Saline and Silicone are both good options
Both silicone and saline implants can provide a nice result if done properly. Many surgeons prefer silicone, but there are also those who prefer saline for most patients. I have over twenty years experience using both silicone and saline implants, but for your situation, I would most likely choose a saline implant.
There are many advantages to a saline implant which include; a smaller incision which can be hidden in the armpit leaving no breast scar, in my practice saline implants have a lower rate of scar tissue problems than silicone implants, and the leakage rate for saline implants over the last twenty years has been less than two percent. Therefore, if your saline implant doesn't leak (98% don't) then it may not be necessary to replace it, and you won't require expensive MRI's to look for silent rupture as you would with a gel implant. This is the recommendation of the FDA and the manufacturer of the gel implants. I have hundreds of patients who have been extremely happy with their results from saline implants and when performed properly and with good patient selection, the implants look and feel very natural. Ultimately, the decision is yours. Good luck.
Saline versus Silicone Breast Implants
Which is better, saline or silicone breast implants? There is no right answer, but there are many factors to consider:
The same size saline implants weigh more than their silicone counterpart.
Saline implants are firmer and more tense.
Silicone implants are softer and more "lifelike".
Saline implants tend to ripple, which can be felt or seen, specially at the lower outer quadrant of the breast where the implant won't be covered by muscle.
Saline implants have a slightly greater chance of rupture over their lifetime.
Both implant companies guarantee their silicone implants for life. Saline implants are only guaranteed for 10 years.
You will be happier with silicone implants!
As others have stated, silicone will feel softer, more natural, and more homogeneous with your own breast tissue. Saline implants will have sufficient tissue coverage in your anatomy for a good result as well, but you may have rippling, a "water-balloon" feel, and potential for eventual deflation requiring re-operation. (All to save a few hundred bucks?) 98% of my patients choose the newest cohesive silicone gel implants for a reason (and NO, you do not have to get an MRI every two years to check for rupture--these implants are cohesive and cannot leak).
As to size, this (and the saline vs. silicone issue) is discussed in detail on my website (link below) and in my article "What is the Right Breast Implant Size for You?" found on my "About" page. Realize that a 50 cc difference is 3 tablespoons and 1 teaspoon of volume, which you cannot even detect. Discuss this with your surgeon, try on implants in a bra (and then allow your surgeon to use 50-100cc more than what you choose), and show your surgeon photos of models or patients (unclothed) with what you consider your own goal--that way your surgeon can use your own anatomy and measurements to select the best size and implant profile to give you as close to ideal results as possible!
Are Saline or Silicone Breast Implants Better?
One of the most popular questions patient ask me regarding breast augmentation is "are saline or silicone breast implants better?" Unfortunately, there is no absolute answer. Both saline and silicone breast implants are good choices, each with millions of satisfied patients, but they each have their own advantages and disadvantages. In general, silicone implants are a little bit softer and more natural feeling, with less tendency to ripple, but they require a slightly larger incision to place, MRI exams after surgery to watch for leakage, and are more costly. Saline implants can be more easily placed through the axilla and require less surveillance after surgery but are slightly firmer to the touch. The less breast tissue you have to begin with, the more noticeable the implant usually is. Hence, many surgeons will recommend silicone implants for women with naturally small breasts.
Best of luck with your procedure,
Larry Fan, MD
Saline vs Silicone Breast Implants
Your doctor is right except for one small consideration. The most obvious area of concern is superiorly if you do not have significant breast tissue to cover the implant. For people like you, this is no problem. However, because of the way the breast tissue drapes over the implant, there is one area, even in you, where there will be thin tissue coverage. That area is just above the inframammary crease. If you ballot the breast in this area, you will be able to tell the difference between a saline and silicone implant. The silicone one will feel more natural. This may not make any difference to you, but you should be aware of it.
if you consider your implant as the frame work of a tent, if you drape a thin sheet over the framework you will see the edges of the framework. If you drape a quilt over the framework you will lose definition due to the thickness of the quilt. Coming in with a solid B, you are a quilt. In your case, it probably does not matter as your tissues will camouflage your implant. You could use saline or silicone, the saline being cheaper. both are guaranteed for life. One other thought I would re size you to verify what size implants you are placing 500 sounds large but, it would also depend on your height and weight.
The choice of implant is yours, but in general the silicone are softer than the saline. AS for the volume, it really depends upon your exam and your specific goals. These are best addressed in the office during consultation.
Breast Enhancement Surgery
If you have a nice layer of coverage or adequate beast tissue you could pick either type of implant as it will be well hidden
Saline versus Silicone: Options to Consider
Patients with a good amount of breast tissue often ask me which type of implant I recommend. The answer is that I have very happy patients with each implant type!
Generally, if a woman has a good deal of tissue, the saline implant will provide more upper chest fullness. This is because of the shape of these implants when they are adequately filled. The problem with saline is that they are more likely to leak than silicone, and in many patients, can produce implant palpability and wrinkling which can be felt in the lower and outer breast. Implant wrinkling is less likely in patients with at least a full B cup of tissue and in patients who select smaller implant sizes, as these tend to thin the lower breast tissue less on average.
Silicone implants can also look great. Smooth surface implants sit lower in the breast than textured surface implants on average. If you prefer the feel and concept of the silicone gel implant, speak to your doctor about smooth vesus textured surfaces. I use both of these implant types to offer patients optimal results. Best wishes!
I generally see three sets of women, I want a gel, I want a saline and what is the best implant for me. If your breasts is going to be more implant than you then a gel will always be better. Other than that is is all up to personal choice. In my practice it is about 85% GEL and 15% saline. There is nothing wrong with a saline filled implant as long as there is enough soft tissue to cover the water baggy nature of the implant. Under thin breast tissue and skin a gel will always be better and appear more natural.