Silicone Vs Saline Breast Implants?

In 20 days, I will be getting a breast lift with implants and I'm indecisive about the type of implant to use - Saline or Silicone?

Doctor Answers 10

Saline vs. Silicone Breast Implants?

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Saline identical to intravenous fluid was the most common type of breast implant filler material used in the United States from 1992 until November 2006, when the FDA reapproved the use of silicone gel-filled implants for primary elective breast augmentation.  Prior to the 1992 FDA restrictions, silicone gel implants were utilized in over 85% of all breast augmentations in this country, and remain the most commonly used implants worldwide.  Other types of filler material have been evaluated over the years, and one or more problems are associated with these. Paraffin, sponges, and other unusual materials were used in early efforts to enlarge breasts; results were dismal until silicone came into use in the 1960’s.  More recently, soybean oil-filled implants were studied extensively, and were used in many patients in Europe, as well as a few US patients in FDA studies.  Breakdown of the oil, rancid smell, and other concerns ultimately led to withdrawal of this implant (Trilucent™) in the US and in Europe.  Fat as implant fill material has the same concern, and is not used. 

Fat graft injections of a patient's own liposuction fat (directly into or beneath the breasts) have been performed by some physicians.  Among other names, this has been termed “natural breast augmentation” using one’s own fat tissue (and you have to pay for the liposuction used to obtain the fat)!  The American College of Surgeons and the American Society of Plastic Surgeons are not yet endorsing this procedure because grafted fat that dies can cause microcalcifications and scar tissue within the breast that can interfere with the mammographic detection of breast cancer.  A recent study confirms that fat cells removed via liposuction are mostly destroyed and non-living; improper freezing of the fat kills even more cells (ice crystals puncturing cell walls kill the fat cells), so this is worthless and potentially harmful.  The same goes for fat harvested with SmartLipo (laser destroys the living fat cells) or ultrasonic liposuction (ultrasonic energy ruptures the living fat cells). Unless your surgeon uses a low-vacuum fat harvest technique, and transplants the fat globules in carefully-spaced tunnels with tiny fat grafts surrounded by abundant healthy tissue for blood supply, fat harvested by these liposuction techniques is not going to survive, and any augmentation achieved is lost as the dead fat is absorbed and carried away by the body.

The latest marketing “hype” around fat grafting for breast enlargement uses the term “stem cell breast augmentation.”  This is the same procedure as fat grafting, but with the possible addition of centrifugation or addition of blood plasma to “concentrate” or “enrich” the “stem cells.”  Until peer-reviewed scientific research validates fat grafting (or the even more “out-there” stem-cell breast enlargement), this should be considered a case of buck-naked Emperor’s clothes, snake-oil “cures,” or lakeside property sales in Death Valley!

Other implant materials are being studied, including a more firm, teardrop-shaped textured-surface cohesive silicone gel (the “gummy-bear” implant). This study implant retains its form and innate integrity even when its outer shell is punctured. This implant is more firm (like a “gummy bear” or silicone bathtub seal) than the softer “standard” cohesive silicone gel implant and requires a larger 2.5-inch incision for placement.

The latest types of silicone gel breast implants presently used (as part of the more general FDA study since 1992) are softer but also cohesive.  These 5th generation implants do not leak if the shell is cut or punctured. These silicone gel implants can be inserted via a 1½-inch incision. Cutting one of this latest generation of breast implants is like cutting Jell-O—you get two solid intact parts and leakage does not occur.

With silicone gel or saline implants, microscopic silicone molecules can still enter a patient's body, just as liquid silicone does in the patient who has an injection with a needle lubricated with liquid silicone. No scientific study to date has provided credible evidence that silicone has any cause-and-effect relationship with autoimmune diseases or conditions such as rheumatoid arthritis, lupus, scleroderma, or so-called "human adjuvant illnesses."  With these studies in mind, silicone gel breast implants were FDA-approved in November 2006 for elective first-time cosmetic breast enlargement in women over the age of 22.  Use of silicone gel implants in women under age 22 would be considered “off-label” use.  I support the right of properly-informed women between the ages of 18 and 22 to consent and request the implants of their choice.

The surface of breast implants can be smooth or textured, regardless of the filler material—silicone gel or saline. When silicone gel implants were used prior to the FDA restrictions of 1992, placement above the muscle was also the preferred implant position for many plastic surgeons. Texturing the surface of the silicone gel implant reduced the incidence of capsular contracture in this position (above the muscle and just below the breast tissue). However, after the FDA restriction on silicone gel implants and the switch to saline-filled implants, placement above the muscle led to unacceptable wrinkling that could sometimes be felt or seen. This led to most surgeons switching to placement of saline breast implants below the muscle to increase tissue coverage and reduce these concerns. Even placement of saline-filled implants below the muscle will not always eliminate implant wrinkles or ripples, particularly in thin patients and/or patients with very little overlying breast tissue. Now that silicone gel implants are again available, more patients will be able to avoid the “water-balloon” feel and visible or palpable rippling seen in some saline implant patients.

Based on the choice of saline or silicone, textured or smooth, and the patient's unique body type, appropriate surgical placement will be determined.  Using textured breast implants below the muscle can cause unnatural adherence to the chest and restricted natural movement of the breast, and is not recommended. In addition, the lack of gel to act as a lubricant inside the implant (saline is a poor lubricant) can allow flexing and creasing of the implant shell surface with each movement or breath of the patient, ultimately leading to a higher risk of failure at one of the low spots in the textured surface, with leakage and deflation of the saline implant. The textured implant shell is also thicker and more palpable. Submuscular placement already reduces the incidence of capsular contracture, so smooth breast implants in this location are preferable to adherent textured-surface implants. The smooth-shell saline-filled implant placed below the muscle is soft, less palpable, and less likely to deflate (if properly filled), and has low rates of capsular contracture formation. It also moves with the patient's position and is therefore more natural and breast-like.

However, smooth-shell silicone-gel-filled implants are even more homogeneous with breast tissue and provide the softest, most breast-like, and most natural “feel” of any implant.  Since the newest generation of silicone gel implants is also cohesive, they cannot leak. While the vast majority of patients are again choosing submuscular silicone implants for their breast enhancement surgery, I believe that the best and most experienced breast surgeons offer their patients a choice of either silicone or saline breast implants.

Since you are having a lift in addition to additional volume via implants, your breasts likely have little tissue to conceal your implants, even submuscular ones. This means rippling and edge visibility may be more of a problem with saline implants. Over 98% of my patients since 2006 (and EACH of my office and nursing staff that have implants) chose silicone gel (latest generation of cohesive gel) implants rather than saline, and every patient who switches from saline to silicone confirm that this was a good choice. That being said, between 1992 and 2006 we performed thousands of breast augmentations with saline implants, the vast majority with fabulous results. Yet, since then, most choose silicone gel; consider that a strong endorsement. Best wishes! Dr. Tholen

You can get good results with either type

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Silicone breast implants have a more natural look and feel, with a lower risk of rippling or implant visibility. However, they are only FDA approved in women over the age of 22. In addition, if a silicone implant ruptures, it can be harder to detect.

Saline breast implants contain inert salt-water that can be fully absorbed by the body in the event of implant rupture. They have an increased incidence of rippling, especially in very thin women.

You can get beautiful, natural results with either type of breast implant. In my practice, most women prefer silicone implants, but this is a personal decision.

Lara Devgan, MD, MPH
New York Plastic Surgeon

Both saline and silicone implants are good products

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In my practice, which is virtually 100% breast surgery, I have found that there is no implant to be used in all women. There has to be a common sense approach to size AND filler material.

Both implants are deemed safe, and in my practice, a more natural result is obtained with silicone implants.

Having said this there, are thousands of women who have had augmentation with saline implants who are VERY satisfied. The decision is ultimately yours once you have been properly educated as to what your options are by your plastic surgeon.

Dr Edwards

Silicone gel implants and saline implants variables

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The decision between silicone gel implants and saline implants is a difficult one because there are so many variables to consider. You need to determine with priority of these variables.

Some include risk of rupture, risk of capsular contracture or hardness, naturalness of feel, presence of ripples, risk of future surgeries, fear of unknown rupture.

In general, if silicone implants didn't have a more natural feel to them, they would probably not be around. The naturalness of your breast will be predominantly determined by the relative amount of natural breast tissue. For example, if you put a tiny implant into a large breast, it probably doesn't matter what you use. Your breast will feel natural. If you put a large implant into a small breast, it will probably feel like the type of implant you use. You can use that as a gauge to determine whether or not it wil be beneficial to go to a silicone implant.

If you need a lift because you have thin, stretched out, and limited breast tissue, chances are you will get a more natural result with the silicone gel and will need to balance this benefit against the risks of capsular contracture and rupture.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

I would definitely use textured silicone gel implants under your breast and not your muscle.

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 Over the years I have found that the best results with the most natural and long lasting results are with textured silicone gel breast implants under the breast when implants are placed in conjunction with a breast lift. While a little more expensive the results are much better in my hands. 

Silicone or Saline Breast Implant Type

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It usuallly takes me 45 minutes to go over the pluses and minuses of saline vs. silicone breast implants with patients.

Briefly, silicone implants feel more realistic, have less rippling but there are lingering concerns about what happens if the silicone gel implants rupture, so the FDA requires monitoring by MRI after they are placed. This is not required with saline implants.

Patients should read as much as they can on reputable websites, talk with their doctors, but ultimately, they must make the choice themselves. For what it is worth, women who have had both silicone and saline breast implants almost universally prefer the silicone.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

Silicone implants could yield more natural results

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Silicone Gel implants will yield a more natural result in general. If you are older than 22 years old, silicone implants will be a valid option for you.

Saline implants will still give you a good result, but there is increased risk of rippling, especially if you have little breast tissue.

No Significant Difference between saline or silicone breast implants

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The reason to shose one over the other should not be based on the ruture rate. Although not exactly the same they are close enough to make that a non-issue when it comes to picking the type.

Your choice should be based on the look and feel and your comfort with having silicone or saline in your body.

Silicone Vs Saline Breast Implants?

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 +1 When seeing patients in consultation for breast augmentation, I individualize my recommendations when it comes to the type of breast implant that will most likely achieve the patient's goals, with the least risk of complications.  In order to provide this type of advice, the patient's physical examination  and very careful communication of her goals are necessary. In my practice, I find the use of  computer imaging and goal pictures very helpful. You will find,  that without posting your pictures and your goal pictures, that online consultants will not be able to be of much specific/meaningful help to you.
The type of implant used may  determine the final outcome achieved after breast augmentation surgery, 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 are implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
Generally speaking, patients should be aware that more important than any technical detail (such as type of implant, placement of incisions...) will be their careful selection of plastic surgeon;  I think that this selection will be the most important factor when it comes to the outcome of the procedure performed.
I hope this, and the attached link, helps.

Talk with your surgeon about silicone vs saline

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But - I prefer silicone over the muscle. I do not like textured, they don't move while the silicone feels more natural.  It is also more expensive than the saline.

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.