Which Breast Implants Are Better, Saline or Silicone?

I’m pretty sure that, if there is one topic that I’ve talked about with patients in consults the most over 16 years, it’s this.  Saline vs. Silicone.

Let’s talk about the history first.  The first breast implants in the 1950s and 1960s were actually more like sponges. Then first generation of silicone devices in the 1960s were silicone but had Velcro-like patches on the back and tended to rupture and form hard scar tissue (capsular contracture).

Second-generation silicone implants were thin and weak because of their outer shells, and the silicone filler was thin and could migrate through the tissues if an implant ruptured. These implants also had high capsular contracture rates. In the 1980s, third generation devices were introduced and had thicker stronger shells.

The FDA stopped the general use of silicone implants from 1992 to 2006 because of complaints that silicone implants were causing multiple diseases in women. 

The implants released at that time (4th generation) had filler gel that was more “cohesive” (less runny). The newest highly-cohesive gel implants (5th generation) since 2013 are considered highly-cohesive and are the type of implants we use today.

Some of these implants are more cohesive, or firmer, than others. This development was necessary so that shaped implants could maintain their shapes.

Even though these shaped implants are almost never used now (because they are all textured- which is a whole other issue), we still have the option of using smooth round implants that have the firmer gel to give a rounder shape with less rippling.

As this was going on, saline implants came on the scene in 1964. They had high deflation rates, but some engineering changes gave us the more reliable implants we have today.

So where are we today? Should you get saline or silicone? Silicone is definitely chosen more by surgeons and patients around the world, but is it best for you? Let’s look at the choices.

There are tons of details and statistics and graphs that we can consider, but I like to keep it simple in my consults. It is reasonable to say that both options have 2 advantages. And NONE of them are about how the implants LOOK.

Silicone

Silicone feels more natural. It feels like fat or like firmer breast tissue, depending on the type of silicone. Generally the implant is able to be felt only on the bottom and outside edge of the implant when they are under the pectoralis major muscle.  So silicone is harder to distinguish with your fingers from the rest of the breast.

Silicone also has a lower rupture rate. Also, if 5th generation silicone implants do rupture, it is not the mess that it was with the early implants. Saline implants are far more likely to rupture or leak over a lifetime.

Saline

Saline implants are less expensive. Choosing saline usually decreases the cost of the surgery by around $1,000. For a lot of women, that is a very important difference.

Saline implants seem to have lower capsular contracture, which is the tight or hard scar tissue that can form around some implants giving an unnatural spherical look and a hard feel.

Again, I did not say ANYTHING about how they LOOK. There are choices of round silicone shapes (some flatter and some more spherical or projected and some flatter) to give more natural vs. more augmented, push-up looks. The same is true for saline, plus you can add extra to make them even rounder.

So, how to choose? Here’s a thought:  Let’s say the lower rupture rate of silicone and the lower capsular contracture rate of saline balance each other out.  Then it comes down to whether the more natural feel (not look!) of silicone is worth $1,000 to you.

Well, if you already have a reasonable amount of breast tissue and the implant you are choosing is not very big, then it will be hard to feel under there anyway. (Think princess and the pea.)  But if you have almost no breast tissue or fat, and you want a bigger implant, it is going to be way easier to feel. And then there’s the question of whether that even matters to you…

So that’s how I like to explain it.  That’s also why I use both types of implants.  All women are different- not just in their anatomy, but in what’s important to them. So in my mind, one “size” (or implant type) does not fit all.