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 breastsTheir 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 siteSaline 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 implantsSilicone 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 breastsSilicone implants experience minimal rippling which is barely visible and may occur mostly when patients lie down on their breastsSilicone’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 costlySilicone 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!
