What Type of Implant is Best for a Breast Augmentation?
Doctor Answers 42
Saline and Silicone Breast Implants Can Both Provide Exceptional Results
Breast implant manufacturers have indicated that the cost of gel implants will remain more expensive than saline implants. This adds about $800 to the cost of breast augmentation. Another cost issue associated with silicone gel implants which may, over time, be much more significant than the increased implant purchase price is post-operative monitoring for gel implant rupture. While saline implant ruptures are immediately obvious, silicone gel implant ruptures are not generally detectable by the patient or physician, and an MRI scan is required to conclusively make the diagnosis. The FDA recommends that patients with ruptured silicone gel breast implants have the implants replaced or removed.
The FDA is also recommending that women with silicone gel implants have a breast MRI scan 3 years following breast augmentation, with repeat scans every two years thereafter.
Yet another cost issue to consider is the fact that the FDA has mandated that silicone gel breast implants are a 'single-use item'. Some surgeons have interpreted this to mean that at the time of a reoperation for capsular contracture the implants may have to be discarded, once they are removed from the implant pockets so that capsulotomy / capsulectomy may be performed. Capsular contracture is one of the primary causes for reoperation in patients with breast implants. A physician performing surgical treatment of a capsular contracture would therefore, in order to adhere to FDA guidelines, have to insert a new implant or implants, the cost of which would be passed along to the patient.
As silicone gel implants are pre-filled, they require a larger incision for implant insertion, which of course varies with the size of the implant that is used. Saline implants are filled after insertion, and can therefore be rolled into a long, narrow shape for insertion through a smaller incision. A patient with a small areolar diameter may not be a good candidate for silicone gel implant insertion through a peri-areolar incision, while essentially any patient may have a saline implant inserted through that approach.
Most surgeons agree that silicone gel breast implants, in general, tend to feel more natural than saline breast implants. However, the degree to which this difference is significant varies a great deal with regard to two issues: the amount of breast tissue that exists prior to augmentation, and the size of the implant that is used. The more natural feel of a silicone gel implant will be much more important to patients who are slender and fit in an A cup bra preoperatively, as they have less subcutaneous soft tissue to conceal the implant. The difference will be less noticeable to a patient who is more full-figured.
Smaller saline implants, in my opinion, better simulate natural breast tissue than larger implants. If the goal of breast augmentation surgery is to produce a natural-appearing breast profile, and by 'natural-appearing' I mean that it matches the rest of a woman's figure and does not look like surgery, I think that most patients are best served by an implant smaller than 300cc in volume. Saline implants in this size range, in my experience, tend to produce results that not only look natural but also feel natural.
There is no one best implant for everyone
The great thing about breast implants, is that we have choices. While many of us prefer one implant more often than the other, both saline and silicone implants are good options. So, how do you decide?
Silicone implants will be a little softer and feel a bit more like normal breast tissue in most women. Generally, I prefer the feel of silicone over saline. However, silicone implants are more expensive, require a longer incision, and a little more difficult to know if they have ruptured. Although they had been taken off the market by the FDA for several years due to safely concerns, all the valid scientific studies have shown these implants to be safe. However, some women -- in spite of these studies -- still have some concerns about them. And these concerns frequently center around the possibilty of implant rupture. However, plastic surgeons and the implant manufacturers have worked long and hard to get them back on the market because of thier advantages to women.
Saline, implants on the other hand, are less expensive, require a smaller incision, can be adjusted in terms of the volume, and are very easy to know if they are ruptured. If a saline implant ruptures, it deflates, the body absorbs the saline, and the implant goes completely flat. However, these implants can feel a little firmer in many cases. But there are some women in whom the saline implants can feel as natural as the sliicone. Generally these women have a fair amount of their own breast tissue and are not using very large implants.
What I usually tell women, is that I feel that silicone implants are a bit more natural, but they can be a little more complicated than saline. So, you need to choose the implant that you will be most comfortable with, once it's inside your body. If cost and incision size are concerns, then go with saline. If you have concerns about having silicone in your body, then go with saline. If, however, you want the most natural feeling implants, then silicone is your best bet. This may particularly be the case if you have very little breast tissue to start with. The smaller your breasts are to begin with, the better option silicone implants will be..
But the bottom line is that both implants are good choices. You choose the one that seem best for you.
What is the "best" implant for breast augmentation
- Saline vs Silicone.....silicone is "best"
- Soft silicone vs firmer silicone......firm is "best"
- Smooth vs textured......textured is "best"
- Round vs teardrop......what's best depends on what look is desired and your current breast shape etc
- Implant profile
The reference to "best" is my professional opinion (with a lengthy explanation for each) and each surgeon will have their own views and justifications for what they believe is "best".
Ultimately, to determine the implant that’s "best" for you, a careful physical examination is required to determine what is technically possible on your frame, and then make sure that is then adjusted to precisely match the look you’re after.
One of the key variables of an implant is its width. So when it comes to determining the implant size for you, the diameter of your breast footprint, or your breast base width, is the maximum implant width we can go. Of course, this is adjusted a little depending on how much cleavage and side boob is wanted.
So for example, if someone has a breast base width of 13cm, then technically, that's as wide as we can go with our implant selection. Choosing an implant wider than this is technically not going to be possible for that persons frame.
The other issue is profile, or how far forward they project. So implants can have a moderate, high (otherwise known as full) or extra high profile (also known as extra full).
The round extra full profiles are generally for those people who are happy to let people know they have augmented breasts.
The moderate profile are a softer look and generally suited for someone who has nice breast shape but just want a soft/natural enhancement
The round full profile is somewhere in between, basically someone who wants a little bit of upper pole fullness and projection, but doesn’t want to stand out too much from the crowd.
Of course, for any given volume, the projection of one implant brand may be labelled high profile, but for a different brand that same level of projection may in fact be called extra high profile. So it can get a little confusing!
When it comes to teardrops, these issues with regards to variable widths and profiles are exactly the same. Of course, the shape is very different with the bulk of the volume down the lower half of the implant with a gentler taper at the top half. This helps create a far more natural look in those wanting that, without that upper pole fullness. The only additional variable with the teardrop implants is the breast base height because some brands of anatomical implants have heights which differ from their width. That is, they have an oval shaped base and not a round base. So measuring the breast base height is also important with assessing someone’s frame.
In the end, an experienced and skilled surgeon should know what's going to work with you.
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There are many options and many factors to consider.
There are many options and many factors to consider when deciding what type of implant to use for breast augmentation. Some decisions that need to be made include: saline or silicone; moderate, moderate-plus, or high profile; round or anatomical; smooth or textured.
The implant is only part of equation to achieve a nice breast augmentation result. Of course, it is very important to choose your surgeon carefully. A nice place to locate some board certified plastic surgeons who are committed to aesthetic surgery is www.surgery.org, the website for The American Society for Aesthetic Plastic Surgery.
Smooth walled, round, cohesive silicone gel implants.
These are my favorite for most women. If a patient is afraid of silicone, or if there is asymmetry to correct, then I use saline filled implants. These give good results too, as long as they are overfilled.
I don't use textured implants, or tear drop shaped ("anatomical") implants. These implants don't give better results and they are associated with more problems.
The "best" is in your hands
Choice of implant type is a personal one and may be guided by consultation with your board certified plastic surgeon. During the consultation you may have the opportunity to feel each type and the surgeon will assess your body characteristics to determine which type may best suit your individual needs. Good luck!
The answer depends on your priorities
Both saline and silicone gel implants can give patients a happy result from a breast augmentation. In my practice about 80% go with gel and the rest saline.
Those that choose saline are willing to accept some potential wrinkles and ripples especially laterally when leaning forward in exchange for something their gut instinct tells them is "safer."
Those that choose gel place the "feel" of the result as a high priority and accept the extensive work done by the FDA which indicates that the gels are safe. Either way, and with either implant, patients can get a very nice outcome.
Silicone may look and feel more natural, but some women are more comfortable with Saline
Many women prefer silicone implants to saline implants because they feel and look more natural. However, they are more expensive and although the safety of these implants is well documented, some women are more comfortable having saline implants. The pros and cons of each type should be discussed with your board certified plastic surgeon.
Andrew Kleinman, MD
Board Certified Plastic Surgeon
Westchester, New York
The Main Choice is Saline versus Silicone Implants
Thank you for your question. The main choice to be made is saline versus silicone implants. I perform breast augmentation with both types, but generally recommend silicone over saline, because silicone creates a soft, more natural-looking result. Saline is also at higher risk for rippling or wrinkles.
For more information about other choices to be made before undergoing breast augmentation, take a look at the Guide to Breast Augmentation on my website from the web reference below. I discuss common patient questions I receive, silicone versus saline implants, round versus anatomically shaped implants, smooth versus texturized implants, implant manufacturer, implant insertion incision location, implant location inside the breast, and more.
Types of Implants
Saline breast implants: Saline breast implants provide a uniform shape, firmness and fee. Also, If implants leak, the saline will absorb and naturally be expelled through the body.
Silicon Implants: Filled with silicone gel. This option will feel a bit more natural. A leaking implant filled with silicone gel will not collapse.
Gummy Bear Implants: Consists of silicone gel, which is a little thicker than regular silicone implants. They are more firmer than traditional implants. These implants maintain their shape even if the implant is broken.
Best of luck!
Dhaval M. Patel
Double board certified