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5 Tips for Choosing the Perfect Breast Implant, Part 1: Saline vs. Silicone

Choosing the perfect pair of implants can feel overwhelming when you're faced with hundreds of options for customizing your best look. While every woman has done a certain degree of research they are still left to make firm decisions on several details about the implants themselves. Without professional guidance from a board-certified plastic surgeon, it's easy to second-guess or even third-guess your choices.

Patient education is something I consistently strive for so, to help empower your confidence and decision-making, I'm doing a blog series detailing 5 factors that are critical in getting the perfect breast augmentation for you. Over the next several weeks I'll cover:

  1. Type of Implants
  2. Breast Implant Size/Volume
  3. Breast Implant Shape 
  4. Breast Implant Profile
  5. Implant Manufacturers


What Types of Breast Implants Are Available?

Breast implant surgery includes many variables, Today, we're taking a deep dive into the details of saline versus silicone gel implants because your additional decisions for breast augmentation hinge on your selection of either saline or silicone gel.  According the The American Society of Plastic Surgeons, most implants placed today in the United States are silicone. That said, many women who choose saline-filled implants have excellent results and high patient satisfaction.

Saline-Filled Implants

Saline implants come empty and are filled with sterile salt water by the plastic surgeon during breast augmentation surgery to the manufacturer's recommended volume.  Because they are filled in the operating room during the procedure, plastic surgeons can custom fill the size in keeping with the volume range designed for the saline breast implant. 

Structured Saline Breast Implants

There is a new generation saline implant with dual filling chambers that has several advantages over the single lumen saline implants.  This implant is made by Ideal® Implant and belongs in its own category called "structured saline breast implant." The Ideal® Breast Implant has several advantages over the older single-lumen implants:  less rippling, more natural look and feel, and it won't go completely flat if it ruptures.

Understanding Silent Ruptures Associated with Implants

Silent rupture is an important distinguishing factor when deciding on saline versus silicone implants.

Saline implant rupture

If a saline implant ruptures, the implant will lose all of its volume, while the body absorbs the saline solution.  The ruptured saline breast implant can be replaced in a simple procedure, so that symmetry, shape and projection are quickly restored.

Silicone implant rupture

If the new generation silicone gel implants rupture it is often unknown or unclear whether the implant is ruptured because the gel will stay within the confines of the implant.  It can be difficult to diagnose a silent rupture with MRI being the most reliable method.  


Saline Breast Augmentation Advantages

The following table(s) summarizes the advantages and disadvantages of saline, silicone, and structured implants:

 No silent rupture When a saline implant ruptures there is no question.  Your breast implant will deflate  and the sterile saline fluid is quickly absorbed by your body.
Variable fill volume There is a range of fluid that can be added to the implant.  It is easily to achieve more perfect size or volume symmetry with saline as the volume can be controlled
Smaller incision The implant is placed without fluid and can fit through a smaller incision.  It is filled after it is placed into the implant pocket.
Cost Saline implants are the least expensive.


Saline implants come in 3 profiles: low, moderate, and high. Saline may have a lower incidence of capsular contracture (scar tissue) due to the absence of “gel bleed.”  Saline capsules are generally thinner and more pliable.  Because they are thinner, they can be placed through a smaller incision making them a good choice for a periareolar (around the nipples) or transaxillary (through the underarm) incision.  Saline implants have a recommended fill volume so that they can be filled to a minimum or maximum capacity allowing for more precise control of symmetry.  In cases where breast size varies, saline implants can more precisely make up any size difference.  

Saline Disadvantages

Less Natural Feel Since saline implants are filled with water, they have a liquid-like feel, and may be noticed when felt.
Rippling Because they are liquid filled, saline implants have a risk of implant rippling more than silicone which can be seen from certain angles and cause lower satisfaction in thinner patients.


Saline breast augmentation can feel less like breast tissue than silicone gel.  In cases where a form-stable implant is desired, silicone gel provides better alternatives.  Form-stable implants l is used in anatomic or breast shaped implants and in highly cohesive implants used to maximize upper pole volume. 


Silicone Gel Breast Augmentation Procedure

Silicone Gel-filled Implants

Newer generation silicone implants come prefilled with a semi-solid gel. These new generation implants are often referred to as "gummy" and closely mimics the feel of natural breast tissue. These implants have been given the nickname "gummy bear implants" because the gel inside is designed to stay within the implant to prevent breast implant leaking if there is trauma that would cause a rupture of the implant.

Silicone implants come prefilled, are more viscous and thus feel more like breast tissue.  There are more choices with silicone implants in terms of breast shape, profile, and gel gumminess.  Silicone implants can be more precisely used to:

  • shape the breasts in cases such as the need to maximize upper pole fill ,or
  • when an anatomic or tear drop shaped implant is desired.  

Since the newest generation silicone implants have more cohesive gel,  if an implant “leak” is detected, the gel is designed to hold together if there was a compromise in the implant shell. 


Silicone Disadvantages

Because these implants are designed to stay in tact when the outer layer is compromised, it can be difficult to tell when an implant rupture has occurred. For this reason, plastic surgeons generally recommend periodic MRI tests to check the implants

Silent rupture MRI needed to rule out breast implant rupture
Slightly larger incision Silicone implants come prefilled meaning that a slightly larger incision is required to place the implants under the chest muscles
More expensive Silicone implants come in 3 gel viscosities, or levels of gumminess.  The costs vary based on breast implant cohesivity.

Now that you have a more information on the types of implants used in breast augmentation, stay tuned for making the right selection for breast implant size and shape.

As always, for questions or to schedule your complimentary consultation, please reach out to our team.