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.
Two basic choices for breast implants: saline and silicone gel
There are two basic choices for breast implants: saline and silicone gel. Each has advantages and disadvantages which I will discuss so that you can be more knowledgeable in your pursuit of breast augmentation. Both implants are composed of a solid silicone outer shell and it is the “filling” that makes each different. Saline implants are filled with saline salt water. Silicone implants are filled with a cohesive silicone gel. If you cut a silicone gel implant in half, the gel will not ooze out – think of the consistency of the inside of a gummy bear. This is a tremendous improvement over the earlier generations of silicone implants that were composed of liquid silicone oil that would run out freely from a ruptured implant.
Saline implants are packaged unfilled
Saline implants are packaged unfilled. This means that the empty implant is placed in the breast and the surgeon fills the implant with saline fluid to the desired volume through a small fill tube. There are several advantages to this. Because the empty implant can be rolled up like a cigar, it can be placed through an incision smaller than the incision required for a silicone implant. Another advantage of saline implants is that the surgeon has some latitude in the amount of volume that can be added. The implants can generally hold a 30cc range of fluid. This means that a 300cc implant can be filled to anywhere between 300cc and 330cc. This allows for intra-operative adjustment of volume to help achieve symmetry of the breasts. This has a specific advantage when performing breast augmentation on women with pre-existing breast asymmetries. We can sit the patient up in the operating room and can look at the breasts and fine tune the volumes – maybe add a little to the right or take a little from the left.
Silicone gel implants come pre-filled
Silicone gel implants come pre-filled. This means that the volume is pre-determined and cannot be adjusted in the operating room, therefore the pre-operative examination and implant size selection is paramount. In addition, the pre-filled silicone gel implants require a longer incision to inert. This longer incision means a longer scar. It also means that some incisions location choices may not be an option. For example, it may be impossible to place large silicone gel implants through a peri-areolar (around the nipple) incision in women with very small areolas.
In terms of the look and feel of the implant, no one will dispute that silicone gel implants look and feel more natural. They are soft and feel very similar to natural breast tissue. Saline implants tend to be firmer and may show visible rippling around the edges. There can also be visible folds, especially during movement or bending over. Placing the implants under the muscle can reduce some of this, but a saline implant will never look or feel as natural as a silicone gel implant.
What happens if they leak
Studies show that the rupture or leak rate of both implants is the same. However, the ability to detect a leak is quite different between the two implant types. When a saline implant leaks, it is obvious. Your breast will be deflated in a few days or weeks depending on the size of the leak. When a silicone gel implant breaks, the gel will not leak out. This means the breast will not change size. Rather, it will change very slightly in shape. These changes can be subtle and an MRI is needed to detect a silicone gel implant rupture. Studies do not show any connection between systemic sickness and a silicone implant rupture. Silicone gel will not get into the blood and travel throughout the body and cause cancer, Lupus, arthritis, or any other illness. 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. 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 has saline implants placed, have returned to have the implants exchanged to silicone.
As you can see, there are advantages and disadvantages to each type of breast implant. To learn more about your options for breast augmentation and implant selection, visit a board certified plastic surgeon. Contact us to schedule your appointment with Dr. Schulman, by calling 212-289-1851.