Breast Implants and Breast Augmentation: Saline vs Silicone

One of the most common questions I get regarding breast augmentation is the differences between saline and silicone breast implants. Indeed, there are many difference and both have advantages and disadvantages. Let us examine saline implants first.

Saline Breast Implants: Four Fun Facts

Saline implants on average are about $1000 less than their silicone cousins. Thus, buying these implants for $1000 less often translates to breast augmentation for $1000 less. So, generally a saline breast augmentation is less expensive than a silicone breast augmentation by about $1,000.
The volumes of the implants can be adjusted much more easily with saline implants. No two breasts are exactly the same shape or size. With saline breast implants, the size adjustment can be done on a table right down to each drop. This is somewhat advantageous. It makes it easier to correct large breast size asymmetries. Often the silicone breast implants change between 25 cc. You can circumvent this by getting different base widths and shapes. However, it is a bit more tricky to adjust size differences with silicone.
Saline breast implants come deflated. This means we are putting them in smaller incisions. The incisions needed for silicone implants are approximately 30% larger because the implants already come filled. Thus, in large silicone breast augmentations, it is not uncommon to have 4.5 cm or 5.0 cm.
Saline breast implants can be placed through four incisions; transaxillary, inframammary, periareolar, and transumbilical. Even with very small areolar sizes, it is often feasible to place saline implants through this approach. In addition, it has also the advantage of augmentation with a transumbilical approach, aka TUBA.

2 More Points About Saline Breast Implants

The FDA lifted its bans on silicone implants for primary breast augmentation years ago. But, one of the stipulations that the FDA recommends is that women with silicone breast augmentations get serial followup MRI studies. Why? The main focus of this request is to study the implant rupture rate. But, there is no similar recommendation with saline implant. Of course, the MRI studies are not mandatory, they are recommended.
If the implant ruptures with a saline implant, it is visible in days as the body absorbs the salt water or saline. Thus, it appears as one has a flat tire on one of the breasts. The diagnosis is very simple of ruptured implants. However, with silicone, it is very possible to have a rupture and not have detection. It is unclear whether this is an advantage or disadvantage because many times ruptured silicone implants have no undesirable outcome. They are often diagnosed by chance on imaging studies.

The Advantages of Silicone Breast Implants

Silicone implants to feel and look much more natural. They are softer. Saline breast implants in women who have small breasts tends to feel hard and more firm. They can also look more like a ball.
Because of its composition, it can be placed over the muscle or in women with thinner breasts with smaller breast tissue with either no or less rippling. Saline implants can more often lead to rippling, particularly in the lateral aspects or the medial portion where there is less or no padding on the pectoralis major muscle.

Those are main differences between silicone and saline breast implants. Although the saline implants can have some smaller advantages, it would be a hard argument to defend them over their silicone cousins which feel and look much more natural. However, it is important to discuss these with the plastic surgeon before considering breast augmentation.