Which are better, saline or silicone implants?

It is interesting to me that there is often an almost religious or fanatical attachment for some patients to either saline implants or silicone implants. I frequently hear “I don’t want those silicone implants that caused all of those people to get sick”, or “I don’t want those fake looking saline implants”.

In November 2006 the FDA lifted its moratorium for the use of silicone gel implants in primary augmentations. The moratorium was the result of a number of women complaining of connective tissue disorders that were felt to be attributed to the implants. The implants were taken off the market while further scientific research on the implants was performed. It is unfortunate that those women had gotten ill but after further research it was determined that the implants were not the cause. In other words, these were illnesses that would have occurred with or without implants. With the release of silicone implants for primary augmentation, the patient again has the choice of saline or silicone implants. So which is better?

Both saline and silicone implants have an outer silastic shell. The silicone implants are filled with a cohesive silicone material and the saline implants are filled with sterile salt water. The newer generation of silicone implants is more cohesive than previous implants which may decrease the risks of gel “bleed” and capsular contracture.

The advantages of saline:

1. ) cost – about $1000 cheaper
2. ) adjustability – implants are filled to allow the surgeon a little more flexibility to “fit” an individual patient or to even up size asymmetries.
3. ) shorter scar – My incision is only 1? long, the implant is filled after insertion.
4. ) Easier to diagnose a rupture or deflation – it simply goes away.
5. ) Lower incidence of capsular contracture.

Disadvantages of saline:

1. ) Less natural feel
2. ) Higher risk of rippling – this is visibility of the implant most commonly beneath areas of poor coverage over the implant.

Advantages of silicone:

1. ) Better feel
2. ) less rippling

Disadvantages of silicone:

1. ) cost
2. ) lack of adjustability
3. ) longer scar – usually at least 2?
4. ) difficulty in diagnosis of rupture – may require an MRI
5. ) higher risk of capsular contracture

Notice that I did not state that one looks any more or less natural than another. Aside from cases where rippling occurs with saline implants, I would submit that they look the same. In my opinion, silicone implants are ideal for the thin patient with little breast tissue coverage. With more coverage (larger breasts or more subcutaneous fat) the advantage of the feel of silicone is lost and saline implants are better for all of the reasons listed above.