« Breast Implants: Consideration #1: How to Find the Right Doctor | Main | Breast Implants: Consideration #3: Round v. Tear Drop »

November 17, 2009

Breast Implants: Consideration #2: Silicone v. Saline

Breast implants are composed of...

  • a shell (made from a silicone elastomer)
  • filled with either...
    • saline or
    • silicone gel

Saline literally means salt water.  It is sterile water with physiological amounts of sodium and chloride.  Saline is what's in most hospital IVs.  If a saline implant were to rupture, the woman's body would absorb the saline--just as if she had been given a bolus of IV fluid.  There is 100% safety.

Silicone is a complex polymer with varying degrees of cohesiveness.  Old silicone filler was minimally cohesive; it had the consistency of molasses.  In contrast, the newest silicone fillers are more like gummy bears.  The contained silicone is a liquid but is very cohesive.  Even if the shell were to rupture, the filler would not "spill" inside a woman's body.  It is so viscous that even a split silicone implant retains its general shape...

Split silicone implant


Nowadays, I generally prefer silicone; however, I use both products.  Certainly, there are advantages and disadvantages to the each of the two filler materials.

Proponents of saline implants will argue...

  • Saline implants are cheaper:  The two American implant manufacturer's sell saline implants for about $500 a piece.
    • Silicone is $900 per implant.  
  • Saline implants are adjustable:  Saline implants can be filled to a range of volumes in the operating room.  Fine adjustments are, therefore, possible.
    • For example, a particular implant could be filled between 300 and 350 cc.
    • Since many woman have one breast which is slightly larger than the other,
    • the implant for the larger breast could filled less--to just 325 cc,
    • while the implant for the smaller breast could be filled more--to 350 cc.
    • Optimal symmetry is thus obtained.
    • Customized adjustments in sizing may be important to those patients who are particularly concerned about their preoperative asymmetry.
    • On the other hand, silicone implants are sealed at the factory.  There is no way to make fine adjustments to any individual implant.
  • I can use a smaller incision for a saline implant:  Incisions for saline implants are generally smaller than for silicone implants.
    • Saline implants do not come pre-filled.  On the contrary, they arrive without any fillers.  They are just shells.
    • These shells can be rolled up like cigars and placed through very tiny incisions (each perhaps only 3 cm in length).
    • The shell can then be filled (via sterile IV tubing) after it is already in position beneath the patient's breasts.
    • Since silicone implants are pre-filled at the factory, the incision must be large enough to accommodate the full volume of the implant.  Incisions for all but the smallest silicone implants must then be 4-6 cm in length.
  • Peace of mind:  Some patients don't believe that silicone implants (even the newest versions) are safe.  (More on this hysteria later.)  At least with saline, there is no concern for safety.

Proponents of silicone implants will argue...

  • Silicone implants have a more natural feel:  Unquestionably, silicone implants feel more like natural breasts.
    • Do a "squeeze test" at your plastic surgeon's office.
    • Saline implants feel like water balloons (which, of course, is what they are). 
  • Silicone implants exhibit less rippling:  Have you ever been bothered by the sight of rippling Hollywood breasts?  These women probably underwent saline breast augmentations, like this patient....

Rippling breast

    • Silicone tends to ripple less than saline.  If you are thin, and if the above picture bothers you, strongly consider silicone.
    • There are other ways to minimize rippling in thin patients (such as placing implants beneath the chest wall muscles).
  • Silicone implants (probably) produce a more natural appearance:  Most patients do agree that silicone implants look more natural,
    • especially, if they are thin, and if they are small-chested to begin with.
    • Undoubtedly, silicone implants look better when bouncing.  After you do the squeeze test at your plastic surgeon's office, do the "jiggle test."  Silicone implants sway like real breasts.  Saline implants move like water balloons.
  • I bet that silicone implants are more durable:  While long-term data on durability are not available, I suspect that silicone implants will last longer than saline.
    • The fill valve on a saline implant is a point of potential failure.
    • There is no "fill valve" on a silicone implant.  It was pre-filled at the factory.

It's funny to compose the above "pro's and con's."  In no other country other than the USA is there a debate between silicone and saline.  Silicone wins hands down.  Why is it that the vast majority of breast implants throughout the world are filled with silicone gel, while in the USA, saline slightly outsells silicone?  Lawyers.

In the early 1990s, it became obvious that the then-current crop of silicone gel breast implants were poor products.  They tended to leak, and the free silicone produced scarring, breast distortion, and pain.  (Remember that this was minimally cohesive silicone filler; it is not similar to today's "gummy bear" products.)

But don't get caught up in the hysteria of yesteryear.  Yes, the old silicone implants were bad.  But it was not as bad as it was made out to be.  Free silicone never caused breast cancer, rheumatoid arthritis, lupus, or any identifiable systemic disease.  However, the medical facts did not stop the lawyers from suing the then manufacturer, Dow Corning, which was forced into bankruptcy.

At the time, the scientific facts didn't matter.  The controversy was too hot.  Political pressure forced the FDA to pull silicone breast implants off the American market.  From 1992 to 2006, women interested in breast augmentations were not faced with the decision "silicone versus saline."  Their only choice was saline.

Since December 2006, sanity has returned.  The USA has rejoined the rest of the world by allowing its citizens to choose silicone implants.  Unquestionably, silicoe implants have become my preference for 90% of my patients.

However, saline implants still have a role in modern breast augmentations.  I do still use saline implants in that 10% of my patients who are looking for the cheaper product, via the smaller incision, and for fine adjustments to produce symmetry.

Otherwise, it is clear that silicone produces more natural looking and feeling breasts with less rippling.

You decide what's right for you.



TrackBack URL for this entry:

Listed below are links to weblogs that reference Breast Implants: Consideration #2: Silicone v. Saline:



I want to thank you for this article.. I'm getting breast augmentation done this September and I have been confused about either choosing saline or silicone. after reading this report i am convinced that i want silicone implants.

thank you very much....

The comments to this entry are closed.

Blog Design & Consulting by flyte new media