which reshapes and elevated your breast tissue higher on the chest wall.  It will increase your cleavage and provides upper pole fullness that is natural and stable since it is secured to the underlying muscle.  An implant can be done at the same time to give you the additional volume that you desire.  However, as other physicians have said, implants will descend in time regardless whether they are saline or silicone.  Remember that implants are not secured but are free to descend and gravity only forces downward.  The best option is The Mini Ultimate Breast Lift.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Saline vs silicone for upper pole fullness

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Thank you for your insightful question.  Unfortunately it is not a cut and dry answer but I will give you my overall opinion.  Generally speaking I do find that HP saline implants that are overfilled do give a better long term upper pole roundness or fullness as compared to silicone.  That being said, how the surgeon makes the pocket significantly contributes to the position of the implant.  Hopefully your PS has seen several photos of the look you desire and he/she understands how to make the pocket to help you achieve your goals.  Good luck to you!


Milind K. Ambe, MD
Orange County Plastic Surgeon
4.7 out of 5 stars 52 reviews

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Saline Vs. Silicone. I Like the Upper Pole That Overfilled Saline Provides. What Should I Do? (photo)

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Great questions but over the internet very hard to give accurate responses. Best to obtain more in person opinions. Additionally think of upper pole fat grafting with the silicone implant (my choice the new uktra high profiles). Good luck. 

Saline Versus Silicone

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There are really so many points you bring up, it would be difficult to address them properly in a response to your post. I will try to touch on each one, but urge you to redress them with your doctor.

1. Appearance: You cannot determine the type of implant based on the appearance of the breast afterwards.  In fact, other factors such as implant size, implant profile, position of implant (above or below muscle), and quality of scar capsule have a much greater impact on the overall appearance of the breast, especially in the upper pole.

2. Durability of Implants: It is true that silicone gel implants are more durable than saline, significantly so in later years.  If you have a deflation with a saline implant, it becomes an urgent problem because you no longer look symmetrical. With silicone gel, there is no indication of rupture; it is 'silent'. Depending on your perspective, this is either good or bad.  If you keep in mind that 40 years of scientific evaluation of silicone implants show they cause no systemic diseases, then you will perceive it as a good thing. You can then assess the status of your implants at your convenience; if there is MRI or ultrasonic evidence of a rupture, you can schedule a re-operation at your convenience, as it is not an emergency.

3. Implant's effect on your body: Saline implants are harder on your body (more wear and tear) than silicone gel. Surgeons that perform a lot of breast implant surgery are familiar with saline implant's tendency to drop more than silicone, and this is known as the 'water hammer effect'  This effect is amplified by the size and projection of the implant, with large, high profile implants being most likely to drop out, loosing fullness in the upper pole.  In general, regardless of implant type, large and high profile implants take a serious toll on your body, causing problems that are going to lead to re-operation more quickly and frequently than smaller, lower profile implants.  Some problems are permanent and not correctable.  This should be taken into consideration by all women, regardless of their age, and you should think twice about making a choice based solely on how you want to look today, forgetting about all the tomorrows to come.

4. Misperception of high profile implants: Most women, and some surgeons, think that a high profile implant will reliably fill the upper pole of the breast better than a lower profile implant.  Why that is wrong is because of the reasons stated in #3 as well as for any given implant size, high profile implants are the narrowest in diameter, and less likely to reach as high as necessary to achieve meaningful augmentation in upper pole.  What high profile implants do reliably is give the most projection for any given size.

5. Individual Appearance: Each individual's body will react differently to any given implant size or profile, that is why expert plastic surgeons will make very specific recommendations for their patients, and not let them pick a size or profile implant based on their misguided beliefs. And that is why an implant that was good for someone else may not be the right choice for you. You have provided a photograph of yourself which shows a very tight inframammary fold and low lying nipples.  The good news is that you're a set up for very full upper poles, regardless.  The bad news is your nipples will actually take on a lower position as the size of the implant increases (contrary to the belief that larger implants 'lift' the breast).

If you have not already, you should consult with a surgeon who not only is certified by the ABPS and is a member of the ASAPS, but also has a great reputation for breast lifts, reductions, and complex revisions.  

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Upper Pole Fulness with Implants

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Thanks for the question,

Both saline and silicone implants can offer great looks in patients having breast augmentations.  If you want more fullness in the upper pole position saline implants are tough to beat.  When you compare similar sized saline to silicone implants, saline implants will always offer more projection (i.e., more upper pole fullness).  Saline implants are very safe and offer the same duration or lifespan as silicone implants.  Be careful that you have adequate breast tissue to avoid rippling with saline implants.  Rippling can occur with both types but is more common with saline.  Ask you surgeon about this and about which ones they feel are right for your specific wants based on your exam.

Hope this helps.

Shaun Parson, MD
Phoenix Plastic Surgeon
4.8 out of 5 stars 47 reviews


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The basic issue is weight not the implant type saline vs gel.  When the weight of the implant is 500 grams or higher the breast ligaments are not able to support that much weight and over time the breast position will be lower and the upper pole fullness will be less.  Even if you wear a bra 24/7 the gravity effects will take over.  With a smaller size implant, a saline implant will provide more upper pole fullness for longer.  Best of luck.

Todd B. Koch, MD
Buffalo Plastic Surgeon
4.6 out of 5 stars 37 reviews

Saline vs. Silicone

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Based on your photos and goals I think you would be very happy with either saline or silicone.  The saline would be a little firmer and a little rounder in the upper pole which may serve your goals better.

It is true that saline implants have a higher rupture rate than silicone and that is a factor to consider.  However, a ruptured saline implant has fewer "concerns" than a ruptured silicone.

It comes down to pros and cons of both and it would take a consultation to discuss all of the variables involved.


-York Yates MD, Utah.

York Jay Yates, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 189 reviews

Yes goals are realistic

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Thank you for your question and photo.  It is true that the saline tends to maintain a higher upper pole volume and projection when you are standing compared to silicone implants.  The most important issue, however, is pocket creation.  If the pocket is over dissected or created too low than the implant choice will not be a factor and your upper pole will tend to be deficient regardless.  You can certainly get a very nice result with the characteristic that you desire using HP silicone implants if the pocket creation is performed properly.  There is of course extra-high profile silicone implants available as well.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Achieving Upper Pole Fullness; What Type of Breast Implants to Use?

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Thank you for the insightful question.

It is very  important that patients know exactly what they are trying to achieve with their breast augmentation procedure. It is also important that patients communicate their goals clearly with plastic surgeons who have significant experience achieving the variety of results possible.  In my practice, I prefer the use of goal  pictures to help with this communication process.

Given that you are looking for a “longer-term upper pole” fullness,  relatively overfilled saline breast implants may be a very good option for you ( especially given that you do have a significant amount of native breast tissue of your own).  I have found that the use of these implants  tend to create a “rounder” look in the long-term, compared to silicone gel breast  implants.   I find that, on the other hand silicone breast implants tend to provide a more “natural” feel and look.

 Of course, there are many more variables involved in achieving the breast look/feel that you are trying to achieve; for example, the position of the breast implant pockets on the chest wall will be important in determining where the breast implants "sit".

 Of course, both types of breast implants do tend to “settle” and look more natural with time but I think that the saline breast implants to a better job for patients who are looking for a rounder/fuller look in the long-term.

 I am not aware of any signs such as suggests that silicone breast implants are more “durable” than saline.

 You may find the attached link helpful.

Best wishes.



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.