Why Do Doctors Suggest Silicone Implants More Than Saline?

Is there a reason why every plastic surgeon I visit would suggest to me to get Silicone breast implants? Is it safer than Saline? And also how soon do people with these implants need to have them replaced?

Doctor Answers 7

Silicone Implants vs. Saline implants

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The return of silicone gel breast implants raises an important question for prospective breast augmentation patients: are silicone gel implants better than saline implants? The answer, in my opinion, will be different for each patient, and will depend on the patient's personal feelings and opinions about a host of issues related to silicone gel implants, including implant cost, the monitoring required to detect silicone gel implant rupture, the incisions required, and the potential need to replace the implants (as in buy a new pair) if a reoperation is required for capsular contracture or other issues. Additional factors that will impact a patient's choice of implant include the pre-operative breast size and the desired post-operative breast volume.

Breast implant manufacturers have indicated that the cost of gel implants will remain more expensive than saline implants. This adds about $800 to the cost of breast augmentation. Another cost issue associated with silicone gel implants which may, over time, be much more significant than the increased implant purchase price is post-operative monitoring for gel implant rupture. While saline implant ruptures are immediately obvious, silicone gel implant ruptures are not generally detectable by the patient or physician, and an MRI scan is required to conclusively make the diagnosis. The FDA recommends that patients with ruptured silicone gel breast implants have the implants replaced or removed.

The FDA is also recommending that women with silicone gel implants have a breast MRI scan 3 years following breast augmentation, with repeat scans every two years thereafter. It is difficult to imagine that health insurers, who in most cases do not provide benefits for cosmetic surgery or for the management of complications of cosmetic surgery, will be willing to pay for these follow-up scans. The cost of an MRI scan includes a charge for performing the test as well as a charge for the test being interpreted by a radiologist, and the combined charges for regional scans of the body are generally greater than $1000.

Yet another cost issue to consider is the fact that the FDA has mandated that silicone gel breast implants are a 'single-use item'. Some surgeons have interpreted this to mean that at the time of a reoperation for capsular contracture the implants may have to be discarded, once they are removed from the implant pockets so that capsulotomy / capsulectomy may be performed. Capsular contracture is one of the primary causes for reoperation in patients with breast implants. A physician performing surgical treatment of a capsular contracture would therefore, in order to adhere to FDA guidelines, have to insert a new implant or implants, the cost of which would be passed along to the patient.

As silicone gel implants are pre-filled, they require a larger incision for implant insertion, which of course varies with the size of the implant that is used. Saline implants are filled after insertion, and can therefore be rolled into a long, narrow shape for insertion through a smaller incision. A patient with a small areolar diameter may not be a good candidate for silicone gel implant insertion through a peri-areolar incision, while essentially any patient may have a saline implant inserted through that approach.

Most surgeons agree that silicone gel breast implants, in general, tend to feel more natural than saline breast implants. However, the degree to which this difference is significant varies a great deal with regard to two issues: the amount of breast tissue that exists prior to augmentation, and the size of the implant that is used. The more natural feel of a silicone gel implant will be much more important to patients who are slender and fit in an A cup bra preoperatively, as they have less subcutaneous soft tissue to conceal the implant. The difference will be less noticeable to a patient who is more full-figured and has wears a B cup bra.

Smaller saline implants in my opinion, better simulate natural breast tissue than larger implants. If the goal of breast augmentation surgery is to produce a natural-appearing breast profile, and by 'natural-appearing' I mean that it matches the rest of a woman's figure and does not look like surgery, I think that most patients are best served by an implant smaller than 350cc in volume. Saline implants in this size range, in my experience, tend to produce results that not only look natural but also feel natural.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Why Do Doctors Suggest Silicone Implants More Than Saline?

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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.

Saline vs silicone

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Silicone is certainly not safer than saline. Also silicone carries with it the burden of needing to obtain MRI examinations to look for silent rupture. However silicone gel implants now all have more cohesive properties and are safer than old silicone gel implants.

Silicone looks and feels more natural. Patients who have had both saline and silicone overwhelmingly prefer the look and feel of silicone.

That being said, we achieve excellent results with saline implants in the right patient.

Most surgeons would say that the implants don't need to be replaced until there is evidence they have failed (noted on MRI, ultrasound or mamogram). This typically occurs at 10 to 15 year intervals.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

Purely Aethetic

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Silicone gel implants look and feel more natural than saline implants, pure and simple. Most plastic surgeons are interested in having natural results and silicone gel implants do that better than saline implants. The implants otherwise are basically the same in terms of rupture and capsular contracture. The saline implants may have a higher chance of visible or palpable rippling.

As long as the patient is well informed as to the other differences(undetected rupture, bigger operation for replacement if ruptures, possible local problems with free silicone if rutured) the decision is up to the patient.

John P. Stratis, MD
Harrisburg Plastic Surgeon
4.5 out of 5 stars 37 reviews

Silicone breast implants are often recommended in thin patients

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In my practice, silicone implants can apply to anyone, however they may offer a better outcome in the very thin patient with minimal preexisting breast tissue.

In this case, the gel implant may cause less rippling, and feel more natural. You may be fitting into this category and thus benefit from the gel implant. Both implants are safe and neither shows an advantage in that regard.

The implant lifespan is often quoted as 10-15 years, however, they may last considerably longer. In rare cases likewise they may show shell disruption earlier. Typically, replacement is not recommended unless there is evidence of rupture.

Hope this helps!

Michael A. Marschall, MD
Chicago Plastic Surgeon

Both are considered safe

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Both implants are approved by the FDA and are considered safe. Silicone has a more natural feel and saline doesn't. This having been said, if a woman has enough breast tissue to cover the implant, they can have a very good result.

Dr Edwards

Silicone implants are simply better!

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Silicone has a much more natural feel to it than does saline. It feels more like a natural breast than saline. It has less chances of visual rippling (especially on the sides) than saline. The only times that I would not recommend a silicone implant is in a woman who does not want the slightly larger scar that is required (usually underneath the breast). With all of the modern implants (silicone or saline), I do not recommend replacement unless there is a problem.

David Rankin, MD
Jupiter Plastic Surgeon
4.9 out of 5 stars 168 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.