What Are the Differences Between Cohesive Gel and Saline Implants?

do cohesive gel implants look and feel more natural than saline. do they feel as heavy as saline does? also, is one safer than the other?

Doctor Answers 5

What Are the Differences Between Cohesive Gel and Saline Implants?

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The  saline and gel implants feel differently outside the body and if you have very little soft tissue covering the implant, you might tell the difference between the saline and gel implants once they are inserted. I think if you have a C cup breast with good amounts of soft tissue under the skin and you go to a D cup with an implant, it would be hard to tell the difference between saline and silicone. If however you are very thin and go from an A cup to a C cup, you would be able to tell the difference. In that case the gel implant will feel a lot more natural.

Gel and Saline Implants

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If you can hold a sample of each implant, the silicone one will feel like soft tissue, and the saline one will feel more like a water balloon. If you then lay them on a tabletop, the difference witll be less, and this simulates the implants sitting on the chest wall. The implants are covered with an amount of breast (and muscle) tissue, making the difference still less.

But the silicone implants will still feel more natural than saline. The difference will be greater   in a small breasted woman with large implants, that let's say a patient with a natural C-cup who has a smaller implant.

Silicone advantages include:

  • more natural overall feel
  • less likely to see or feel ripples, or folds in the implant

Saline advantages include:

  • smaller incision, and more choice of incision, as these are inserted while empty and are then filled. The gels are all pre-filled.
  • less expensive.

In terms of leak, the rates seem to be similar. A leak is obvious with saline, as the implants will deflate, usually quickly. With silicone, leaks are usually not apparent, because the silicone is not absorbed like saline and usually stays in place, contained by the capsule that has formed around the implant. 

Most surgeons and patients prefer the silicone implants, and their usage has increased steadily since they reappeared on the general market a few years ago. 


Thanks for your question, best wishes.


Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Differences between implants

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There are a few basic differences between saline and silicone implants.

1.  silicone feels more natural, or what you think a breast should feel like

2.  silicone ripples less

3.  It is harder to detect a leak with a silicone implant because often there is no change in the outward appearance - the rupture rates of saline and silicone implants are very similar, and both very low.


For these reasons, silicone tends to be the preferred implant by most plastic surgeons and patients.

David A. Lickstein, MD
Palm Beach Gardens Plastic Surgeon
5.0 out of 5 stars 9 reviews

Saline or Silicone Breasts Implants?

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Thank you for the question.

The type of breast implant used during breast augmentation surgery may  be a factor in determining the final outcome  of the procedure, 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 the  breast implant capsule area without a visible difference  externally ( “silent leak”).   Therefore, 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’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan ( Allergan) Medical.  

You may also find the attached link helpful.


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Cohesive gel is SILICONE, SALINE is (water). Depending on how much breast tissue you start with is how your breast is determined whether saline or silicone would be best for you. There is not one implant that is better than the other. You need to read about the Pro’s and Con’s to Saline & Silicone so you can make an informed decision.



Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon

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.