Saline Vs. Silicone: “Which Implants Are The Best?”
Patients always ask which implants are best: saline or silicone. The simple answer is, “It’s complicated.”
Without getting into the whole history of breast implants and the big silicone scare of the 1990s, I can summarize by saying that it has been dramatic and complicated. Fortunately, all this attention over the years has led us to the current era of very well-studied and proven modern silicone implants. In a consult, I like to share as much information as I can to educate my patients, but it’s impossible to teach everything in one consult that it has taken me 25 years to learn.
Additionally, when evaluating the many studies that have looked at implant complications, durability, and need for revisional surgery, there are many subtleties in the studies that make it hard to draw conclusions. For this reason, I always use consults and preoperative visits to break the topic down to the most important concepts, comparisons, and even analogies. When we talk with patients about silicone vs. saline implants, I like to contrast the 2 types of implants in the most important categories and also clarify the similarities between the 2 options.
(In this discussion, I will be referring to data on Allergan/Natrelle saline and silicone breast implant 10-year data, since this is the implant brand that I most commonly use. Different numbers exist for other manufacturers, timeframes (5-year data), and subclassifications of types of silicone.)
The first question patients usually ask about is durability, or rupture rates. At 10 years, the rupture rate for saline is 13.8%, and it is 13.0% for silicone- about the same. Importantly, though, saline ruptures are easier to diagnose and surgically easier to address with simpler removal and replacement than ruptured silicone implants.
I also focus on capsular contracture, a term which refers to the tightening and hardening of the normally soft scar tissue capsule or membrane that forms around any breast implant. When the capsule gets tight enough, the implants can feel firm and look very round and unnatural (the grapefruit look everyone worries about).
Furthermore, if the capsular contracture gets even worse, the implants can feel hard and even be painful. The 10-year rates of severe capsular contracture are 20.8% for saline and 18.9% for silicone- again, almost the same. If placed under the pectoralis major muscle (which we always do), that rate for silicone drops to 15.7%.
There are several other implant properties that are similar between the 2 implant types. The presence of visible rippling (mostly at the bottom of the breast) is the same between saline and silicone. Also, the “look” or appearance of the implants in patients is the same, since there are so many different sizes and projections/shapes available (natural vs. medium fullness vs. roundest) in both silicone and in saline.
People want to know which looks better, or which looks more natural. The answer is that there is no difference in appearance. Additionally, patients with either implant type have essentially the same chance of developing self-diagnosed Breast Implant Illness (BII).
So, what ARE the big differences?
- Silicone feels more natural. That accounts for most people’s preference for silicone. The silicone fill feels more like natural fat, while the saline can feel like a Zip-lock freezer bag with water in it- especially at the bottom of the breast where there is no muscle to cover the implant. This difference in feel is a big issue in thinner women. On the other hand, a larger woman with more fat or any woman with more breast tissue will “hide” the crinkly feeling of a saline implant better. Similarly, a patient with smaller implants can also “hide” the less natural feel of a saline implant more easily.
- Saline implants are less expensive. In fact, a pair of saline implants usually costs $1,000 less than a pair of silicone implants. This is understandably a very important factor for many patients.
In summary, saline and silicone implants are very similar in most ways. I often say that it comes down to whether or not the more natural feel of the silicone implant is worth the extra money to the patient. If the patient has very little fat or breast tissue to cover the implant, or if the implant is large and it will be hard to have enough soft tissue coverage to “hide” the feel of saline, then I recommend silicone.
On the other hand, if the patient has plenty of soft tissue coverage and does not want to spend the extra money on silicone, I tell them that saline is a very reasonable choice for them. Finally, if a patient is very price conscious and wants the “look” but isn’t worried about the “feel”, then saline can be a fine option for her also.