Saline or Silicone Breast Implants?

When considering breast augmentation, there are many decisions to make. The most important is that you choose a qualified board certified plastic surgeon with a large experience performing breast augmentation surgery. Because there may be different surgical plans for each patient, it is important to trust your doctor to help you make informed choices about how you want to proceed. In addition, viewing his or her portfolio of before and after pictures is important to make sure you have the same aesthetic sense as your doctor, so you have an idea of what your results will be.

Most women considering breast augmentation first ask, “do I go with saline or silicone breast implants?” Both implants are safe, effective, and FDA approved for breast augmentation.

Experienced plastic surgeons get excellent results with both saline and silicone breast implants. They both have the same outer silicone shell. The main difference is what’s inside. The saline implants are filled with sterile saline. The same fluid you would receive if you had an IV started in your vein. Silicone implants are filled with silicone gel. All the newer generation silicone implants are filled with a cohesive gel, meaning they tend to act more like a solid substance instead of a liquid substance.

Both devices are usually round and provide the same amounts of size, shape and projection. The main difference is not usually appearance once implanted in the breast, but instead in how the device feels. The amount a woman feels her breast implant is related to how much tissue is covering it. In women who are thin and flat chested, the implant will be palpable. In these cases, the silicone implant may feel more like breast tissue than a saline implant, which feels more like a water balloon. Visually, results can be similar with both devices. Silicone implants do not prevent skin rippling where you see implant edges through the skin. If a woman is thin enough, and you see her ribs, you can potentially see the implant irrespective of whether it is saline or silicone.

Silicone implants are more expensive than saline implants. They both have the same longevity as they both have the same shell with a 10-year warranty. A hole or rupture can develop in the shell, usually from daily wear and tear. When a saline implant ruptures, the patient notices a breast size decrease as the fluid leaks out of the bag and gets absorbed. If a silicone implant ruptures or develops a hole, there may be no outward symptoms, as the cohesive gel may not get out so the breast looks and feels the same. Therefore women with silicone implants need to be aware of “silent ruptures” that can go undetected. MRI is the best non-invasive way to check on the integrity of silicone breast implants. The FDA advises women with silicone breast implants to undergo routine MRI of their breast implants 3 years after breast augmentation and every 2 years thereafter. There is no urgency nor risk associated with ruptured saline or silicone implants. Implants should be removed and replaced at the patient’s convenience when a rupture is detected.

Choosing between saline and silicone implants is a personal choice. Results depend more on patient characteristics and your surgeon’s expertise than device. If you have thick tissues, good skin tone and are a candidate for submuscular positioning; both implants will provide an attractive and natural result. Patients who are thin with less breast tissue, or those who are better candidates for over the muscle (subglandular) positioning may fare better with silicone implants as the implant is more perceptible in these patients and results may look and feel more natural.

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