Silicone or Saline – Which is the better breast implant?

Several times each day I am asked the question, “Is silicone or saline a better implant?”  I explain that I cannot say which is “better” because it is impossible to define “better.”  Also, breast implant selection is a very personal decision.   I do tell my patients that silicone implants tend to look more natural and feel more natural.  They then must decide if this constitutes “better” in their mind.

 Silicone implants have used for a long time.  In the 1980s and 1990s there was immense controversy surrounding silicone implants. There were accusations that silicone implant carried with them a risk of cancer and auto-immune diseases.  In response, these implants were removed from the market, except for the use in breast reconstruction after mastectomy.  During this time, plastic surgeons began to gather an incredible amount of data about these silicone implants and the patients who have had them implanted.  After 14 years of data collection, the data was analyzed and there was no evidence that any systemic or chronic illnesses can be attributed to silicone implants.  In 2007, the FDA removed the restrictions and silicone implants were again approved for use in cosmetic breast augmentations.

 In my practice, approximately 80% of women select a silicone breast implant.  They find the implant softer, more natural, and without the common “rippling” that can be seen in saline implants.  Also, many patients who previously hassaline implants placed, have returned to have the implants exchanged to silicone.

 The rate of implant rupture and leaking is no different between saline and silicone. The only difference is that a ruptured saline implant is very obvious – the woman will “deflate” within days as the body absorbs the salt water.  Detecting a silicone implant rupture is more difficult. Because silicone is not absorbed by the body, the breast will not “deflate.”  Rather, there may be a slight change in the overall shape and feel of the breast. This change may be so slight that it can go undetected for motnhs. An MRI is needed to absolutely detect a ruptured silicone implant.

 The other difference is that a silicone implant is supplied pre-filled, as opposed to a saline implant which is empty and inflated after it is put in the body.  This means that a larger incision is needed to place a silicone implant. It also makes silicone implants more difficult to place through the underarm and impossible to place through the belly button.

As stated earlier, implant selection is a very personal decision. As a physician, I provide the details of each implant type, giving enough information so that my patient can make an informed decision for herself.