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Breast Augmentation: Saline vs Silicone, which is best for me?

Breast augmentation is one of the most gratifying procedures for the patient and surgeon alike. It can truly be a life altering change for many women which as surgeons make us very delighted to assist in that transformation. There are specific things to think about when considering breast enhancement and one of those big questions is, “Do I want a saline or a silicone implant?”


Why should a patient choose one over the other? First let’s comment on the original moratorium the FDA placed on silicone implants about 20 years ago; this proved to be a bit of a knee jerk reaction for there were concerns that there might be problems silicone caused and frankly no one had looked closely at any disease process that might be related to silicone in the body.  Therefore the FDA under Dr. Kessler said let’s take these implants off the market until someone looks at the issue closely.  Well multiple large epidemiologic studies were done from very reputable institutions and no linkage could be found between silicone and any systemic illness.  It would take pages to cover all the studies in detail, but in short the FDA realized there was nothing wrong with silicone breast implants and allowed them to be brought back to the market in November of 2006. One advantage of the moratorium however is the fact that the manufactures did improve the implants significantly with stronger outer shells and more “cohesive” silicone elastomere. Cohesive silicone means it sticks to itself much more and doesn’t move around easily. So patients and plastic surgeons got a much better set of breast implants out of the down time when only saline breast implants were available to patients. The bottom line is if saline implants were in every way as good an implant as silicone breast implants, then we never would have cared if silicone was made available again or not.

There are definite advantages to silicone implants and across the whole spectrum they are a better quality “breast enhancer” than saline implants, but that still does not mean silicone is the end all and be all, and many patients are absolutely satisfied with their saline implants.

Difference Between Saline and Silicone

Let’s walk through some of the differences between saline and silicone. First off silicone is a more expensive implant, about three times as expensive in fact. Medical grade silicone is expensive stuff, the technology in manufacturing silicone implants is more expensive and it makes for a higher priced device. That alone is enough reason for some patients to choose saline implants. Also the FDA , manufacturers, and surgeons request that if you have silicone implants that you intermittently get MRI imaging of the breast to check if your implant is still intact and looks normal and that is an expense to the patient over time that saline implanted patients need not concern themselves with.  So what makes me say that silicone is a better “breast enhancer” than saline. One reason is that silicone implants feel much more like your natural breast.  Saline is by definition essentially water and your breast is fat and tissue that has a denser feel and quality to it that “feels more like silicone” than it does salt water. About three times as many patients with saline implants will say they can feel the edge of their saline implant compared to silicone patients.  Another advantage of silicone over saline is it’s about one third as likely to show any rippling in the breast.  While rippling fortunately isn’t very common, it still happens with enough frequency to saline implanted patients that some of them choose later to change their implants to silicone. Another reason patients may choose silicone is that the breakage rate for silicone is about half of the deflation rate for saline implants so over the years your more likely to have to replace your saline than your silicone implant.

The Best Decision For You

Do be aware that everyone doing breast augmentation needs to think that over the course of their life they may need more than one operation following breast augmentation. An implant may break, your breast may change from pregnancy, age or weight changes over the years. Perhaps you may later want a smaller breast, or your might get a capsular contracture (hardening of scar tissue around the implant) that makes you want to have another surgery to correct the problem or change or lift up the breast. The implants do add weight to the breast and change the rate that the skin will change over the decades. In my own plastic surgery practice in Tucson Arizona, about 45% of my patients choose saline implants and 55% choose silicone.  It’s important that you make the right decision for you, we are here to guide you in that decision making with solid valid information. Please consider looking at the implant manufacturers web sites to get more information or use the web site of the American Society of Plastic Surgeons to broaden your knowledge about breast augmentation and Plastic Surgery in general. Hopefully this has helped you answer a few questions that relate to saline vs silicone implants…  If you have additional questions or would like to schedule a consultation please contact my plastic surgery office in Tucson Arizona at (520) 575-8400




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