Saline or Silicone Breast Implants?

Silicone breasts implants were reintroduced into the US market in 2007 after a nearly 20-year absence, during which the implants and their supposed ill effects were the subject of law suits; bankrupting of Dow-Corning, the manufacturer; and a whole lot of hoopla. Now, silicone implants are being used for breast augmentation by about 20% of cosmetic surgeons in the US.

The silicone breast implant has become infamous as the most researched medical device in history. It was approved by the FDA after numerous trials and is now offered as a choice for women considering breast enlargement with an implant. Risks still exist, of course, as with any surgery, and the FDA approval only means that the silicone implants do not have any risks over and above those of surgeries with saline implants. So why do most plastic surgeons not use silicone implants?

Breast implant choices

There are a number of reasons that must be considered when talking about breast implant choice:

1. The plastic surgeon’s preference

Many plastic surgeons have been using saline implants for 15 years or more and are now comfortable with how they behave and perform. They may have little experience with silicone implants. Cosmetic surgeons such as myself were the last group to train almost exclusively with silicone breast implants in early 1990-1992.

Saline implant breast enlargement

Breast Augmentation gone wrong2. Patient concerns about safety

Despite all the testing over the past decade, there is a persistent idea that silicone implants are not safe. Even the FDA is still not 100% sure.

3. Size of scar

Silicone breast implants are pre-filled in the factory to their specific volumes. The incision that is needed to insert the implant thus has to be almost double the size of the incision needed for placement of the saline implant. My scars for a saline implant are typically 2.5 cm. The larger scar also limits the locations through which the implants can be placed.

4. Feel of implant

A silicone breast implant has a much more natural, squishy feel than a saline implant when you hold it in your hand. However, since over 95% of breast implants are placed under the muscles of the chest in order to decrease the risk of capsular contracture (internal scarring around the implant), the feel of the implants is the same as your breast and chest muscles and not the implant that is pushing everything forward. The softer implant feel is not felt!

5. Look of implant

The final result of both implants is similar when the breast implant is placed under the breast tissue and muscles of the chest. In very thin patients, the saline implants may show more of the rippling that occurs to some degree with all implants. In such patients I may use a silicone implant, only because they really have no muscle and the breast implant is for practical purposes placed over the muscle.

6. More complex secondary surgery

Sometimes a second surgery is necessary with either saline or silicone breast implants. In such cases, the surgery for the saline implants is much easier. Typically, an exchange of implants can be performed under local anesthesia in the office, whereas silicone implant revision requires the procedure to be done under general anesthesia.

7. Cost

Silicone implants are more expensive than saline implants!

8. Age

FDA rules only allow silicone implants for cosmetic breast enlargement on women older than 22!

9. History of fibromyalgia

FDA rules exclude women with fibromyalgia from using silicone breast implants!

There are many aspects to consider in choosing between a silicone and saline breast implant. Ask your cosmetic plastic surgeon to give you all the reasons for their recommendation of a particular breast implant.

Need more information on breast surgery? Find it here:

Breast surgery

Morad Tavallali, M.D., FACS


Top Blogs

Leave a Reply