Saline vs silicone - pros and cons? (Photo)

Question

Hi I’m considering a breast augmentation, I primarily have very little tissue to start with and an A cup. I Imost likely will be going with a dual plane placement. I also have asymmetrical breast in size so I will need to compensate for about 20 cc between the right and left side. I have considered both saline vs silicone. Most doctors prefer silicone. I do fear a silent rupture and I’m very claustrophobic in MRIs which is the reason I considered saline (due to the fact of obvious deflation if ruptured). I have noticed most doctors discourage using saline due to its feel and rippling. Are there people out there who are still choosing saline? Is BII more prevalent in salines? Are high definition ultrasounds sufficient to detect silen ruptures in silicone?

Harry T. Haramis, MD, FACS · Answer

Saline vs silicone gel implants- majority of our patients go with gels. They look and feel more natural, last longer, less visible rippling if thin, etc. This is usually recommended.

Saline is still a good option, they tend to look rounder, more full on top and faker. Salines volume can be adjusted slightly during surgery.

Both have the same outer silicone shell.

Gel rupture can be difficult to identify as MRIs can be wrong either way. Usually will appear changed clinically on exam and ultrasound can assist also.

Further discussion with your/a plastic surgeon is recommended for your best outcome.

Fernando Ovalle Jr., MD · Answer

Hello and thank you for your question. The short answer is yes, patients still choose saline implants, although most patients today choose silicone gel because it usually feels softer and more natural, especially in someone starting with very little breast tissue. With an A cup and thinner tissue coverage, saline can be more prone to visible or palpable rippling, even with a dual-plane placement. That said, saline is not “wrong”. For some patients, the peace of mind of knowing a rupture would cause obvious deflation is worth that tradeoff.

Regarding your size, a 20 cc size difference is very small and, yes small asymmetries can be managed by using slightly different implant volumes, but we also have to accept that perfect symmetry is never guaranteed.

Regarding rupture: with saline, rupture is usually obvious because the implant deflates and the salt water is absorbed by the body. With silicone, rupture can be “silent,” meaning the breast may look and feel normal. The FDA says that MRI is the most effective test for silent silicone rupture, but ultrasound is also considered an acceptable screening alternative. Current recommendations are ultrasound or MRI starting about 5–6 years after silicone implant placement, then every 2–3 years afterward. For someone who is claustrophobic, I would usually consider high-resolution ultrasound as the first-line screening tool.

As for breast implant illness, it has been reported in patients with both saline and silicone implants. The FDA has not established that BII is more common with saline versus silicone, and both implant types contain silicone (saline implants have a silicone outer shell).

In your situation, the decision comes down to priorities: If your top priority is the most natural feel and lowest chance of visible rippling: silicone usually makes more sense. If your top priority is knowing immediately if the implant ruptures and avoiding future MRI anxiety: saline is reasonable, as long as you understand the tradeoff in feel/rippling.

Neither is the "right" or "wrong" answer. The next step would be an inperson consult to answer all of your questions based on your exam and this should also include trying on sizers, reviewing your tissue thickness, implant dimensions, incision options, and looking at examples of patients with a similar starting point.

John LoMonaco, MD, FACS · Answer

You are thin and the universal recommendation will be a gel implant for a softer "feel" and less visibility and less wrinkling.  Using the muscle to cover the uppper pole of the implant is also a good idea.  You will need to have the implants imaged at some point (I prefer around year 5 but this varies) and yes, high-def ultrasound is a good screening test in the hands of an experienced operator who sees a lot of breast implants.

Saline impants do offer a  bit more flexibility when making smalll size adjustments because you can use the same implant and profile and base, but change just the volume.  Gel implants get wider with each size up, and getting that perfect match can be hard.

Get a few opinions !  Best wishes from Texas.

Semih Yildiz, MD, FEPOBRAS · Answer

Both saline and silicone implants are still reasonable options, but with very little natural breast tissue, silicone gel often feels softer and tends to show less edge visibility or rippling. Saline can still be chosen, especially if the reassurance of obvious deflation matters to you, but it may be more palpable or visible in a thin breast envelope. A dual-plane pocket can help add some coverage, but it does not remove the need to choose the implant type, profile, and size carefully during an in-person exam.

A small volume difference, such as 20 cc, is commonly used to improve asymmetry, but cup size goals and chest measurements are more important than the number alone. Breast implant illness has not been proven to be more common with saline versus silicone; symptoms can be reported with either type, so this is something to discuss honestly with your surgeon.

For silicone rupture surveillance, MRI is very sensitive, but high-resolution ultrasound is increasingly used and can be a practical option when MRI is difficult. The quality depends on the machine and the experience of the person reading the study. Ask your board-certified plastic surgeon what follow-up imaging plan they recommend for the specific implant brand you choose.

Ahmed AbdelAlem, MD · Answer

Since you have very little breast tissue, most surgeons recommend silicone implants because they feel more natural and have less rippling than saline implants.
Saline implants are still an option and some patients prefer them because a rupture is obvious immediately. However, in thin patients, rippling and implant edges are usually more noticeable.
Regarding silent rupture, high-quality ultrasound is often very helpful, while MRI remains the most sensitive test when needed.
As for Breast Implant Illness (BII), current evidence has not shown a higher risk with saline versus silicone implants.
For most A-cup patients seeking the most natural result, silicone implants are usually the preferred choice.
Ahmed AbdelAlem, MDBoard-Certified Plastic SurgeonCairo, Egypt

Saline vs silicone - pros and cons? (Photo)

Answers (5)

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