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Saline or Silicone Breast Implants?

In the US, both saline filled and silicone gel filled breast implants are available.  Both come in a variety of shapes and sizes, though the gels feature many more options.

Saline implants typically come as empty silicone shells that are filled with a sterile salt water solution during surgery to the size that is desired and recommended.  Silicone-filled implants are silicone shells that come prefilled with a thick silicone gel substance and are inserted during surgery.

The two most important distinctions between the two to consider for surgery are the feel versus the cost.  Silicone implants feel and look more natural, especially in thin patients, but saline implants do cost a little less.

Since breast implant surgery started in the 1960s, we have been through three main phases of change.  The first implants were all filled with a syrup-like silicone gel.  Then in the 1970’s it became apparent that ruptured implants were leaking the syrupy substance, which led to misshapen breasts, hardness or lumpiness.  We then went through a phase using only saline-filled implants, which lasted all the way until 2006.  In 2006, the “new and improved” silicone gel implants were released onto the US market.  Since then, almost all patients who feel both a saline and a silicone implant will choose the silicone implant due to the softer more natural feel.  The newest generation of silicone gel implants offers varying levels of cohesiveness (“stiffness”) in many different sizes and profiles.  The risk of rupture for the new cohesive gel implants (“gummy bears”) is very low and the manufacturer warranties are very favorable.

However, sometimes a saline implant can be the right choice for a patient.  Salines are available for women under age 22, whereas silicone implants are not approved for those under 22 unless there is a medical reason, such as asymmetry, to justify their use.

Saline implants can be placed through a shorter incision since they are inserted and then filled.  If a saline implant is ruptured, there is typically no doubt since the salt water solution leaks out relatively quickly.  The leaking saline solution is not harmful, though a deflated implant is very noticeable.  Saline implants offer the possibility of adjusting the fill volume during surgery for a more precise match side to side in cases of slight asymmetry.  Typically, saline implants tend to be about $800-$1000 less than silicone implants.

A recent trend is the desire for excessively large breast implants.  The largest silicone implant currently available is 800cc. Therefore to get more volume, one must choose saline implants and “overfill” them to the desired size.  This of course highly increases the risk of rupture, but creates a very large, tight hard look which may be desirable to some patients.  It is not recommended for most patients and negates the manufacturer warranty.  In general, the larger the breasts, the more likely they are to become saggy and unattractive over time.

Almost all of the recent innovations in breast implants have been with silicone implants.  Recently however, a new saline implant has been introduced that has baffling inside to stabilize the walls of the implant so the chance of rippling is lessened.  This new implant will not be cheaper but may be an option for patients who are simply opposed to silicone implants.