The Saline Versus Silicone Debate

If you’re considering breast augmentation, at some point you will have to decide if you want saline or silicone implants. Either choice works well but there are distinct benefits and drawbacks for each. In this article we compare these different types of breast implants so that you can make this choice with confidence. 

Fact #1: All implants have the same type of shell

You may have heard or read that saline implants are the “safest” option because saline implants don’t contain silicone. This is false. This is what you need to know:

  • Here’s the reality: Saline implants have an outer silicone shell made of a silicone elastomer.  This silicone elastomer is important because it allows saline implants to hold their shape when filled.
  • The same shell: Implant manufacturers use similar silicone shells for every saline or silicone breast implant they sell.  There are very few differences from one type to another. 
  • Silicone is safe: Silicone is an inert compound.  Due to its size, it doesn’t travel to other parts of the body, even in the rare case that a silicone gel implant ruptures. 
  • It’s well contained: After surgery, all implants have some microscopic shedding of their silicone shells into the surrounding soft tissues.  In response, your body forms protective scar tissue around the implant space, effectively containing this process. 

Fact # 2: Saline Implants are filled with saltwater, and silicone with viscous gel

  • Saline Implants: As discussed, these implants have a hollow silicone shell that is filled with a sterile saline solution during surgery.
  • Silicone Implants: Like saline implants, silicone-filled implants also have a silicone outer shell. These implants come prefilled from the manufacturer.

Fact #3: Saline and silicone implants do rupture 

Rupter looks different for saline versus silicone implants. Both implant technologies have advanced tremendously in recent years and implant failure is uncommon.  The rupture rates of modern silicone implants are less than 2% over 5 years and less than 15% over 10 years. Understanding the differences in what happens when an implant envelope fails is helpful should this ever occur to you:

  • Saline ruptures: Saline implant ruptures are almost immediately noticeable. As the sterile saltwater quickly leaks out of the implant following a rupture, your breast rapidly deflates and changes shape.  The remaining liquid then is absorbed into the surrounding tissue: 
    • If you have a sudden change in your breast size or a new onset of unevenness, your implant may have ruptured. 
    • There are no safety risks associated with saline ruptures unless, in rare cases, there was mold contamination in the implant itself during the initial surgery.
  • Silicone ruptures: In contrast, silicone implant ruptures are considered “silent”.  In most cases, the silicone gel is cohesive and stays within the scar capsule surrounding the implant. In this scenario, there will be little noticeable change externally: 
    • Because ruptures tend to be silent, you will be encouraged to get a screening MRI of your breasts at regular intervals to monitor the health of your implants. If a rupture is found, a timely removal and replacement surgery will be recommended.

Fact #4: Silicone implants look and feel more natural

Although both types of implant are considered safe, current implant technologies make silicone a better choice for those seeking a natural look and feel:

  • More natural: Silicone implants feel more like natural breast tissue. They have a soft and natural texture,  jiggle like real breasts and they maintain their shape better.  
  • Less natural: Saline implants tend to feel firmer when overfilled and have visible rippling when underfilled. They are also more abt to have palpable ridges along the edge of the implant over time.  

Fact #5: Saline Implants can be adjusted in the OR

  • Fine-tuning: The benefit of saline implants is that their fill can be adjusted during surgery to fine-tune for asymmetries.  This may be helpful if your breasts are drastically different sizes. 
  • Pre-filled: Silicone implants come in set fill amounts (refrrred to as volume) from the factory so their size can’t be fine-tuned in the OR like saline implants.  In most cases you can work around this limitation by using different silicone implant sizes.  

So which type will you choose?

Together we will determine which option best fits your aesthetic goals. Remember, Saline implants are filled after placement in the OR, which allows for easier correction of size asymmetries.  Leaks with these implants are obvious as your affected breast will quickly deflate. Saline implants wripple more and often feel less natural.  Meanwhile, silicone gel-filled implants better mimic the soft, natural feel of breast tissue. Today’s cohesive “gummy bear” silicone implants hold their shape well and are less likely to wrinkle or fold. They are also more durable. But the downside to silicone implants is that leaks can go undetected for longer so they must be monitored with periodic MRIs.  

I hope this helps dispel some of the confusion about different types of breast implants! Let me know if you have any other questions.