Silicone vs. Saline Breast Implants – An Informed Consent

Breast Augmentation is the most common cosmetic surgery procedure in the United States, with, according to the American Society of Plastic Surgeons, over 300,000 procedures performed annually. Currently, there are two types of implants approved for breast augmentation: saline-filled and silicone gel filled implant. The saline (sterile salt water) implant is empty prior to insertion. The implant is filled with saline through a tube which attaches to a valve at the top of the implant. After the fill volume is reached, the tube is removed and the valve covers the opening on top of the breast implant. The silicone filled implant is pre-filled with silicone gel and is inserted as such. Currently, as dictated by the FDA, silicone breast implants cannot be inserted in patients under the age of 22 years.

The advantage of silicone implant is the feel. The silicone implant feels more natural than the saline implant. This difference is more noticeable if the patient has thin skin. The disadvantage of silicone implant is the cost. Currently, the silicone implants cost twice as much as saline implants.  Furthermore, in case of an implant leak, the body will absorb the saline (salt water) which has leaked out. An implant leak, therefore, will be apparent by the change in size and feel of the affected breast. In case of an older silicone implant (manufactured before 1985), the gel will leak outside the implant, but the body cannot absorb the gel. Additional studies, therefore, may be necessary to confirm a leak with silicone implant.  Current silicone implants contain cohesive gel, which means when the implant shell fails, the gel will not leak out.  However, you can have a “failed” implant and not be aware of it. Some patients are O.K. with this concept, and some are not.  Silicone, by itself, is not dangerous for you.  Therefore, this is an individual decision based on your comfort level.

An advantage of saline implant is the ability to adjust the volume of each implant individually by 1-2 ounces or more. This is especially helpful if the patient has pre-operative breast asymmetry. Since the silicone implant is pre-filled, the ability to adjust the breast implant volume is not possible. In cases of breast asymmetry, different size implants can be available at the time of surgery. However, the ability to adjust the breast shape is not as precise as the saline implant. A common misconception is that the shape of the breast will be better after breast augmentation with silicone implants. This is not true since the shape of the breast after augmentation is dictated by the surgeon’s skill and experience.

The decision to choose either breast implant is an individual one. We hope this information will assist you in your determination. If you have any questions about this article, please contact Dr. Jazayeri, plastic surgeon in Santa Ana, at (714) 834-0101.