Silicone vs. Saline - Which is Better?

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The honest answer is that there is no one best breast implant for every patient. Both saline breast implants and silicone gel breast implants have their own advantages and disadvantages. To help you decide which one is better for you, below is a comparison of the two.

Implant Advantages

Saline

Silicone Gel

Lower cost
Smaller incision*
Easy to detect deflation
Possible lower risk of
capsular contracture**
Some volume adjustment is
possible during surgery

More natural feel
Less risk of rippling

*Saline implants come filled with air which is removed before they are inserted into the breast. This creates a flat, empty implant which can be folded-up and placed through an incision which is 30-40% smaller than what is necessary for inserting a silicone implant which are completely filled and cannot be emptied or deflated without breaking the implant shell.

**The capsule is a scar tissue pocket which forms around every breast implant. As long and this scar tissue pocket stays as large as or larger than the implant, then the implant remains soft and pliable. When the scar tissue shrinks and compresses the implant, this is known as a capsular contracture. The breast may then become hard and painful and it can develop an unnatural shape. Capsular contracture was very common with the old “low bleed” silicone gel breast implants, particularly when they were placed on top of the muscle. The risk of a capsular contracture forming with saline implants placed under the muscle is felt to be less than 5%. The newer silicone gel breast implants which have a thicker shell and a more cohesive silicone gel have a much lower rate of capsular contracture than the old silicone implants and some studies suggest that the incidence may be as low as it is with saline implants.

Implant Disadvantages

Saline

Silicone Gel

Less natural feel
Higher risk of rippling

Higher cost
Slightly longer scar
More difficult to detect a rupture***
Possibly a higher risk of capsular contracture
Implant size is not adjustable

***Unlike a saline implants which completely deflate and go flat when they rupture, modern day silicone gel breast implants generally stay the same size and shape even after disruption of the implant shell. Statistics show that plastic surgeons can detect a rupture of a new style silicone gel implant about 30% of the time by physical examination. CT scans, ultrasounds and mammograms are generally poor tests to detect implant rupture. In the best hands, MRI’s are about 89% specific for detecting silicone gel implant ruptures. The FDA recommends that patients who have silicone gel breast implants should have an MRI within three years of implantation and every two years thereafter to look for implant rupture.

So, which is better, silicone or saline? It really depends on the patient. My recommendation: For the patient who is not real thin and has a reasonable amount of natural breast tissue to cover-up the implant, saline is probably the better choice; smaller scar, lower cost, easy to tell if the implant has deflated so no need for MRI’s to look for rupture. For these women there is generally very little difference in the final result comparing silicone to saline unless a very large implant is used. This represents one extreme.

Now take the opposite end of the spectrum; someone who is very thin with minimal breast tissue. For these women with very little natural breast tissue to cover-up the implant, whatever is used for augmentation of the breast is what the breast is going to look like and feel like. Here is where I feel that a more natural implant like silicone gel is advantageous wit