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Saline vs. Saline Breast Implants

Which breast implant type is best for me?

One of the big choices you will make before breast augmentation is what type of implant to get: saline, silicone or form-stable (gummy bears). No doubt you have already started your research on this matter, and have probably learned that there is no shortage of opinion on which of these options is best. Below, Las Vegas cosmetic surgeon and nationally-recognized breast enhancement specialist Dr. Samir Pancholi outlines what he wants every patient to know before making a decision.

What types of implants can I choose from?

Currently, FDA approved implants are available in two forms: saline and silicone. Silicone implant types vary from a softer cohesive gel to a more highly-cohesive, form-stable silicone gel (gummy bear). Saline implants are FDA approved for women age 18 and above. Silicone gel implants are approved for women age 22 years and older.

The two main FDA-approved breast implant makers, Allergan and Mentor, have branded their silicone implants for marketing purposes. Allergan has named their silicone gel implants Natrelle and Inspira with their highly cohesive shaped silicone implant being the Natrelle 410. Mentor’s silicone gel implants are called MemoryGel, MemoryGel Xtra and MemoryShape is their shaped gummy bear version. Dr. Pancholi has used both extensively, and believes both are excellent, superb quality products.

Saline vs. Silicone vs. Gummy Bear: what’s best for me?

When deciding between saline and silicone gel implants, a lot of women base their choice on a friend’s experience or on what they read online from others. Although this is a good start, you’ve got to focus on your own individual needs when making such a personal choice. Before you get your mind set on a certain type of implant, consider the following facts and questions about each type of implant:

Video transcript

“So, a lot of people get confused as far as whether to get saline or silicone, and the big reason is there’s a lot of marketing, mostly to silicone implants. It’s thought to be a premium product, and I don’t necessarily believe that it is. This is why when we talk about breast implants, there are three main things that you want to look at.

One is look. Can you look at someone and know whether they have saline, silicone, or anything else filling up their implants? The answer to that is no, you can’t.

Can you feel the difference between saline and silicone? So that’s a second thing, feel, and that depends on how much breast tissue they have. If they have very little natural breast tissue, you’re going to be able to feel everything, and if they have a lot of breast tissue, you’re probably not going to be able to feel much of anything inside. Either way.

The third is what’s maintenance like after you get the implant. So did you just buy something that’s requiring you to do a lot, or do you have to do nothing at all? This is where saline really shines. It shines because you don’t have to do anything. If you get saline implants, you just keep going until one day they break, because all implants break.

If you get silicone implants, this is where you have to go get MRIs every 5 years to monitor whether they’re broken or not. So when you’re really looking at whether you should get saline or silicone implants, part of it is saying, “Do you want to do the maintenance?” The other is really taking a hard look at yourself and figuring out, do you have enough breast tissue to hide your implant? If you do, it probably doesn’t matter. And if you have very little breast tissue, you’re probably going to figure out what’s underneath, and you may want to slant towards silicone implants.”–Dr. Samir Pancholi

♦ Silicone and saline implants feel different

Most women say that silicone gel implants feel more like natural breast tissue compared to saline implants. There are two types of “feel” to consider. One is where you touch your breast and feel the implant. The more breast tissue you naturally possess, the less impact the “feel” of the implant will have. Another factor is the percentage of your breast made up by implant. If your new breast is 90% implant, you will “feel” the implant more than if your new breast is 10% implant.

The second is what you feel when you are lying on your stomach. This has less to do with the amount of breast tissue you have naturally. Women who’ve had both often say saline implants feel like lying on two little beach balls, while silicone gel implants feel more like part of their body. The new form-stable implants may feel a little firmer than the silicone gel.

♦ Is wrinkling or rippling going to be an issue?

Saline implants wrinkle/ripple the most and form gummy bear implants the least (with silicone gel being in the middle). Your ability to see or feel wrinkling/rippling, however, is dependent upon how much breast tissue you have naturally. The less breast tissue you have to cover the implant, the more you may notice the rippling, wrinkling, or feel of the implant. If you have a large amount of breast tissue to begin with, this may not be as important of a factor.

♦ Know what happens with possible rupture

All implant types will eventually rupture, with the risk increasing most significantly after 10 years. Saline implant ruptures are detectable by looking in the mirror and noting the difference between the breasts. The saline that fills the implant is IV fluid (the same fluid that is placed in your body when you get and IV) and harmless to your body. It typically leaks out within a couple of days as the implant deflates. If a rupture occurs, we usually will recommend both implants be replaced, to avoid a second surgery if the opposite implant were to break soon after.

Detecting an implant rupture with silicone gel or gummy bear implants requires monitoring with MRIs. The FDA recommends that a screening MRI be performed 3 years after augmentation and every 2 years thereafter. The current cohesive silicone gel implant is one of the most extensively studied medical devices of our time, and has an excellent safety record. If a rupture is detected by MRI, the implant and breast capsule are removed and a new implant is placed. We will usually recommend both implants be replaced, to avoid a second surgery if the opposite implant were to break soon after.

That said, Dr. Pancholi recommends his patients exchange silicone gel implants after 10 years to prevent aesthetic complications stemming from a silicone rupture. Removing a ruptured silicone gel implant is more complex and can compromise breast symmetry. This is not as big of an issue with gummy bear implants, as the thicker silicone filling is less likely to migrate outside the implant shell, even if the shell breaks.

Learn more about reasons to replace breast implants on Dr. Pancholi’s blog

♦ Do I have significant asymmetry to correct?

Saline implants are filled by your cosmetic surgeon during surgery. This allows Dr. Pancholi to adjust the amount of saline to maximize symmetry between the two breasts. Silicone gel implants come pre-filled in specific size increments and may require two different implant sizes, depending on the amount of asymmetry you have. If the asymmetry is slight, the implant size increments may be too great and over correct the difference and create a different asymmetry.

Rest assured, everyone has differences from one side to the other. In fact, we have yet to find a patient whose breasts are exactly the same from one side to the other, and unless you are noticeably different between sides, using same size silicone gel implants for each breast can do an excellent job of enhancement. If you do have dramatic differences between the sides, Dr. Pancholi will likely recommend different sized implants, regardless of whether they are saline or silicone gel implants, to maximize symmetry.

It’s not all about the implant

So much time is spent talking about the breast implants. What if I told you that at least 50% of the equation to getting great results with breast augmentation has nothing to do with the implants! It has to do with you and your anatomy.

Your rib cage plays a role. Think of yourself lying on your back. Your ribcage is the floor that your implant will stand on. Does your rib cage slant toward the center? If so, your implants will want to move to the center. Is your rib cage flat or does it curve dramatically to the side? If the latter, you may find your implants tend to slide that way as well.

When you stand and look down, do you see one side project forward more than the other? Do both sides seem to sink in or bow out? All of these factors play a role in implant selection and may not result in a size you planned from looking at before and after pictures. Similarly, breast and nipple position and size will play a role in which some implants may work better than others.

Transgender patients

We see many and welcome transgender patients. Although most of the above topics play a role, there is a little more nuance to getting the best look. Various factors play a role. In terms of masking the implant, the more breast tissue you have the better the implant can be hidden.

A weak chest muscle is preferable, so try not to work out your chest in the months leading up to surgery if you can. Remember, even as you try to tone your arms, you will start to recruit your chest muscle and build them. So prior to augmentation, it would be best to limit this.

The distance from your nipple to your breast fold will play a role in whether the implant will be placed above your chest muscle or below. Ideally, placing the implant under the muscle helps to create a softer and more natural look (even if you want a pushup bra look). In those that don’t have a lot of distance between the nipple and the fold, going on top with the shaped gummy bear implant can create a beautiful and natural result.

The very best way to choose: consult with a breast augmentation specialist

Overall, choosing your implants depends on many factors, and the most qualified person to help you choose is an experienced cosmetic breast surgeon. Feeling the implants in your hands, and discussing your goals, and receiving a full assessment by Dr. Pancholi will help you understand what unique circumstances your body presents and what will help you achieve your best result.

To schedule a consultation, call or contact us online.