Silicone Vs. Saline Breast Implants: What’s The Difference?

By Cameron Craven, MD, FACS September 11, 2018 No Comments

silicone vs saline breast implants

One of the first decisions every breast augmentation patient must make is whether to use a silicone or a saline implant. Both types of implants have a similar outer shell made of silicone but differ in terms of filling: saline implants are filled with sterile saline (salt water), whereas silicone implants are made of a silicone (plastic) gel. While other implant variables like size or shape are important, implant composition can play a significant role in determining the final result and patient satisfaction.

Here’s a side by side comparison of both implant types:

Natural Feel

Advantage: Silicone implants feel more natural.

Silicone and saline implants do feel very different. Silicone implants are engineered to closely emulate both the look and feel of natural breast tissue. Thus, silicone is softer to the touch and “squishier” when squeezed, while saline implants are often firmer and unnatural feeling.

The more natural feel of silicone implants makes them an ideal choice for patients who have less naturally occurring breast tissue or for those who prefer an over the muscle placement.

Natural Look

Advantage: Silicone implants look more natural.

There are also some major differences in terms of how natural each implant looks. In general, saline implants appear firmer and rounder compared to silicone implants. This is due to the pliability of each type of material.

Saline implants tend to be deliberately overfilled which leads to more superior fullness and firmness to the touch.

Silicone gel is highly pliable and usually less full superiorly. If you hold a silicone implant from the top, most of the silicone will move to the bottom with gravity. This pliability gives silicone implants more similar physical characteristics of natural breast tissue.

All variables equal, silicone provides a more natural end result, while saline implants often look more dramatic yet augmented.

Scars and Incisions

Advantage: Saline implants require smaller incisions and leave smaller scars.

Placement techniques for silicone and saline implants vary. Saline implants are actually inserted without filling (empty) and saline is pumped in once the implant is in place. In contrast, silicone implants are pre-filled and thus require a larger incision in order to be properly inserted. So saline implants require smaller incisions and result in smaller scars (typically about ½” smaller).

Saline implants also offer more incision placement options in comparison to silicone implants. While both types of implants can be placed using incisions under the breast fold (inframammary), through the areola (periareolar incisions) or along the armpit (transaxillary), saline implants can also be placed through the belly button (TUBA).

Implant Size

Advantage: Saline implants are slightly more customizable.

When it comes to implants, size is important! While saline and silicone implants come in a similar variety of sizes, there is one big difference: the volume of each silicone implant is fixed (i.e. 425cc), while saline implants can be slightly overfilled or under filled as needed (i.e. 410cc to 440cc). This enables plastic surgeons to adjust the volume of saline implants during surgery to ensure symmetry between the breasts. The size of some saline implants can even be adjusted postoperatively through a remote injection port (common in breast reconstruction procedures).

Implant Shape

Advantage: Both saline and silicone implants are available in the same shapes.

Saline and silicone implants are both offered in round or teardrop (contoured) shapes. Learn more about implant shape.

Additionally, both types are offered with the similar projections: low profile, moderate profile, moderate plus profile, high profile and sometimes ultra-high profile.

Implant Texture

Advantage: Both silicone and saline implants are available in the same textures.

Saline and silicone implants are both offered with either smooth or textured outer shells. While not scientifically conclusive, many surgeons believe textured shells decrease the risk of capsular contracture or improper moving of the implant. However, textured shells may also be more susceptible to rippling or wrinkling. Textured surfaces have also been linked to a rare form of lymphoma while smooth shells have not.

Longevity

Advantage: Saline and silicone implants last equally as long.

Mechanical devices are prone to failure at some point over their lifetime, and breast implants are no exception. While implants are highly durable some patients will need to replace their implants at some point in time. However, there is no study that shows a difference in longevity between saline and silicone implants. Both implant types can last equally as long when placed in the body.

Rippling

Advantage: Silicone implants have less chance of rippling or wrinkling.

Breast implant rippling (or wrinkling) results in folds or wrinkles in the implant that may be visible through the skin. Ripples usually occur on the bottom or sides of the breast. All variables constant, saline implants have a slightly higher chance of rippling compared to silicone implants due to the lower viscosity of saline compared to silicone gel.

Rupture

Advantage: Saline implants rupture is easier to detect and saline is harmlessly absorbed into the body.

While uncommon, one of the risks of breast augmentation is rupturing of the implant. Rupturing occurs when the outer shell of the implant weakens to the point where a tear or hole develops. The filling from within the shell then leaks out causing deformities in the appearance of the breasts.

A saline implant rupture is immediately detectable as deflation (loss of volume) occurs quite rapidly. The saline (salt water) filling rushes out of the implant and into the body where it will be harmlessly absorbed. While this deflating of the breast may be aesthetically displeasing, there is no real urgency to fix the implant since saline is non-toxic.

In contrast, silicone implant ruptures do not result in a rapid deflation of the breasts. Instead the silicone implant filling slowly oozes out of the implant but often collects within the breast pocket. This is referred to as a “silent rupture” as a visual diagnosis is nearly impossible. The FDA recommends women with silicone breast implants have an MRI screening for silent rupture 3 years after surgery and every 2 years after that.

Cost

Advantage: Saline implants are less expensive.

A major contributing factor that determines the total cost of a breast augmentation surgery is the cost of the implant. In general, saline implants are less expensive compared to silicone. Women can typically save $500 – $1,000 by choosing saline.

Risks

Advantage: Saline and silicone implants have similar risks.

Breast augmentation surgery is a relatively low risk procedure. Risks, while uncommon, include capsular contracture, a change in nipple sensation, implant rupture, and infection.

Saline Vs. Silicone: What’s Better?

In the United States, silicone implants are far more popular with roughly 75% of women choosing silicone over saline. However, that does not mean that silicone is the best choice for all women. Since both types of implants have their own unique advantages and disadvantages, patients should keep a relatively open mind before seeing a board-certified plastic surgeon for an in-person consultation.

A skilled surgeon will have years of experience using both silicone and saline implants and patients with many different characteristics. This experience will allow your surgeon to help you determine the best implant type for your specific body type and desired final result.


Cameron Craven, MD, FACS

Cameron Craven MD, FACS is board certified by the American Board of Plastic Surgery. Dr. Craven specializes in the full spectrum of cosmetic surgery including breast augmentation, liposuction and body contouring, facial rejuvenation, laser surgery, eyelid surgery, and rhinoplasty, as well as reconstructive surgery for skin cancers.


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