American Society of Plastic Surgeons
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Silicone or saline implants: Which is best for your breast augmentation?

silicone or saline breast implants?

Breast augmentation has long been one of the most popular procedures in plastic surgery, and that doesn't seem likely to be changing any time soon. This procedure involves enhancing the shape, size and placement of the breasts, most commonly with the use of breast implants.

The idea of breast augmentation may traditionally conjure images of oversized, bolted-on implants, but the most popular varieties in recent years lean towards a more natural look that works well with the unique frame and appearance of the patient.

Even with the widespread awareness about breast augmentation, many patients and prospective patients may be unfamiliar with the different types of implant options available to help them achieve their goals – silicone and saline. Both types of implants are similar and can help you reach your desired results, but there are a few key differences between them that have contributed to a notable shift in the preferred option among patients.

To help understand these key differences between silicone and saline and the shift in popularity, we reached out to two experts in the field of breast augmentation – Michelle Roughton, MD, and Kristy Hamilton, MD – for their insights on the topic.

The differences between silicone and saline breast implants

When considering the different implants available for breast augmentation, comparing silicone and saline is a pretty good place to start. While generally similar and both safe, these implants do differ in several key areas, including weight, consistency and appearance.

"Both implants consist of a silicone shell with different interior fills," said Dr. Hamilton. "Modern silicone implants are filled with silicone cohesive gel, like a 'gummy bear'. The days of liquid silicone fills are gone. Silicone implants are by far the most popular today because they are lighter weight than saline and both feel and look more natural. Saline implants are filled with sterile salt water."

While silicone implants were once avoided because of their potential for rupturing and leaking, they are by far the most preferred type of implant for women seeking out breast augmentation for two reasons.

"In a nutshell, I tell my patients the silicone implants feel more natural and last longer," said Dr. Roughton.

When choosing the right type of implant for a patient, it all comes down to their individual preferences. This also involves taking into consideration the shape and cohesiveness of the implants to find the right fit for the patient.

"In addition to implant fill, implants can be round or shaped, smooth or textured," said Dr. Hamilton. "When choosing silicone implants, there are also different degrees of cohesiveness – or 'gumminess' – available from which to choose. More cohesive implants will look perkier with more upper-pole fullness, while less cohesive implants will relax into a more natural, tear-drop shape when placed in the body. Choosing between those looks is a matter of personal preference, which is why I spend so much time working with patients to get inside their heads to determine how they'd like to look in order to choose the right implant for them."

Another consideration when choosing the right type of implant is a patient's body type. Many patients are after something that both looks and feels natural rather than something oversized or uncomfortable.

"The patient's measurements are of primary importance – we, as plastic surgeons, call this biodimensional planning," said Dr. Hamilton. "I guide patients in this category to determine what range of implants they can choose from that will fit their frame appropriately. Subsequently, I have patients try on sizers in a surgical bra to get a general idea of what volume they like, both in terms of look as well as weight, to ensure they're not too heavy. Finally, I review photos, or 'wish pics,' to help patients choose the level of gel cohesivity they would like – firmer will yield more cleavage."

Providing your plastic surgeon with a visual of what you hope to achieve with breast implants can be one of the most helpful steps in the consultation process.

"I think 'wish pics' or goal photos are the most helpful," said Dr. Roughton. "The least helpful thing I've found is the word "natural" which has vastly different meanings to different women. I use a VECTRA device, which can give them some idea of what different sizes will look like on their body."

The presence of social media in driving implant trends

Patients are now coming to consultations with more understanding about the different types of implants because of social media.

"I have been amazed at how much more knowledgeable my patients are today compared to five years ago," said Dr. Roughton. "All of my patients have some knowledge before consultation. They're excited to see and feel saline and silicone implants and the differences in cohesivity, but the amount of information they have beforehand is incredible."

This increase in patient awareness can be attributed to the growing use of social media among younger age groups in addition to the greater availability of accessible information online.

"There has indeed been a significant shift in the level of awareness among patients about breast implants and breast augmentation surgery, and I do attribute it to the rise of social media as the primary form of information gathering for Gen Z and millennials," said Dr. Hamilton.

Social media can be a great place for patients to find information, but there's no guarantee that the information is accurate. To counter this, it's important plastic surgeons keep their patients properly informed throughout the process.

"Overall, social media has created a positive influence because education is essential for patients choosing to proceed with breast augmentation," said Dr. Hamilton. "However, with social media also comes the increased ability to propagate misinformation which sometimes needs to be corrected during the consultation. My breast augmentation consults are at least an hour, and patients almost always comment that they learned a significant amount during them. Patient education is essential."

Tips for patients interested in breast augmentation

As with any plastic surgery procedure, there are a few key steps that you can take to set yourself up for success on your breast augmentation journey.

Always choose a board-certified plastic surgeon

While it may sound like a broken record, finding a board-certified plastic surgeon who is an ASPS member is a crucial step in the process of pursuing breast augmentation.

"It sounds simple but many are confused – tricked even – by a 'club' that 'certifies' cosmetic surgeons," said Dr. Hamilton. "It is not a real board of medicine. The key is to see what training the surgeon has. He or she must have completed a plastic surgery residency or fellowship training program."

Do your research before your consultation

When planning for your initial consultation, do your homework and take the time to research the procedure, the different types of implants and what to expect following the surgery.

"There is so much information online that you can be pretty prepared prior to your consultation," said Dr. Roughton.

Doing your homework can also involve researching the surgeon themselves, including looking at their before and after galleries.

"Be sure you like the results," said Dr. Hamilton. "A gallery represents the surgeon's very best work, so you will likely be receiving a look similar to what is presented there."

By preparing for your consultation, you can set yourself up for a positive and informed discussion with your prospective surgeon.

A healthy lifestyle is key

It's easy to get so caught up in planning for recovery after your procedure that you forget about what you need to do prior to your breast augmentation. One key step to take is to ensure that you are following a healthy lifestyle, including exercise, eating nutritious foods and getting adequate sleep.

"Prior to surgery, engage in a healthy lifestyle, avoid drinking, stop smoking or using nicotine products entirely and make sure all your supplements and medications are approved by your plastic surgeon," said Dr. Hamilton.

Plan ahead for your recovery

It's also important to properly plan to set yourself up for success in your recovery. This involves taking time off work as well as taking a closer look at your long-term calendar to ensure that you have plenty of space to rest and recover.

"Also, if you're actively planning a pregnancy or still nursing, it's not the best time to have elective surgery," said Dr. Roughton.

Choosing the implants that are right for you

Many patients may be aware of breast augmentation, but they may be unclear on the differences between silicone and saline breast implants. Saline has been traditionally the popular choice among women, but there has been a noticeable shift towards silicone within the past several years, partly because of the prevalence of information online and on social media.

There is no doubt that breast augmentation will continue to reign as one of the most sought-after procedures within the specialty for many years to come. If you're among the many patients who will be seeking out this procedure, it's important to understand what choices you have when it comes to implants and work with your plastic surgeons to find an options that works best for your aesthetic goals.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.


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