Silicone More Natural Looking Than Saline. Fact or Myth?

Hi, I've got several questions. I want to know if silicone implants do in fact appear more natural (less rippling on the breast) than saline after surgery or is this a myth? Also I am considering breast augmentation but do NOT want it done via periareolar incision since i love them and want to know if it's preferable for me to get it done over the pectoral muscle or partially under since i think i may have tubular deformity. Thanks!

Doctor Answers 30

Saline vs Silicone Implants

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I agree with most of my colleagues that you do not have a tubular deformity. If you did, going above or below the muscle is not typically how you would treat  this problem. I believe that silicone implants feel better than saline implants in most instances. They also have a lower rippling rate than saline as well. As a rule, many of us prefer under the muscle as well. However, well placed saline implants under the muscle can look and feel as good as silicone in many patients. We all have many examples of this before silicone became available for cosmetic use in November of 2006. We all have our opinions and our biases. The key is be sure your surgeon explains all your choices and options and why they prefer one way over another. Please visit my website for more info on this very topic.

Minneapolis Plastic Surgeon
4.8 out of 5 stars 178 reviews

Silicone feels more soft and natural; saline may ripple!

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First of all, you do not have a tuberous breast deformity of either breast, but do have a bit of volume asymmetry seen in lots of women! You have attractive breasts ideal for augmentation; I would recommend (slightly different-sized to even things out) implants placed via inframammary incisions into the submuscular plane. But which kind of implants?

Properly-filled saline breast implants can yield very nice results with both excellent appearance and a soft, natural feel. This is most true when the saline implants are beneath the muscle, and when the patient has adequate tissues of her own to cover and obscure edges or ripples in the implants, particularly in certain positions, such as when bending over. If your surgeon is planning over-the-muscle placement with saline implants, even optimal filling will often not prevent visible or palpable edges or ripples that many patients find bothersome. That is why a substantial number of my saline-implanted patients have opted for replacement with silicone gel implants in the years of the FDA restriction on silicone gel implant use for first-time cosmetic augmentation. Since November 2006 when the FDA again released silicone gel breast implants for use in elective breast enlargement patients, over 98% of my patients have chosen silicone gel implants for the softer, more natural feel, and very little chance of visible or palpable rippling.

Submuscular placement provides better tissue coverage of your implants (saline or silicone), reduces visibility of rippling (mostly saline), and makes breast self-exam and mammography easier (both). Submuscular placement also reduces the risk of bacterial contamination of the implant surface with bacteria from the ductal system of the breasts, whereas submammary position literally "bathes" your implants with ductal bacteria, potentially increasing your risk of biofilm-induced capsular contracture. Submuscular placement has no specific advantage or disadvantage for the surgical treatment of tubular breast deformity (which you do not have), but I believe it is still better for the reasons listed above.

If after reading all of this you are still not sure of the answer to your question, re-read my answer's headline: Silicone feels more soft and natural; saline may ripple!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Silicone or saline? Which is more natural? Fact or Myth?

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Both silicone and saline implants result in natural appearing breasts.  The silicone have a slightly more "mature look" to them in that they typically have a little less projection than the saline for a given size and profile.  This difference is extremely subtle, and hard for even a plastic surgeon to distinguish in some patients.  The main difference is in feel.  The silicone implants are softer, and frequently it is difficult to distinguish them from the surrounding breast tissue.  The silicone are much less likely to show rippling, especially if placed over the muscle. I reccommend placing the implants under the muscle because this is the preferrred position for future mammograms.  

You have a very nice shape to start with and are an excellent candidate for the surgery.  You have mild assymmetry.  The left side is slightly smaller and shows a very mild tubular deformity.  This can be addressed with a submuscular placement of implants using an inframammary incision.  Proper positioning of the implants should allow for correction of the assymmetr. Keeping in mind that all women are a little uneven, I would recommend using the same sized implants as I don't think there is a big difference in size between the 2 sides.

Beverly Friedlander, MD
Short Hills Plastic Surgeon
4.8 out of 5 stars 19 reviews

Saline or silicone?

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Much of the final “look” achieved after breast augmentation surgery  depends on several factors:

1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.

2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.

3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.

On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.

Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.

On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.

4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" means different things to different people and therefore prove unhelpful.

Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the press implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.

Sep 16 '11, 4:46am

Saline vs Silicone

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In thin patients like yourself, I place all implants in the submuscular plane.  Silicone breast implants definitely feel softer than breast implants.  Regarding appearance, both implants look similar but saline implants have been known to continue dropping over time, often dropping too much, whereas silicone implants seem to behave better over time.  Issues such as rippling and edge palpability are much more common with saline implants.    I also prefer the breast crease incision.  You do not have a tubular breast deformity; rather, you have mild asymmetry that may require slightly different sized implants to achieve a very symmetrical result.  This should be a relatively straightforward procedure.  

Brian M. Braithwaite, MD
Chicago Plastic Surgeon

More natural appearing breast implants

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Saline and silicone breast implants in the same volume and same projection will appear very similar.  The silicone gel filled breast implant has the more natural feel, but not necessarily the more natural look.  I do think you have a mild tuberous breast deformity of the left breast with asymmetry in size of the two breasts.  I have found that tuberous breasts tend to respond better to subfascial (above the muscle) breast augmentation with radial scoring of the lower constricted pole of the breast.  When I place implants in the subfascial plane, silicone gel implants tend to do much better in terms of feel and having a much lower risk of rippling.

Kent V. Hasen, MD
Naples Plastic Surgeon
4.8 out of 5 stars 67 reviews

The Look of saline and silicone implants

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Saline and Silicone generally look the same, but silicone feels more like a breast than saline does.  However, If you read the various answers regarding above or below the muscle by many talented and experienced plastic surgeons, the most striking thing is how varied the opinions are.  This is because often there is no one solution and because there is no perfect solution.  Often patients will get confused when they hear  different opinions from different physicians and then are not sure  what to do.  This is why it is important for a patient to ask the second question...not just WHAT is the right procedure, but also WHY is that the right procedure.

Joshua Korman, MD
Mountain View Plastic Surgeon
4.8 out of 5 stars 29 reviews

The Look of Silicone And Saline Breast Implants Is Usually Similar

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The natural appearance of silcone vs saline breast implants is largely a myth. But as in all myths there is usually a kernel of fact in them as that is equally true of this breast implant issue. With good breast tissue and a submuscular position, both types of breast implants will have a similar appearance and one could not tell the difference. However, differences in their appearance could be seen in very thin patients with little breast tissue particularly if they are placed above the muscle. The real differences in these implants is how they may feel, with saline implants having a higher risk of rippling which can be felt in the bottom and sides of the breasts where there is no muscular cover.

Silicone More Natural Looking Than Saline. Fact or Myth?

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Wow hard to be specific and scientific to a very subjective question. In over 34 years of doing breast implants, my personal opinion is silicones to me feel more natural. One interesting factoid is the less than 35 year olds want the firmer, tighter look & feel. While the more mature woman desires a more soft, natural feel. But lets not forget about the fee difference of over a $1,000 swing. If the fees were the same I am sure most implants (over 85%) would be silicone. As for your own issues, you are asymmetric, the right inframammary fold is at least 1 to 2 cm higher. And each breast has a differing shape. I would recommend infra incision (your request not to incise the areolae) and partial sub muscular placement. From Miami 

Silicone gel breast implant myths

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There are many ideas as to which are better, saline or silicone gel breast implants, and the answer is always it depends. One myth is that silicone gel will look more natural than a saline implant. The true answer is that a moderate profile saline cannot be distinguished from a moderate profile silicone gel on before and after photos. The look is the same. Ripple? with good cover, the saline will perform well with ripple that is more felt than seen. Any yes, a ripple or fold can appear in a silicone gel implant is well. Softer? With no capsule or a grade 0, both are pretty soft though gel is better, but add any degree of capsule formation, or a cohesive gel implant and bets are off. The bottom line is that there is place for both saline and silicone gel, and both have advantages and detractions. Take time to understand both options.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 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.