This Article Has Been Medically Approved By

Dr. George H. Sanders


Women who had breast augmentation surgery in the 1990’s and 2000’s had saline implants inserted in most cases. As those implants are now nearly 20 years old, many are being replaced. Some leak, others are replaced because women want a different size, and others develop capsular contracture as the surrounding scar tissue squeezes down on the implant and produces an odd appearance, mammographic difficulties, and pain. As women come in for implant replacement surgery they are faced with a choice between saline or silicone replacements. Which is better?

First of all, a bit of background is helpful. Silicone implants were the original breast implants. In the early 1990’s, however, concern over leakage and other issues prompted the FDA to limit access to them. Saline implants became the new face of breast augmentation. Several years ago, however, the FDA lifted many of the restrictions on silicone implant usage, allowing women over the age of 21 a choice of saline or silicone implants.

What are the differences?

• When you examine the implants outside the body, the silicone implant feels much more natural than the saline implants. When placed inside of a person, however, they feel much more alike. There is also no significant difference in mammograms between the implants and the risk of capsular contracture seems to be about the same as well.
• An advantage to the silicone implants is that they leak less frequently and therefore last longer.
• Silicone implants are now filled with a more cohesive silicone gel that “sticks together” more than the original silicone gel that was more liquid in character. As a result, if there is a leak from a newer silicone implant, the silicone is far less likely to leak into the surrounding tissues because of the stickier nature of the silicone gel. When they do leak, however, it may be difficult to detect the leak, prompting the need for an MRI scan. On the other hand, when a saline implant leaks, it usually deflates within 48 hours, making the leak easy to detect. To some degree, manufacturer’s warranties cover replacement of the leaking implant in the case of both saline and silicone.
• Another advantage to the silicone implants is that they wrinkle less than do the saline implants. This is especially true in women with small breasts and minimal subcutaneous fat.
• Saline implants cost several hundred dollars less than silicone implants.

So which is better? Answer: There are advantages to each!

For example:
• A woman under 22 must use saline implants.
• If a person has a great deal of breast tissue, there is going to be less concern with the chance of wrinkling with a saline filled implant.
• Some women are put off by the difficulty one may have in detecting a leak from a silicone implant, finding the need for an MRI unsettling. On the other hand, having an implant deflate may be equally unsettling, favoring the choice of a silicone implant.
• A very slim woman may prefer the lesser degree of wrinkling that comes with a silicone implant, and she may also appreciate the longer life expectancy as well.
• Someone for whom the softest and most natural result is important may lean toward a silicone implant.

In the end it’s a bit like the difference between chocolate and vanilla ice cream. Both are good, but each flavor has its enthusiasts!

To help you better understand the difference between the implant types in your particular situation, please contact the office for a consultation.