Breast Augmentation Choices: Silicone or Saline?

Breast implant choices

It’s been more than 10 years since silicone gel implants re-entered the market following a 14-year moratorium. Now, thanks to advances that make silicone implants look and feel remarkably similar to natural breasts, the majority of my breast augmentation patients at my Granite Bay-area practice — and nationwide — choose silicone gel-filled implants.
The choice of implant type is among many decisions breast augmentation patients make. This is the second of 3 blog posts I’m writing about breast augmentation choices. Last month, I discussed what to consider when making the decision to get breast implants. Next month, I’ll explain why patients may choose to combine a breast lift with breast augmentation.
Below, I explain the advantages of each type of breast implant and discuss some other choices patients have to make after selecting silicone or saline implants:

Implant Pros and Cons

Saline: I can typically make smaller incisions when patients choose saline implants because they’re filled after I insert them. I can also adjust the size after placing them. Another benefit of saline implants is that if one leaks — which is rare — it’s immediately noticeable, and the body absorbs the harmless saline solution. The drawbacks of saline implants are that they are more prone to visible rippling and wrinkling than silicone gel implants, and most patients believe they feel less like natural breast tissue.
Silicone gel: In addition to feeling and looking more natural than saline implants, silicone gel implants offer many more options, such as cohesive “gummy bear” implants and teardrop-shaped implants. Because silicone gel implants are prefilled, incisions are slightly larger. And some patients are concerned about a “silent rupture” — the situation where a ruptured implant isn’t noticeable until revealed by an MRI.

Size and Shape

Silicone gel implants are available in both round and shaped options. A round implant generally provides more fullness in the upper portion of the breasts, while the anatomically shaped implants are preferred by women who want more fullness in the lower two-thirds of the breasts. Implant size is a highly personal choice, but I explain to patients that choosing a size that looks proportional to the body’s frame usually produces very satisfying results.

Surgical Options

I can customize breast augmentation procedures in many ways, based on a patient’s personal preferences involving incision location and where to place the implants. I offer 3 different locations for the incision — on the underside of the breast (inframammary), along the lower edge of the nipple (periareolar), or in the underarm crease (transaxillary). You can also choose to have the implants placed either above the chest muscle and behind the existing breast tissue (subglandular), or behind the muscle (submuscular). Each option has advantages and I help patients understand the benefits of each choice.

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