Breast Augmentation - Saline Versus Silicone Gel

from plastic surgery

So what is the best option for you in breast augmentation? Saline or Silicone? Like most procedures, both options have their own pros and cons. In saline implants, the shell is filled with sterile salt water; in silicone gel implants, the shell is filled with liquid silicone gel, which has the consistency of molasses.

Pros and Cons of Silicone Gel Implants

The advantage of silicone gel implants is primarily aesthetic: they look and feel so soft and natural that they typically cannot be distinguished from breasts without implants, provided they do not develop a capsular contracture. They also have a lower rate of rippling and wrinkling. Hence, thin women with modest breast tissue may choose to have them placed in the subglandular plane. If the same women chose saline implants, they would most likely be advised to have them placed in the subpectoral plane to reduce the risk of rippling. Also, because silicone is lighter than saline, the risk of downward displacement due to gravity is lower.

The disadvantages of silicone gel breast implants include higher cost and a typically longer scar. The longer scar is usually necessary, as silicone gel implants are prefilled by the manufacturer and must be able to fit through the incision. In general, larger implants require longer scars. Also, the risk of capsular contracture is higher with silicone. This is because silicone implants might incur a late capsular contracture due to implant rupture, whereas saline implants do not form capsular contractures in response to rupture or deflation.

Finally, silicone gel implants might rupture "silently," such that there is no outward evidence that a rupture has occurred. Physical examination by your plastic surgeon will identify only 30 percent of ruptures, whereas magnetic resonance imaging (MRI) will identify about 90 percent of ruptures. So women with silicone gel breast implants are encouraged to have an MRI scan every two years, beginning three years after surgery.

Pros and Cons of Saline Implants

The advantage of saline implants is a presumed (studies currently are underway) lower rate of revision surgery than silicone gel, as saline implants tend to get mostly early capsular contractures, rather than both early and late. Further, the scar is usually shorter, as saline implants can be filled after they are placed, allowing a smaller incision. The primary disadvantages of saline implants are that they tend to look round and feel stiff and unnatural, particularly in thin women with modest breast tissue. In addition, large saline implants have a higher rate of downward displacement than silicone, as they are heavier than their silicone counterparts.

Recommendations

Thin women with a modest amount of breast tissue tend to select silicone gel implants, as the cosmetic advantages are substantial and easily offset the known disadvantages and risks. Heavy women and those with a more generous amount of breast tissue enjoy less of an aesthetic advantage with silicone, as both silicone and saline tend to feel soft and natural in women with more breast tissue. Hence, the disadvantages of silicone implants are not warranted, and saline is often selected. An exception here is with larger implants. If a large implant is selected, silicone offers the advantage of a lower rate of downward displacement. Women with an intermediate amount of breast tissue find themselves caught in the middle of this decision. For these women, I recommend they decide which is most important: optimal cosmetic result (silicone) or lower rate of revision surgery, shorter scar, lower cost, and avoidance of routine MRI scans (saline). Once they make this decision, the choice is clear.