Saline vs silicone implants for breast augmentation

For women considering breast augmentation, I recommend that patients not come into a consultation with a set list of the exact size, shape and type of implant they want. While having an idea of desired details is certainly a good thing, a large part of a plastic surgeon's job is determining each patient's ultimate aesthetic goal, then determining how to help her get there from her current look.

That said, patient education in advance of a meeting with a doctor can be beneficial when it comes to understanding what various implant options can and cannot do.

Choosing between saline and silicone

One of the most talked-about choices in terms of breast augmentation is saline vs silicone.

To start, all breast implants have a silicone component: the shell. Whether it's textured or smooth, the casing that holds material inside is a skin of the versatile polymer.

Saline implants

Saline is the technical name for sterile salt water – basically, the same fluid found in IV bags used to replenish patients' fluids or keep them hydrated if they can't keep liquids down. Saline implants can begin as an empty silicone shell, which is inserted and then filled to the desired size, or they may come pre-filled.

While breast implants are designed to be long-lasting devices, the reality is that, over time, they have an increased chance of failure. In other words, there is a possibility that they will rupture. If a saline-filled implant leaks, remember that the solution is sterile and made up of elements already found in the body.

Unfortunately, a leak would also lead to the implant deflating – and a resulting change in the shape and size of the breast. This would need to be resolved with implant revision, during which the implant may be replaced.

Silicone implants

Silicone implants are filled with a different formulation of the material that makes up the shell. As a polymer, it is thicker and more viscous than salt water, which many women prefer due to the material acting and feeling more like natural breast tissue.

Silicone leaks are not as obvious since silicone does not easily flow like water. In order to detect a possible rupture of a silicone-filled implant, women need to have a special screening that detects problems. I recommend that women get regularly scheduled check-ups throughout the life of their implant in order to ensure its ongoing proper function.

In recent years, a modified version of silicone, known as "form-stable silicone," has become a popular filler. This material has even fewer liquid properties, resembling more of a thick and chewy candy, such as a gummy bear. Nicknamed "gummy bear implants," these are even more likely to stay intact in the case of a rupture – though routine check-ups are still recommended.

Implant shapes

For some time, implants were only available as round devices with saline or silicone filling, but advances in the development of these devices have led to the creation of both round and anatomical-shaped implants.

Round implants give a full look to the upper pole of the breast and can potentially rotate in the envelope – though such a shift shouldn't be visible. Anatomical implants (named because they resemble the natural teardrop-shaped slope of the breast) have a tapered top, so the fullness is more emphasized on the bottom pole of the breast. If these shift, however, the visible change can be more pronounced.

The silicone shell itself may also be textured or smooth. A smooth implant is freer to subtly move in its pocket, which some women feel better mimics natural breast tissue. Textured implants more firmly anchor themselves once inserted, making it more difficult for them to rotate.

Women considering breast augmentation should find a board-certified plastic surgeon they feel comfortable discussing any of these features with – and more. It is important to understand the available options, as well as why certain implant shapes or styles would better suit certain individuals and not others.