Breast Implants: Saline vs. Silicone

Breast Implants

Breast Implants

Breast implants are synthetic devices used to make a breast larger (breast augmentation)  or to rebuild a breast that has been removed due to cancer (breast reconstruction).  There is an ever increasing number of breast implants available.  These devices are all made with a silicone elastomer shell.  The implant shell is commonly confused with the scar capsule.  All patients form a scar capsule around the shell of their implant after it is placed.   The shell of the implant can be smooth or textured. Some implants contain sterile saline (salt water) and others contain silicone gel.   All silicone gel is not created equal.  Some gel is soft, while other gel is firm.  Gel implants come in both round shapes and tear-drop shapes (anatomic).  Round and tear-drop shaped implants come in different volumes with different dimensions for the same volume (profiles).  Implants do not come in cup sizes.  There are different manufacturers of breast implants that provide different characteristics of the implants.    It is important to have a discussion about your options for implants when considering breast augmentation or breast reconstruction with your plastic surgeon.

Saline Breast Implants

Saline breast implants are filled with sterile salt water. The saline implants are inserted empty, and then filled once in place. In the event the implant shell leaks, a saline implant will collapse and the saline will be absorbed and naturally expelled by the body.  There is no need to follow saline implants with imaging, such as an MRI, because if it ruptures, you will know it.

Saline breast implants are FDA-approved for augmentation in women age 18 or older and to women of any age for breast reconstruction.


Structured Saline Breast Implants

This is a new type of saline breast implant that has been FDA approved.  It is a saline implant with internal baffles that attempts to make a saline implant feel more like a silicone implant.  The overall experience with this type of implant is much more limited than with standard saline and silicone implants.  It can be difficult to obtain these implants and the cost is higher than standard silicone implants.


Silicone breast implants


Silicone breast implants are pre-filled with a silicone gel—a substance that mimics the feel of  breast tissue, making it feel more natural. In the event the implant leaks, the gel may remain within the scar capsule, or alternatively may escape into the breast implant tissue.   Less commonly, the silicone can migrate to lymph nodes in the armpit, or to distant organs.  A leaking implant filled with silicone gel may not have any outward change.  If you choose silicone implants, it is recommended you visit your plastic surgeon regularly.  The FDA recommends that women with silicone breast implants have an MRI to detect for rupture 3 years after they are placed and every 2 years after that.

The silicone that fills the breast implant can vary as well.  Some silicone gel is firm (higher cohesivity) and some silicone gel is soft (lower cohesivity) .  A softer gel will typically have a thick liquid consistency, while a firmer gel will have a more solid, rubbery consistency that is like the inside of a gummy bear.

There have been no studies to indicate that even ruptured silicone gel implants, whether soft or firm, cause any diseases.

Silicone breast implants are FDA-approved for augmentation in women age 22 or older and to women of any age for breast reconstruction.


Breast Implant Texture

Breast implants can have a smooth shell or a textured shell.  An implant with a smooth shell does not attach to the body.  It moves within the scar capsule that forms around it.  This can make it more comfortable.  

Textured implants were developed for different reasons.  Some studies suggest that textured implants reduce the risk that your scar capsule around the implant will become thick, tight, and/or painful (capsular contracture).  Textured implants can also be used to prevent movement or rotation of the implant.  Texturing of an implant feels like a sandpaper coating  that allows the scar capsule to “grip” the implant and reduce the chances of movement.   Avoiding rotation is important for an implant that is not round.  If a round implant rotates, the shape does not change.  If a tear-drop shaped (anatomically shaped) implant rotates, however,  it will cause a shape change of the breast.  Textured implants that adhere to the scar capsule may be less comfortable than smooth implants.

There is some evolving data suggesting that texturing of implants may be linked to a very rare form of lymphoma called breast implant associated anaplastic large cell lymphoma. (BIA-ALCL).


Implant Shapes

Breast implants can be round or anatomically shaped.  Round implants are not spheres.  They are more like the shape of a donut that doesn’t have a center hole.  These are the most commonly used implants.   If they rotate when in place, it does not change the shape of the breast since they are isometric.  Round implants come in different volumes with different dimensions.  For a given volume, there are several different profiles.  For example, you can have a 300 cc implant that comes with a narrow base and a higher projection, or a wider base with a lower projection, depending on your needs.  Usually, your plastic surgeon will determine the dimensional analysis.

Anatomically shaped implants have a tear-drop shape.  They are usually textured to avoid rotation.  They are usually made of a firmer (higher cohesive) gel to maintain a form-stable shape.  These can be used to limit the volume in the upper part of the breast.  These are usually more expensive than round implants and they have the risk of rotation.


Gummy Bear Breast Implants

Implant manufacturers describe the type of silicone implants based on the “cohesivity” or firmness of the silicone gel.  “Gummy Bear” is a term patients and doctors have used to describe a highly cohesive type of silicone gel.  This type of silicone gel is so firm that it holds its shape and is therefore, “form-stable”.  If you were to cut one of these implants in half, the inside would look like the inside of a gummy bear. This type of gel can be found in both round and anatomically shaped implants.  Because it is firmer, one advantage of this implant is maintenance of projection and reduced rippling.


Silicone vs Saline

More women today choose silicone over saline implants for both augmentation and reconstruction.  Silicone implants feel more natural to most people and tend to have less edge rippling than saline implants.  Women who have had both types of implants will typically say that saline implants feel colder than silicone implants.    

A drawback to the silicone implants is that a rupture is often clinically “silent” – meaning that you may not know the implant is ruptured.  No study has found that silicone implants, even if ruptured, cause diseases not caused by saline implants.  Despite that fact, some women are still hesitant to use silicone implants.  If a rupture of a silicone implant is detected, removal of the ruptured device is recommended, and replacement can be performed.

Saline implants can be a good option for women who opt not to use silicone implants.  Women who cannot have MRIs because of various reasons will often choose saline implants because they do not require monitoring with imaging.  Saline implants are typically less expensive than silicone implants, unless you are selecting a structured saline breast implant.

Whether you choose saline or silicone implants, it is important for you to monitor your breast implants and follow-up with your plastic surgeon for appropriate checkups. Contact Dr. Schaefer today to discuss the best options for your individual needs.