Saline Vs. Silicone Part I

Part 1of 3: The pros and cons of Saline Breast Implants

This is Part 1 of a three-part blog centered on the issue of deciding whether you want saline breast implants or silicone breast implants. In order to make an informed decision on this very important issue, you first must be very familiar with all of the advantages and disadvantages of saline and silicone breast implants. This part will focus on saline breast implants. Part 2 will focus on Silicone breast implants. And Part 3 will tie it all together and help you figure our which is best for you, with some important tips from me.

The advantages of saline breast implants are several. They are not listed in any particular order.

  • Lower cost: Saline implants cost less than silicone breast implants by about $900-$1300 per pair (depending on your plastic surgeon). This has nothing to do with the way they are placed. It has only to do with the cost of production of the implants that the manufacturers charge to your plastic surgeon. Silicone implants simply cost more to make.


  • Shorter scar: Saline implants are deflated when they are placed, so they can often be placed with a shorter incision (and shorter subsequent scar) than silicone. In most cases, the difference is less than an inch. In the case of small silicone implants, the difference may be negligible, as small silicone implants can often be placed through an incision the same size as a saline implant.


  • No concern over silent rupture: Saline implants do not have silent deflations. In other words, if your saline implants deflate, you will know it right away. It may seem odd that this is an advantage, as no one really wants their breasts to shrink – especially quickly and with no warning. But, compared to the issue of silent rupture (in which the implant shell has torn but there is no way of knowing it, which may be the case with silicone breast implants), this is seen by some as an advantage compared to the alternative of simply not knowing.


  • No concern over silicone leakage: Upon deflation, your saline breast implants will be releasing saline into your body. Saline is a natural fluid which is typically administered intravenously. So the release of several hundred ml of saline into your body will simply hydrate you, as the concentration of saline in saline breast implants matches that of the saline in your body fluids.


  • Lower Risk of Capsular Contracture: The risk for capsular contracture with saline implants is lower than that for silicone implants. This comes about for a few reasons. The actual risk difference appears as though it will end up being about 1% per implant per year – which is important if you are in that 1%. It also is important with time, as after 10 years, the difference in risk of capsular contracture may be as high as 10%, with more occurring in those who have silicone breast implants.

Saline breast implants have two main disadvantages.

  • Less favorable cosmetic outcome: Saline breast implants simply do not result in as natural a breast as silicone breast implants for most women. Just how natural (or unnatural) the saline implants look and feel has everything to do with how much breast tissue a woman has before breast augmentation: the more tissue, the more natural is the final result; the less tissue, the less natural is the final result. For practical purposes, the result is judged on two issues: how natural the implanted breast feels and how natural the implanted breast looks. The following three examples will help illustrate this important point:


    • Example 1: A woman with almost no breast tissue. A woman with breasts that are so small that she does not have a crease beneath her breasts will have the most unnatural result with saline implants, compared to women with more breast tissue. Her implants will be easily felt through the skin – and this is true regardless of whether she chooses to place the implants under or over the muscle. Her implants will be clearly evident upon feeling the lateral side of the breast and the bottom of the breast, as muscle fails to provide additional cushioning in these places even if the implants are placed under the muscle. Moreover, this woman will ALSO tend to appear quite unnatural with saline breast implants. Her breasts will tend to appear round rather than breast-shaped. In other words, her implanted breasts are likely to look AND feel unnatural. From a cosmetic standpoint, this woman is absolutely best suited for silicone breast implants. (Note that some plastic surgeons would recommend a teardrop implant for these women, but teardrop implants imposed a number of other unfavorable issues.)
    • Example 2: A woman with moderate to significant breast tissue. A woman with a significant amount of breast tissue – particularly firm breasts, as opposed to flaccid breasts – will look and feel the most natural with saline breast implants (as compared to women with less breast tissue or flaccid breasts). This woman will almost certainly have the same appearance regardless of whether she chooses saline or silicone. She may even have the same feel with saline as she does with silicone; but this will depend upon the amount and consistency of her breast tissue. In this woman, the difference between saline and silicone is typically minor and possibly indistinguishable. From the standpoint of cosmetic results, this woman can typically easily select saline breast implants without much (or any) cosmetic compromise. (The exception here is the woman who chooses large saline implants which have a higher rate of downward displacement (see below) than same-size silicone implants. So, I tend to steer women in this category toward silicone in order to avoid downward displacement. Under no circumstances do I advocate that these women choose a smaller size in order to be able to choose saline, as SIZE MATTERS!! My philosophy and strong recommendation is to select the very best size and work everything else around that decision.)
    • Example 3: A woman with small breasts who is somewhere between Example 1 and Example 2. A woman with breast tissue somewhere in-between will end up with a result…well…somewhere in-between. She will most likely feel the implants through her skin, but her breasts will typically not appear any different than if she had had silicone implants. In other words, her breasts will clearly feel more natural with silicone than with saline, but her appearance will not likely vary. This woman is the most typical woman in my practice – and in most plastic surgery practices.
    • BTW, when I talk about how the breast FEELS, I am talking about what the breast feels like to the fingers that are touching it – not how the breast is perceived by the woman with the implant when she is not touching her own breasts. In fact, whether silicone or saline, unless a woman is touching her own breasts, they will typically feel the same to her in terms of her perception of them on her chest wall.


  • Increased risk of downward displacement for larger implants: The risk of downward displacement is greater in saline implants than silicone implants, particularly larger ones, such as those above 500 cc. Yet, even in this population, the issue of downward displacement is not the rule, just a greater risk. For most women, this issue is not nearly as much of an issue for smaller implants, so unless you are considering a larger implant, do not fixate on this. By the way, there is not a clear cut-off at which point the rate of downward displacement goes up. This is more of a slippery slope such that the larger you go, the greater the risk. There is almost no difference of risk of downward displacement between implants that are 30 or even 50 cc apart; but there is a difference between implants that are 300 or 500 cc apart. So, I guess what I am trying to say is that the 500 cc amount is not a clear cut-off. If anything, it is a general guideline. Also, for what its worth, I think that the cut-off defining which size implants are more likely to displace downward varies from woman to woman, depending upon how stiff or flaccid her breast tissue is. I think that a woman with firmer stiffer breasts may do well with saline implants of 600 cc, 700 cc, or even 800 cc without having the problem of downward displacement. However, a woman with flaccid, loose, floppy breasts (irrespective of droop) may suffer downward displacement with implants that are 400 cc or even 300 cc. So, again, there is really no clear line. The 500 cc mark is really just a general reference. Having said that, it is very true that IF you did select a saline implant which did result in downward displacement; it is very possible that a similarly sized silicone implant might not have.


In Part 2, I will cover the pros and cons of silicone implants. In Part 3, I will tie everything together and tell you what I tell my patients.

Breast Wishes!

Jean M. Loftus, MD

PS – Unless someone starts to complain, I might just keep on saying Breast Wishes, even though it really goes against my grain as an author…

PPS- Please do throw your comments into the pot. I’d love to hear from you.

Click here to see Breast Augmentation Before and After Images