Saline vs. Silicone Breast Implants: What Are the Trade-Offs?

Female patient and doctor compares different kinds of breast implants.

Choosing the type of implants used in breast augmentation is one of the fundamental decisions women make for breast enhancement surgery. Implants can be filled with either saline or silicone gel, and my breast augmentation patients in Chicago make their choices based on personal preferences after I explain each option’s trade-offs.

Most plastic surgeons strongly push patients toward choosing silicone gel implants, which is reflected in statistics from the American Society of Plastic Surgeons showing that nearly 90% of women in 2018 opted for silicone implants. I feel equally strongly, however, that a more nuanced view recognizes that both types of implants involve trade-offs. There is no perfect implant. After I inform my patients about the advantages and disadvantages involved with both types of implants, most patients choose saline implants.

Differences Between Saline and Silicone Implants

Both saline and silicone gel implants share 2 basic limitations:

  • The risk over time that an implant will leak
  • The possibility of developing capsular contracture (when excessive scar tissue develops around the implant, distorting its shape and making it firmer)

Implant leaks: It’s obvious when saline implants leak because the implant deflates and the body harmlessly absorbs the fluid. Silicone gel implant leaks are often called “silent leaks” because the cohesiveness of the silicone allows the implant to maintain its shape. In most patients, however, the silicone gel causes inflammation, which results in the development of scar tissue and capsular contracture. To learn more about implant safety, read this related blog post.

Capsular contracture: Severe capsular contracture occurs in 12 to 15% of patients 10 years after getting silicone gel implants, according to large, FDA-sponsored studies conducted by the 2 major U.S. implant manufacturers.  Even though there is no hard data for saline implants, many experienced surgeons, including myself, have found severe capsular contracture rate of 1% or less for saline implants. A significant percentage of patients have completely soft implants, even 15 to 20 years later. 

Look and Feel of Implants

If you’ve been researching breast augmentation online, you may believe that it’s universally believed that silicone gel implants look and feel more like natural breast tissue than saline implants. In fact, saline implants generally appear more natural than a silicone gel implant with mild capsular contracture, a condition that can make the implant round rather than the teardrop shape of natural breasts. Silicone gel implants often do feel more natural in cases involving a thin patient and large implants in relation to the amount of breast tissue.

Technique Matters

One drawback of saline implants is that they tend to have visible rippling when placed above the muscle. That’s why I’m careful to place saline implants either below the muscle (submuscular) or under the fibrous layer (fascia) of the pectoral muscle instead of under the muscle fibers. This greatly diminishes visible rippling. Patients with at least a moderate amount of breast tissue who choose medium-sized, saline implants placed in a submuscular or subfascial plane will get results that feel just as natural as silicone gel implants. These results depend on the technical expertise of the plastic surgeon creating the implant pocket.

I’ve performed more than 2,000 breast augmentation procedures during my career, the vast majority of them using saline breast implants. The satisfaction rate of my patients who choose saline implants has been just as high as those patients who choose silicone gel implants. Additionally, patients with silicone gel implants who develop capsular contracture and then switch to saline almost always avoid capsular contracture after converting and are highly satisfied.

If you’re looking for a plastic surgery practice in Chicago that specializes in breast augmentation, contact us using the online form to request a consultation or call us at (312) 788-2560 to schedule an appointment. It’s also helpful to view our gallery of before-and-after photos showing the types of results you can expect.

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