Whats the Difference Between the Saline and Silicone Implants in the Breast? Also Which Are More of the Natural Kind?

what are the pros and cons of each, which ones would look more lifted?

Doctor Answers 14

Natural Looking Breast Implants

augmented breasts can and should look natural. With the right implant in the correct position, they can also feel completely natural. Excessively large breast implants never look or feel natural, so the first important factor to consider is implant size. Not only do large implants look odd, they also stretch out breast skin and tend to become very droopy over time. Most patients with excessively large implants end up having multiple operations over time to address problems with implant position ('bottoming out', for example, where implants drop below the desired level of the inframammary fold), implant visibility, and overstretched skin. If the goal is a natural-appearing breast augmentation, then most patients will require an implant volume between 250cc and 450cc. A petite patient looking for a B-cup to C-cup transition may need a 275cc implant for example, while a tall, broad-shouldered patient looking for an A-cup to C-cup transition may require a 425cc implant.

Implants can also look unnatural if they are too small, however. A pair of 225cc implants on a patient with a broad chest will result in augmented breasts that appear too far apart, which is another odd and unnatural appearance. Too small an implant can also be a problem if the goal is to fill out an underdeveloped or 'constricted' lower pole, or to improve a 'tubular breast' appearance - in these situations the lower pole of the augmented breast will be almost all implant, so a larger volume implant is needed compared to a patient with a larger amount of natural breast tissue in the lower pole. It is important for your surgeon to measure the preoperative breast base diameter (the width of the breasts) and the intermammary distance (the space between the breasts), and to take into consideration the breast implant base diameter, in order to choose an implant size and profile that fills the appropriate amount of horizontal space on the chest wall and thus creates an aesthetically ideal, natural appearance.

A common error that leads to an unnatural appearance after breast augmentation, even with implants of an ideal size, is inadequate lower pole dissection and/or inadequate release of the pectoralis major origin just above the inframammary fold. As a result the implants sit too high and appear excessively full in the upper poles (the area above the nipple-areola complex), while the lower poles - which should be the fullest area of the breast - are underfilled. Inadequate muscle release may also result in bizarre-appearing breast implant 'animation' when the pec major muscle contracts. In some cases this may result in one or both of their implants jumping up literally to the level of a patient's collarbones. An alarmingly unnatural look, and one that is totally avoidable.

Most patients want to have the fullest breast profile that still looks natural on their body. The limiting factor for implant size is almost always the appearance of the upper pole 



Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 109 reviews

Silicone vs Saline breast implants

Saline breast implants are constructed of a silicone shell filled with sterile salt water.  Silicone implants are composed of a silicone shell filled with a silicone gel.  Silicone implants feel more like natural breast tissue.  Choosing silicone or saline is based on personal preference.  Saline implants are less expensive than silicone.  In general silicone is better if you have little natural breast tissue.  The more breast tissue you already have, the less you probably need a silicone implant.  Implant manufacturers make the silicone in a thick,viscous form – sort of like a gummy bear- to decrease leaks.  This can make implant rupture more difficult to detect so MRIs are recommended every 2-3 years.

Andrew Jimerson, MD
Atlanta Plastic Surgeon
4.4 out of 5 stars 523 reviews

Saline or Silicone

Most patients like the silicone gel implants when they compare it to a saline implant.  Both have a silicone shell but one is just filled with saline and the other with a cohesive gel.  Both are good implants but the silicone feel much more like a real breast.  If you don't have much of your own breast tissue to start off with, you will definitely want a silicone gel implant.  If a saline implant deflates, it will be noticeable because that breast will be obviously smaller.  If silicone ruptures, you will not necessarily know so a mammogram, ultrasound or MRI may be necessary. Take a look at my You Tube video for more detailed information.  ac

Angela Champion, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 5 reviews

Saline vs. Silicone Implants

There is no question that silicone implants look and feel more natural. About 75% of my augmentation patients choose silicone. 

Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 59 reviews

Silicone versus Saline Implants

Patients prefer silicone implants. They look and feel more natural. They are safe. If you were my wife, daughter, or sister, I would recommend the newer silicone implants.

Saline vs silicone

This is not even a debate.Siliocne is far softer and more natural than saline so if you have a choice pick silicone.The FDA says you have to be 22 to get silicone.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.8 out of 5 stars 56 reviews

Comparing saline-filled to silicone gel-filled breast implants

Dr. Pousti has the best response I see at this point but let me see if I can put it in different terms. It's a bit like comparing apples to oranges. If you put adequate coverage over them it would be hard to tell the difference, but if you put them in a thin plastic bag you would definitely be able to tell the difference. Which one is better? It depends on what's important to you in your particular situation. 

Breast implants are just pillow volume. They do not lift the breast up; they only fill out. The only difference between saline-filled and silicone gel-filled is the fill material. The shell of the implant is the same and the sizing choices are very similar. 

After more than 30 years experience with both I can tell you that in my opinion and experience, silicone gel-filled breast implants have only one advantage but it can be an important one -- they feel like tissue regardless of where you put them. Their big disadvantage is that currently we have no simple way to know if they've failed and need to be replaced. There is no good evidence of threat to health from a non-intact silicone gel-filled implant but there is no easy way to know that the implant is not intact. 

Saline-filled breast implants have several advantages. They cost less than half of what silicone gel implants cost. They can be put in through a 2 cm incision (preferably in the inframammary crease). And they can have their volume adjusted at least somewhat from one side to the other. Silicone gel-filled implants cannot be adjusted for volume. The other big advantage of saline-filled breast implants is that they tell you when they need to be replaced and do not require tests or guesswork. Their big disadvantage is that they don't feel like tissue and require adequate tissue coverage to mask this. 

There is no significant difference in the look of the result between silicone gel-filled and saline-filled implants if they are sized properly, positioned properly (under the pectoralis muscle), and filled properly (saline). 

Scott L. Replogle, MD
Boulder Plastic Surgeon
4.0 out of 5 stars 1 review

With out a doubt silicone gel filled breast implants will give you a much more natural looking and feeling result

For many years we could only use saline filled breast implants for cosmetic breast augmentation and we got quite nice looking and feeling breast. Since the moratorium on the use of silicone gel filled breast implants has been lifted we can now again use them for cosmetic augmentation mamoplasty. While saline gave acceptable results the silicone gel filled implants give a far more natural felling and looking breast. Because saline implants feel harder and ripple extremely more than silicone gel filled breast implants, they should usually be placed under the chest wall muscle (pectoralis major) to hide the ripples. 

In my practice I get the best results with textured silicone gel filled breast implants placed under the breast if there is enough breast tissue in the upper pole of the breast to mask the ripples which are present with all implants. If the patients upper pole of the breast is not thick enough to hide the ripples then I prefer to place the same type of implant in a dual plane which is under the breast on the bottom half and under the muscle in the upper half. This way the patient gets the most natural looking breast possible for this patient. The textured implants become attached to the tissue and there for don't slide around under the breast like smooth wall implants do. They stay on the chest wall when the patient lies down and don't slide in to the arm pit area  and they don't tend to bottom out. 

If the patient is very small breasted then a trans axillary sub muscular placement of smooth walled silicone gel implants may be the next best choice. The only advantage to saline filled breast implants is they are less expensive. With some patients they have heard about the risks of silicone gel which was related to the old thin walled liquid gel implants of the 80's and hence are not willing to use gel implants. These patients get very nice results with trans axillary sub muscular placement of the saline implants but they are never as natural looking and feeling as the silicone gel filled implants. In fact when patients come in with deflation of their saline implants and they are replaced with silicone gel filled implants, they almost always like the gel so much more. 

Carl W. "Rick" Lentz III, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 15 reviews

Saline or Silicone Implants

There are pros and cons of both types of implants, and you should talk with a qualified surgeon to decide which is best for you. Worldwide, silicone implants are the most popular, since they feel more like natural breast tissue. Both types of implants have a silicone shell, but one is filled with saltwater and the other is filled with silicone gel. The newest silicone implants are very strong and the gel won't ooze or spread even when the implant is cut in half. Still, some women feel more comfortable with saline because it is harmlessly absorbed and eliminated by the body if the implant ruptures. Neither implant will lift your breasts, but you can choose from different profiles to increase the projection. Good luck to you!

Andrew Smith, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 20 reviews

Saline or Silicone Gel Implants?

Both the saline and silicone implants have the same type of outer rubbery silicone shell. The inner fill is different: sterile saline solution in the saline Implant and silicone gel in the silicone Implant. There are advantages and disadvantages of each type of implant. Both are utilized by surgeons across the country with satisfactory results. They are both safe and approved for usage by the FDA. Currently there are more silicone gel implants used in the U.S. While either implant can produce excellent cosmetic results in the appropriate patient, most patients prefer the feel of the silicone gel implant.

The best way to determine what the best implant is for you is to discuss the advantages and disadvantages of the various types of implants along with your concerns and personal preferences at a consultation with a plastic surgeon who should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAP).

Robert Singer, MD  FACS

La Jolla, California .

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 19 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.