What’s the Difference Between Saline and Silicone Breast Implants?

If you’re thinking about getting breast implants, you probably have questions about your options. Like, when it comes to saline vs. silicone, what are the differences? Are they both safe? How can you decide what’s best for you?

Both saline and silicone breast implants have outer shells made of silicone, says plastic surgeon Martin Newman, MD. The differences between them depend on what goes inside that shell.

Differences between saline and silicone breast implants

Breast implants may be filled with either silicone gel or sterile saline (saltwater). Let’s take a look at what else differentiates the two types of implants.

Look and feel

These days, both saline and silicone implants come closer than ever to replicating the look and feel of natural breasts. But there are still some factors that set them apart.

• Consistency: “Silicone gel has a thicker consistency that more closely mimics human fat, which gives silicone implants a more natural look and feel,” Dr. Newman explains.
• Firmness: Saline implants often feel firmer than silicone ones. They’re sometimes described as feeling like a water balloon to the touch.
• Rippling: Both types of implants may show irregularities like dimples, wrinkles or ripples, especially if you have thin breast tissue. “This is less common with silicone implants,” Dr. Newman points out. “And this characteristic is most important when you’re choosing an implant for reconstruction as opposed to augmentation.”

Both types of implants come in two primary surfaces: smooth or textured. Taking into account factors like your anatomy and personal preferences, your surgeon will help you decide which type is best for you.

“If you’re going for a certain look with implants, I recommend bringing your surgeon a photograph that illustrates your goal,” he adds. “It’s a helpful starting point for them to see what you’re hoping for.”

Surgery and placement

Implants are placed during breast augmentation surgery, sometimes called a “boob job.” But the specifics vary depending on what type you’re getting.

• Saline implants are inserted empty. Your surgeon will fill them with saline once they’re in place. This allows for a smaller surgical incision than is required for silicone implants.
• Silicone implants are pre-filled. They’re already full when they’re placed in your body, so your surgeon will need to make a slightly larger incision. 

How long they last

The silicone shell of breast implants weakens as they get older, which can cause them to rupture or leak. But ruptures don’t look the same in different types of implants.

• Saline implant rupture is often obvious. If your saline implant starts to leak, your breast size will noticeably decrease — sort of like a deflated balloon. It’s not dangerous, but you may choose to replace it for cosmetic purposes.
• Silicone implant rupture can often go unnoticed. Silicone implants are designed to stay in place, even if they rupture. So, you may not notice if there’s an issue. “If your implant is silicone-filled, you should have an MRI test at certain intervals to make sure it’s intact,” Dr. Newman advises. “If there’s a rupture or leak, I recommend removal or replacement, though not every surgeon will.”

Implants aren’t considered lifetime devices. Many surgeons recommend that breast implants be replaced every 10 years, but that’s not necessarily true.

“There’s no actual ‘expiration date’ on them,” Dr. Newman clarifies, “so there’s no set timeframe for replacement — just a general recommendation.”

Safety

“Extensive research has shown that both saline and silicone implants are safe,” Dr. Newman says. “But in addition to the possibility of rupture, there are some other possible risks.”

They include:

• Implant rupture: There’s no safety risk associated with leaking saline implants; the saltwater is absorbed into your body. But ruptured silicone implants can cause lumps, hardening, swelling and pain.
• Capsular contracture: When scar tissue hardens around the implants, it can cause pain and discomfort. Some people say it makes their implant feel “hard,” and it can also change the way your breasts look. This complication is the most common reason for breast implant removal and/or replacement. 
• Breastfeeding concerns: Breast augmentation doesn’t typically affect your ability to breastfeed, but it can be unpredictable. Breastfeeding with implants is considered safe for both you and your baby. But milk production can sometimes be affected.
• Breast implant illness (BII): Researchers think this collection of symptoms — which includes fatigue, brain fog, joint pain and rash — may be related to the body’s autoimmune or inflammatory responses. “A board-certified surgeon should assess your situation to determine if removal is the best course of action,” Dr. Newman urges.
• Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL): The risk of developing this rare cancer is very low, but it’s still important to know about. “It’s most often associated with textured implant surfaces, though it can also occur with smooth implants,” Dr. Newman explains. “We recommend electing for smooth-surface implants.”

Because implants don’t last forever, there’s also the consideration that you may need additional surgery down the road. That’s not a safety risk, per se, but it’s definitely something to be aware of.

How to choose what’s best for you

Your plastic surgeon will walk you through the options so you can decide which type of breast implants is best for you.

Though some cosmetic surgeons without formal plastic surgery training offer breast implant procedures, Dr. Newman advises choosing a board-certified plastic surgeon. They have extensive, rigorous training and undergo peer review.

“Board-certified plastic surgeons have experience with all aspects of the surgery, including breast implant removal,” he states. “They’re also trained to handle any complications that might arise.”