I've read all 9 of my colleagues' answers (thus far), and find it unusual that not one wants to tell you an obvious fact. Saline implants are indeed durable, but irrespective of the leak/deflation rate quoted, saline implants CAN and DO leak! Cohesive silicone implants cannot leak since they are a solid cohesive silicone gel, much more so than earlier silicone gel implants that were filed with silicone oils or sticky silicone gels. These COULD and DID rupture and leak, but the latest generation of cohesive silicone gel implants (by any of the three USA manufacturers), are extremely durable, essentially "leak-proof," and take extreme forces to rupture or fracture the solid elastomer.So if you want the lowest cost overall, a zero - negligible chance for implant rupture, and the softest, most natural "feel," submuscular cohesive silicone gel implants placed by an experienced ABPS-certified plastic surgeon with lots of saline and silicone breast implant patients over many years will cost you about $600-800 more initially (higher cost of silicone vs. saline), but that is way less than the wages lost from an additional few days or week off work for even "free" implant replacement. (And who pays for the surgery after the first ten years if a saline implant leaks or deflates?)It's a clear choice and recommendation in my mind [SILICONE], and I've been using silicone gel implants since they were the old sticky, leak-prone kind before the FDA restrictions, thousands of saline implants between 1991 and 2006, and now 98-99% of my patients choosing the latest generation of cohesive silicone gel implants (or switching their saline implants for new silicone gel ones). Certainly, there is nothing wrong with saline implants, and they're extremely durable--but silicone cohesive gel implants CANNOT leak, take an extraordinary force to rupture or cleave the solid cohesive gel, and will likely last longer than you will. Salines--well, they CAN and DO leak. And that means an operation to replace the deflated implant(s).Bear in mind that implant rupture is not the most common reason for re-operation--most reports tell you that capsular contracture is the highest reason (again, at varying percentages; ours runs about 3% overall), but in my practice, requesting larger size is the most common reason that patients undergo re-operation for. So choose an experienced ABPS-certified plastic surgeon who does lots of breast surgery, and check out his/her photos. Click on the web reference link below for examples of my own augmentation patients. Best wishes! Dr. Tholen