Silicone Vs. Saline - Which Breast Implant is Safer?

Which type of breast implants are safer - silicone or saline?

Doctor Answers 17

Saline Breast Implants vs. Silicone Breast Implants

In November of 2006 the FDA lifted the moratorium on the use of silicone gel implants for primary aesthetic breast augmentation. Women seeking breast augmentation may now choose between saline-filled and silicone gel-filled breast implants, and thus it is extremely important for prospective patients to understand a number of differences between the two kinds of implants.
Currently in my practice about half of patients choose saline implants and about half choose silicone gel implants. Beautiful and natural-appearing results can be obtained with both styles of implants, and a patient’s decision regarding saline vs. silicone gel implants usually comes down to individual preferences regarding the pros and cons of each.
I think it is important for patients to understand, in advance of choosing a type of implant, that both types of implants are safe and that claims which have been made about silicone gel implants have not held up under scientific scrutiny. A small number of women with silicone breast implants reported symptoms similar to those of known diseases of the immune system, such as systemic lupus erythematosis, rheumatoid arthritis, scleroderma, and other arthritis-like conditions; this eventually led to the FDA moratorium on their use for cosmetic patients only (during which time the FDA still allowed their use for patients undergoing breast reconstruction following mastectomy for breast cancer).
To date there is no scientific evidence that women with either silicone gel-filled or saline-filled breast implants have an increased risk of these diseases. These inflammatory and autoimmune diseases appear to be no more common in women with breast implants than they are in women who do not have breast implants.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

Both saline and silicone implants have advantages and disadvantages

The choice of which type of breast implant to use is a very common one. There are advantages and disadvantages with both, so it's very important for you to sit down with your plastic surgeon and discuss everything in detail.
The short answer is they are both safe options. Silicone implants have a silicone shell and are filled with a cohesive silicone gel. Saline implants ALSO have a silicone shell, but are filled with saline.
In my view, the advantage of a saline implant is that you need a smaller incision during surgery (about 3 cm or just over an inch) and if it does leak, you will know (the breast will flatten as your body absorbs the saline) and so you will be able to have it replaced. The disdvantage to saline implants is that in some patients, especially very thin ones or if they are placed above your pectoralis muscle, they can show some rippling or folds of the implant wall.
Silicone implants have the advantage of a much more natural look and feel, even in thin patients and even in cases where we place the implant above the muscle. The disadvantage is that you need a slightly longer incision to introduce the implant (4- 4.5 cm in most cases) and you often will not know if it leaks or ruptures. This is why the implant companies recommend an MRI of the breast every couple of years to view the implant to rule out a leak. For many women this is a minor inconvenience for the superior look and feel that silicone implants offer.
In the end, for most patients we can achieve a very nice, safe result with either option, so the choice is truly yours.

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 149 reviews

Both are safe, but which one fits you better?

Thank you for your question!

When you are making a major decision, it is best to look into the benefits and risks of your options, however the options have to be tailored to your breast characteristics, your preferences, and desired looks.
As such, the best person to inform you would be a board-certified plastic surgeon during an in-person consultation.

Regardless, we can go over the pros and cons of both saline and silicone implants.
However, before I do that, please realize that the outer shell of all implants is made of silicone and it prevents the content (saline or silicone) from leaking out into the body. As such, silicone will always be in the picture when considering implants unless you consider a natural fat-based breast augmentation.  
Also, please note that there are inherent risks with getting breast implants which are more relevant to consider in the context of safety when deciding to get an implant.

Complications can include any of the following: hematoma, seroma, infection, changes in nipple sensation and lactation, capsular contracture (formation of fibrous scar tissue around the implant), double bubble deformity, synmastia, bottoming out, breast tissue wasting, breast sagging, implant rupture/deflation, implant rotation, rippling, breast asymmetry, pain, etc.

Saline implants:
  • Appear in a non-inflated form that allows their volume to be adjusted during operation to make aesthetic looking breasts
  • Their non-inflated form also allows them to be inserted without having a large incision on the skin and, consequently, results in minimal scarring.
  • Saline implants can be inserted through any incision site
  • Saline implants have a 1%/year chance of spontaneously deflating (10% chance after 10 years), and although no one can predict when this will happen, it will be obvious as the breast with implant deflation will reduce in size significantly. Even if the implant rupture, there is no harm. Saline is “Salt water” which is administered into veins when a person is extremely dehydrated, and thus, it is harmless when absorbed by the body.
  • When saline implants are under-filled, there will be swooshing sound just as the one you hear when you are running with a half empty water bottle.
  • Saline may not make the breasts feel natural because it is not compressible – there will be a strong resistance when you squeeze your breasts making them feel firm rather than soft and squishy. However, the difference in feel compared to silicone disappears with the amount of breast tissue you have. 
  • Saline implants have higher chance of rippling (wrinkling) which may be visible if you have less soft-tissue coverage (i.e., soft tissue refers to your skin, fat layer beneath your skin, and the breast tissue). The rippling is more visible when the implant is placed above the muscle (subglandularly). The thinner you are the more you see it. Rippling often develops on the outer perimeter of the augmented breasts: on the side, bottom or in between the breasts. It can be caused by under-filling of the implant. Solutions would be to choose a moderate sized implant, choose behind the muscle implant placement, choose smooth surfaced implant, and gain weight. 
  • Saline implants are less costly compared to silicone implants

Silicone Implants (5th generation silicone breast implants)
  • Silicone as a filler will make the implant feel softer resembling the feel of the natural breast tissue due to its gel-like cohesiveness. This characteristic also makes the implants less detectable even by touch or feel.
  • Silicone implants are ideal for thin woman with small breasts
  • Silicone implants experience minimal rippling which is barely visible and may occur mostly when patients lie down on their breasts
  • Silicone’s cohesive gel allows more a greater variety of implants – i.e, shaped implants are only silicone-based and provide a natural look which is helpful in treating certain conditions related to the chest wall or breast development.
  • Silicone implants have a 1%/year chance of rupturing similar to saline implants (10% chance after 10 years), however, the rupture is silent which means that you will require an MRI test to diagnose the gel leakage/rupture unlike saline implants, which cause the breasts to deflate making you aware of the problem right away. For many women this is a minor inconvenience for the superior look and feel that silicone implants offer.
  • Unless they are small, silicone implants can more safely be introduced behind the breasts through the inframammary or peri-areolar approach compared to the transaxillary appraoch (scarless technique)
  • Silicone implants are more costly
  • Silicone implants appear in pre-filled form which means implant insertion requires a longer incision on the skin and thus the scar will be longer.
  • The volume of silicone implants cannot be manipulated.
  • There is often a concern over safety and monitoring, but silicone implants have a similar complication rate compared to saline implants, and several clinical trials have shown the safety and longevity of silicone implants that allowed them to be approved by the FDA since 2006. The concern over silicone implant safety originated in 1990s when it was speculated that silicone was associated with connective tissue diseases such as cancer, systemic lupus erythematosis, rheumatoid arthritis, scleroderma. This soon led to the ban of silicone implants worldwide. After over 100 clinical trials showed that silicone implants are not associated with connective tissue diseases, it was not until 1999 that an independent committee of 13 research scientists affiliated with National Academy of Science concluded that silicone breast implants do not cause any major diseases such as depression, lupus, or rheumatoid arthritis, etc. However, silicone was said to be responsible for localized problems such as hardening or scarring of breast tissue. After structural re-engineering of silicone implants, FDA approved them in 2006.
That being said, the biggest difference between saline and silicone implants is that the incision is slightly larger with a silicone implant and silicone provides a more natural feel and the current FDA recommendation is to have a MRI 3 years after implantation, and subsequently every 2 years. Please note that today's 5th generation silicone cohesive gel implants have been proven to be very durable and safe. In fact, they have lower rates of capsular contracture and silicone gel diffusion. Silicone gel diffusion which can lead to an inflammatory response was a major concern with previous silicone implants along with capsular contracture. This was the case in the 1970s, and this problem cannot be applied in the contemporary context because the more cohesive silicone gel and the higher number of shells prevent silicone’s movement, diffusion, leakage, and exposure to the surrounding breast tissue. In fact, even in the case of an implant rupture, the silicone gel remains restricted inside the shell because of its thickness – this is referred to as “gummy bear silicone”. The new silicone implants have thicker shells, wider variety of surface textures, and implant shapes, giving patients more options to meet their desired looks.

Final Verdict: Both saline and silicone implants are very safe and durable, and there is almost no difference in terms of safety. However, if your question considers only the filler of the implant, then saline solution is inherently safer when exposed to the body compared to silicone which can cause an inflammatory response.
If your major concern is safety, and you also prefer a natural look, then the new IDEAL IMPLANTS may the right choice for you. Ideal implants have been created to provide the natural look and feel but with saline as a filler rather than silicone. The unique structure of the Ideal Implants allows for a similar look and feel as silicone with the safety of saline.
Hope this helps!

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 457 reviews

Both Silicone and Saline Implants Are Safe

Both Silicone and Saline Implants are Safe. Please note that the outer shell of saline implants are made of silicone so it is not like you are eliminating this risk. Also realize that Saline implants have more problems with rippling and capsular contractures in many reports in the literature.

Despite three decades of safety testing and monitoring of silicone breast implants, there is still a public perception that silicone breast implants are more toxic or dangerous than saline implants. The truth is that there has no known toxicity from silicone gel breast implants. In fact, silicone is one of the most common materials used in medical devices and implants. There is no known toxicity from silicone gel breast implants. It has been studied by the FDA for more than three decades to establish its safety. Silicone is the most common material used in medical devices/implants. Examples include shunts that go from the brain to the abdomen (for hydrocephalus) which are left in for a lifetime, artificial finger joints, syringes, IVs, catheters (including ones that go next to the heart), surrounding pacemakers, and even oral anti-gas tablets.
The one possible exception may by the PIP implant made in France (generally not available in the USA). Most of the concerns about the PIP implant were about the use of non-medical silicone and manufacturing problems, and do not relate to implants used in the United States by board-certified plastic surgeons. This is not to say that breast implants, like any implant, can have problems; they may have to be removed and are not meant to last a life time. Common reasons for replacement include: capsular contracture, rupture, infection, change in breast size, and pain—but not for toxicity.
To answer the perceived toxicity of Silicone by the general public—this is quite a different matter.
Breast implants have been around since the 1960s. About 15 years ago Connie Chung ran an exposé, Face to Face with Connie Chung, claiming silicone implants were responsible for different health problems. This led to lawsuits, a huge windfall for lawyers, and the subsequent ban on silicone implants for first-time breast augmentation patients went into effect. They were always available for breast reconstruction (e.g. after mastectomy) and replacement of existing silicone breasts. Also, please note that saline implants are still covered by a silicone envelope.
Soon after, a ban on silicone implant use became worldwide. This lasted for years until more than 100 clinical studies showed that breast implants aren’t related to cancer, lupus, scleroderma, other connective tissue diseases, or the host of other problems they were accused of causing.
June 1999, The Institute of Medicine released a 400-page report prepared by an independent committee of 13 scientists. They concluded that although silicone breast implants may be responsible for localized problems such as hardening or scarring of breast tissue, implants do not cause any major diseases such as depression, chronic fatigue syndrome, lupus or rheumatoid arthritis, etc.
The Institute of Medicine is part of the National Academy of Sciences, the nation’s most prestigious scientific organization.
Eventually, a federal judge dismissed/rejected the lawsuits, declaring them junk science and ended for the most part the barrage of lawsuits. This led to the present reintroduction of silicone implants years ago and their approval by the FDA. Interestingly enough, most of the rest of the world reintroduced them many years prior to the United States.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 154 reviews

The safety studies for both implants show that both are...

The safety studies for both implants show that both are very safe, in fact some reports suggest that the safety risk is better for silicone gel implants.  However, I think that further studies will show both equally safe in terms of capsular contracture rate, rupture rate, etc..

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Safety of Silicone Breast Implants

More women tend to choose silicone breast implants due to the natural feel and appearance. Cohesive Silicone implants are now made of a gel which are anti-leak even when cut. It is often called “gummy-bear like”. #Silicone implants are also the preferred choice for over the muscle placement. Also, silicone implants require a larger incision than saline, because they are pre-filled.
Although, the new generation of silicone implants are far superior than those used in the past and have a proven track record of safety, some prefer an alternative. This is where the #IdealImplant comes in. It was created for women who are not comfortable having silicone implants in their body, but desire a more natural feeling implant than traditional saline implants on the market. The unique structure of the Ideal Implant allows for a similar look and feel as silicone with the safety of #saline.
Your choice of silicone or saline will also determine the incision site for which the implant is to be placed.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

Silicone & Saline Implants - the Differences

The type of breast implant used is one of the most important decisions facing patients undergoing breast augmentation. Silicone and saline implants both offer significant advantages for breast augmentation and are both associated with high satisfaction rates. Both implants are considered to be extremely safe.
In the past, the safety of silicone breast implants had been the source of significant controversy. This controversy had its origin in 1990 when concerns arose over the potential for silicone breast implants to cause connective tissue diseases. In response to these concerns the FDA made silicone implants unavailable for breast augmentation surgery.
Since that time, silicone breast implants have undergone extensive testing and have been found to have minimal risks. They are considered to be extremely safe and for this reason the FDA lifted its moratorium on silicone implants in 2006. They are now once again available for breast augmentation surgery.
Both saline and silicone breast implants are considered to be extremely safe. For this reason, implant safety isn’t a major factor in the implant selection process. Never the less despite a large number of scientific studies that demonstrate the safety of silicone implants, many patients continue to have anxiety about their use. Under these circumstances saline implants offer an excellent alternative.
It’s important that the advantages and disadvantages of saline and silicone implants be thoroughly discussed with your plastic surgeon prior to breast augmentation surgery. Your surgeon should be able to help you choose the breast implant that meets your aesthetic goals and fits your life style.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Safer implant

Both are safe when your surgery is performed by an experienced plastic surgeon. It just depends on what look you want to achieve.

Michael Constantin Gartner, DO
Paramus Plastic Surgeon
4.7 out of 5 stars 137 reviews

Silicone Vs. Saline

The current gel and saline implants are both extremely safe. Some patients do feel additional comfort that the saline implants are not filled with cohesive silicone gel. There are advantages and disadvantages of both. Consult in person with 3 board certified plastic surgeons to understand your options, and choose the one that is best to meet your needs/objectives.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.4 out of 5 stars 41 reviews

Speak to your surgeon to help weigh your options

Both saline and silicone breast implants have been FDA-approved for breast enhancement in the United States; however, there are still ongoing studies being completed regarding the long-term effects of leaked silicone on the body.  There are many factors that drive a woman’s decision to select saline or silicone implants.  For many women, the higher viscosity of silicone gel more closely emulates the consistency of human fat or natural breast tissue.  Because there are so many components to selecting breast implants, it’s best if you speak to a board certified plastic surgeon who can help you weigh your options given your specific goals.

C. Edwin Pittman, MD
Athens Plastic Surgeon
5.0 out of 5 stars 10 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.