Saline or Silicone Breast Implants

Silicone breast implants vs. saline breast implants: what are the advantages and disadvantages?

The good news is that you really can't go wrong either way. Both silicone gel and saline implants are safe, work well and can look totally natural. It really is a matter of understanding the performance differences between the two types of implants, figuring out what your priorities are, and deciding what it best for you personally.

Saline breast implants are inserted uninflated and are filled with sterile saline (salt water) from a bag of IV fluid - the same fluid that is administered intravenously to patients during surgery. As they are inserted unfilled, they can be introduced through an incision that is slightly smaller than what is required for silicone gel implants. Their fill volume can be varied - for example a 300cc implant can be inflated to any volume between 300 and 330cc - so minor asymmetries in breast volume can often be 'fine tuned' by varying the fill volume of the implants.

The silicone gel implants that were approved by the FDA in 2006 for general cosmetic use are cohesive silicone gel implants, a term which means that the gel material inside the implants is in a solid state. This solid gel material feels somewhat firmer than the old liquid silicone gel implants, but has the distinct advantage of not leaking out of the implant if and when the outer shell fails. Gel implants are packaged pre-filled, and come in sizes that vary in fill volume by about 25-30cc.

Major difference #1: implant palpability

In most patients, silicone gel implants are difficult to discern as separate from breast tissue when feeling for them with your fingertips. They feel soft, natural, and the shell of the implant is usually palpable only in very slender patients with small breast volumes preoperatively (A, small B). In most of these cases the implants are palpable only in the most lateral aspect of the augmented breast, where there is the least amount of natural tissue concealing them. In many patients with cohesive silicone gel implants it is essentially impossible to detect the presence of the implants by feel. It is not uncommon for a patient with cohesive gel implants to report at their six- or twelve-month follow-up appointment that they tend to forget that they have breast implants, as the look and feel of their augmented breasts is so natural.

Saline implants are soft, but because the fill material is non-viscous (salt water) the outer margins of the implant are less well-supported. The outer shell of the implant therefore tends to collapse at the edges of the implant, making the outer shell material more easily palpable as 'ridges' or folds. This is most significant in patients with the least amount of natural tissue to conceal the implants: slender women with A-cup and small to medium B-cup breasts. On the other hand, fuller-figured patients with full B-cup breasts who are seeking a C- or D-cup breast enhancement often get a result with saline implants that feels completely natural.

So silicone gel implants provide a palpability advantage for slender, small-breasted women. For fuller-figured women with a fuller preoperative breast volume, there is less of a palpability difference between saline and silicone gel implants.

Major difference #2: what happens if the outer shell fails?

If the shell of a saline implant fails, the saline solution leaks out and is absorbed by the body almost immediately. This is referred to saline implant deflation, and when it occurs it leaves the patient augmented on one side only. This situation requires a return the operating room to remove the deflated implant and replace it with a new one.

If the shell of a cohesive gel implant fails, there is no outward sign that anything has changed. Silicone gel is inert and is not absorbed by the body, and with cohesive gel implants the solid gel material remains within the implant shell. So the breast will not look or feel any different, and the patient will only know that they have a ruptured implant if they undergo an MRI scan to screen for implant rupture. It is recommended that if a ruptured cohesive gel implant is detected on an MRI scan, that implant should be removed and replaced.

Making your decision

If you have zero tolerance for your breast implants being easily palpable and you are slender and/or you have A-cup or small B-cup breasts, then cohesive gel implants are ideal for you. On the other hand, if you feel strongly that you would prefer to have an implant that does not require a radiologic study like an MRI scan to detect implant rupture, then you should go with saline implants.

If you choose saline implants, you will not need any radiologic studies like MRI scans to monitor your implants for deflation. If a saline implant fails, it will be obvious, and you will require a surgical procedure to correct the problem. If you choose cohesive gel implants, then you never have to worry about the inconvenience of implant deflation, but you will have the inconvenience (and expense) of undergoing an MRI scan if you want to know whether or not your implants have ruptured.

Regardless of which implant type you choose, you can be guaranteed of having a breast augmentation that meets your expectations and is satisfying to you over the long term as long as you choose a surgeon who is devoted to creating natural-appearing results. The right size implant in the right position will look beautiful and natural. Too large a breast implant will never look or feel natural, whether it is saline or cohesive silicone gel. Placed in an incorrect or non-ideal position, both types of implant will produce an augmentation result that looks like a pair of implants, not like a pair of aesthetically ideal, natural breasts. So do your homework when doing a surgeon.