Breast Augmentation - Saline vs. Silicone Implants

Sacramento plastic surgeon continues the virtual consultation on breast augmenation, Saline vs. Silicone breast implants

This page is part two of our virtual consultation on breast augmentation, If you have not read the first part of the consultation with Sacramento plastic surgeon Dr. Mabourakh click here, then come back to this page.

In this part Dr. Mabourakh will review your concerns about Saline vs. Silicone implants.

Have you been been asking the following questions?

What is the difference between Saline and Silicone implants?

Saline implants have been around since the 1960’s. These type of implants have not changed much over the years. The implant is made of silastic rubber shell, which is a silicone rubber type material. There is a valve to allow the plastic surgeon to fill the implant with saline after placing it in the appropriate site. Over the years the shell has changed minimally but the valve has become more reliable. The leakage rate has improved as well to approximately 1% to 3% per year.

Silicone implants round and contoured

Silicone implants – Round Smooth – Textured – Contoured

Silicone implants have gone through many changes and upgrades since their introduction. The newest gel implants are made of a more cohesive silicone which allows the gel to maintain its shape better yet stay soft. The shell also has become thicker but more pliable. Silicone implants have no valves since they are pre-filled at the factory and the size is predetermined, unlike saline that can be filled to a ranee determined by the manufacturer. The newest silicone implants are very cohesive and maintain their shape much better, these are sometimes referred to as “gummy bear” implants.

What happens when a breast implant leaks?

With saline implants, when there is a leak the saline slowly is released from the shell, either through a failed valve or a break in the shell. The size of the breast will then become smaller. This size change can occur within a-few days if the leak is continuous, or can take weeks if it is an intermittent leak. A leaking saline implant is not a medical emergency and can be treated electively at any time. Waiting weeks however can cause the capsule around the implant to decrease in size making the replacement more involved.

Leakage of silicone implant is not an event to ignore. Older implants are more of a problem, since the silicone gel could easily leak out of the silastic shell, and over time cause severe tissue reactions. The newer implants with the cohesive gel are less likely to cause as much tissue reactions since the gel tends to remain inside the shell even if there is a break. However a leaking gel implant should be exchanged as soon as diagnosis is made and not waiting months to years as some patients have done in the past. We recommend  and offer free yearly followup exams to all our patients and the FDA recommends MRI exams at specific intervals to follow silicone breast implants for possible rupture.


New cohesive silicone implants do not leak out when cut.

What type of breast implant is best Silicone or Saline?

The answer to this question is not a simple one. The best breast implant is the one that offers patients the result they expect, the cost they are willing to pay financially, and the risk they are willing to accept. Silicone implants will offer a much better look and feel then saline breast implants. Gel implants mimic breast tissue were as saline implants tend to ripple much more and not feel as natural. In patients with moderate breast tissue who choose a smaller implant this difference is much less noticeable. Silicone breast implants also offer shaped implants that offer a great improvement over round implants in a subset of patients with very small breasts as well as in breast cancer reconstruction. These shaped breast implants can offer a more natural looking breast augmentation in this group of patients but are much more expensive.

What about mammograms and saline vs. silicone breast implants?

Breast cancer detection with mammogram becomes more difficult when implants are present. More views are taken to be able to better evaluate the breast. Even with more views some areas are not seen well. Silicone tends to block mammogram more than saline. Additional studies such as ultrasound or MRI are sometimes used in addition to mammograms.

What other factors should be considered when having breast augmentation?

1. Breast implants are not a life time event. Assume you will need future surgery at some point in time. This is due to a  variety of reasons such as natural aging process, pregnancy, breast feeding, change in weight, breast ptosis (breast droopiness), capsule formation, implant leakage.

2. Breast implant re-operation may not be covered by insurance. Normally removal of leaking silicone implant and severe capsule contracture causing pain may be covered by  some insurance carriers.

3. Breast implants do not correct ptosis (breast sagginess) and can speed up the process depending on the size of the implants.

4. Breast feeding should not be affected by breast augmentation if the incision used does not go through any breast tissue such as using an infra-mammary incision.
By Dr. Shahriar Mabourakh