Saline vs Silicone Implants: What's the Best Choice for Me?

We're going to go out on a limb and say that plastic surgery is one of the most misunderstood fields in medicine. In truth, that limb is more like a second trunk of the tree.

Many patients expect to walk into a plastic surgeon's office with a picture of Christina Hendricks and say, "I'd like these breasts, please!" It's actually a more involved process.

Breast augmentation surgery comes with a side range of choice: implant type, size, incision location, implant placement, adding a lift, and more. For you, the patient, that's good news! It might make for a more complex consultation than you thought but it gives you more control over your results.

One of the key choices you'll need to make is the type of implants you want. For the most part, you can choose between saline vs silicone implants. To help with your choice, check out these pros and cons.


Pros and Cons of Saline vs Silicone Implants

For the most part, breast augmentation has a high patient satisfaction record. In fact, 98% of patients on the popular cosmetic review site RealSelf were happy they had their surgery.

Still, some patients might have certain aspects of their results that they like or dislike. Everyone you talk to has a different experience, and part of that depends on the implants they choose. Here's how you can compare your choices.

Advantages of Saline Implants

A saline breast implant has a silicone shell that's filled with saline, a sterile saltwater mixture. Picture it like a water balloon that's round rather than teardrop-shaped. While silicone implants were on the market first, saline implants have some unique advantages.

Easier Rupture Detection

With all implants, there is a risk that it will one day rupture. In other words, it may develop a tear in the silicone shell.

In saline implants, the saline leaks out when this happens and your body absorbs it. That causes your implant to "deflate," so you know right away when the rupture occurs. If this happens, you would know to call your surgeon to schedule an implant replacement.

Potential for a Smaller Incision

Did you know surgeons actually place silicone and saline implants in different ways? A silicone implant comes from the manufacturer pre-filled. With a saline implant, the surgeon just receives the empty shell from the manufacturer. They place the shell inside the breast first and then fill it with saline.

As a result, saline implants don't need as large of incisions because the surgeon only needs room for a compact shell, not the whole implant. For patients, this means a smaller scar.

Keep in mind, though, that your scar will vary based on other factors too. If you choose a breast lift along with your augmentation, for instance, the scars will be the same no matter what implants you choose.

Ruptures Have Fewer Risks

You may have heard of saline before. Think of it as a neutral fluid for your body: a harmless one that doctors can use to replace other fluids like plasma.

In the case of a rupture, this is good news. It means your body will absorb the saline from your implant in a safe, non-toxic way.

With silicone implants, on the other hand, your body doesn't absorb the silicone if the implant ruptures. While we haven't found silicone ruptures to cause health problems, they can later lead to symptoms like breast pain if you don't catch them. 

Available at a Younger Age

Many people think that patients of any age can get plastic surgery as long as a parent consents if they're under 18. When it comes to breast implants, though, there are even more restrictions.

Silicone implants are only FDA-approved for patients who are at least 22 years old. Saline implants, on the other hand, are FDA-approved for ages 18 and up

For patients who are between 18 and 22 years old, some choose to get saline implants now rather than waiting until they can get silicone implants. 

Disadvantages of Saline Implants

While the advantages of saline implants can be alluring, most surgeons and patients prefer silicone implants due to these disadvantages of saline. 

Publicly Noticeable Ruptures

As we mentioned above, you will notice right away if your saline implant ruptures. While that's good for rupture detection, most patients see it as a negative overall.

Imagine being on vacation or in a public place when your implant starts to deflate. The worry about having very uneven breasts until their replacement surgery is enough to scare away many patients from saline. 

Higher Risk of Rippling

As with any medical procedure, breast augmentation has some risks of side effects or complications. While it's not dangerous, rippling is a complication that leaves some patients feeling frustrated with their results.

"Rippling" after breast augmentation means that the implant creates irregular ridges or ripples on the top of the breast. It's understandable that this makes patients feel embarrassed to show their breasts, even in bath suits and low-cut clothing.

While rippling is possible with any breast augmentation, it's not as rare for saline implants as it is for silicone. If you choose to have your implant on top of your pectoral muscle rather than under it, the risk is higher still. 

Not Good for Women with Little Soft Tissue

A breast augmentation surgery can be much different for women going from a C cup to a DD compared to women going from an A to a D. For women who don't have much soft tissue to start with, saline implants don't tend to be a good fit.

There are plenty of patients that this could apply to. In addition to women with small breasts, women who are getting implants as part of a breast reconstruction after a mastectomy may fall into this group. In addition, patients who are receiving male-to-female gender confirmation surgery tend to be better suited for silicone than saline implants. 

Higher Risk of Downward Displacement

Breast implants aren't immune to gravity. The problem, though, occurs when it drops so much that it creates a "lump" under the breast. While it's not a health risk, it doesn't create a look patients want, either.

Like rippling, this displacement is a possibility with any implant but it tends to happen more with saline implants. Saline implants are heavier than silicone ones, so gravity has more of an impact on them.

Advantages of Silicone Implants

To really have a better picture of your options, it's important to weigh the pros and cons of silicone as well as saline. Silicone implants have a similar shell to saline ones, but instead of saline, they're filled with a thicker silicone gel. Check out the unique advantages they offer.

Look More Natural

For the most part, this is the factor that sways most patients toward silicone implants. They tend to pair well with the breast's natural shape so they look more like natural breasts.

By contrast, saline implants tend to add more roundness at the top of the breasts. Natural breasts are shaped more like teardrops than globes, so the saline implants tend to make it more noticeable that a woman has implants.

More Natural Feel

Silicone implants don't just look more natural. They tend to feel more natural as well.

The texture and weight of silicone implants tend to mimic natural breasts better. Women with saline implants, on the other hand, often say their breasts feel like water balloons in a way.

On top of the feeling on your chest, silicone implants feel more natural to the touch as well. For a woman who wants her surgery to be discrete, silicone may be the way to go.

Last Longer

There's a common misconception that breast implants last forever. In truth, they do eventually need replacement after a few decades.

While this isn't a guarantee, many breast augmentation surgeons feel that silicone implants tend to last longer than saline. Over the course of a lifetime, this can make a big difference.

For instance, let's say you get implants at 25. Perhaps your saline implants last 15 years and your silicone implants last 20 years. By age 70, you will have had three saline implant replacements compared to two with silicone. Keep in mind that each patient is unique, though, and that these numbers are only theoretical.

More Options Available

If you're someone who enjoys customization, silicone implants may be the better choice for you. They offer a wide variety of options than saline implants do.

For instance, there's a new type of silicone breast implants known as "gummy bear" implants. The silicone gel inside them is thicker and more cohesive. Think of the texture of a gummy bear. These implants offer more distinct shaping than saline implants or traditional silicone implants. 

Disadvantages of Silicone Implants

Of course, as with any medical device, silicone implants have their disadvantages to consider as well. Here are the factors you need to think about.

Silent Rupture

As we mentioned above, when a saline implant ruptures, you know about it because your implant will "deflate." With a silicone implant, on the other hand, the silicone stays in place in the area around the implant.

When this happens, most patients don't realize their implant has ruptured. That's why women with silicone implants are advised to get MRI scans every several years. These MRIs can detect an implant rupture so you can get your implants replaced. 

Less Customization During Surgery

When you choose your implants, you and your surgeon will also discuss what size of implants you want. Implant sizes are based on the filling volume, so you'll hear the sizes measured in CCs or cubic centimeters.

Silicone implants come from the manufacturer filled and sealed. Your surgeon can choose the specific filling volume for each breast but when the implants arrive, their sizes are fixed.

Saline implants, on the other hand, offer more flexibility. Your surgeon will fill them after they're in place. This allows the surgeon to make on-the-spot changes to make sure your breasts are symmetrical.

In truth, this could be a pro or a con for silicone implants. You might miss the customization of saline implants, but you might also be worried about whether your results are less predictable with surgeon-filled saline implants.

Higher Cost

The cost of a breast augmentation surgery depends on many factors like your surgeon and your location. It also depends on the implants you choose.

Silicone implants require more expensive material, so manufacturers charge more for them. That extra cost is passed along to you. Just as a car repair has "material costs" and "labor costs," so does a breast augmentation.

Still, the cost difference isn't significant enough to play a part in many patients' decisions.

Which are More Popular: Silicone or Saline Breast Implants?

Sometimes it's helpful to consider the path other patients have chosen. When it comes to breast augmentation, the overwhelming majority choose silicone. In fact, in 2017, 87% of breast augmentations in the US used silicone compared to 13% who used saline.

Should I Choose Silicone or Saline Breast Implants?

When it comes down to it, your choice is a personal decision. Every patient is unique, and you need to take your own circumstances and goals into account to decide between saline vs silicone implants.

On top of considering these pros and cons, it's a good idea to look at photos as well. Look for before and after photos for patients with silicone implants and those with saline implants so you can compare them. Pay close attention to the patients who started with similar body types and breast sizes to you.

Remember that throughout all this, your plastic surgeon is a great resource. A surgeon has years or decades of experience working with each type of implant and has likely treated patients with similar body types to you. They'll be able to make their recommendation about which option suits you best.

If you're ready to take the next step toward breasts that make you feel confident, schedule your consultation with our plastic surgeons today.