How are silicone and saline-filled breast implants different?

Tara Whitworth
Saline breast implants are filled with salt water. They are inserted while empty and then are filled to the desired amount by the surgeon. Saline implants tend to wrinkle and they are not as soft as silicone implants.

Silicone implants are prefilled, so a bigger incision is required. Silicone implants are softer, look more natural, and have less wrinkling.

Your doctor can help you decide the implant that is best for you.
Stuart A. Linder, MD
Plastic Surgery
In general, saline and silicone implants behave differently in the body. Saline implants act more as a water balloon, normally have a less natural shape, rounder in appearance, and feel more unnatural. Silicon gel implants are softer, feel more like breast tissue, they often  have less visibility, and there is sometimes less rippling along the side of the breast. Silicon gel generally is softer, has a more viscus and conforms in a more normal pattern with the female chest. Saline implants may form ripples along the side and indentations which can especially be notable with women leaning forward and along the lateral aspects of the breast where there is no muscle coverage. Silicon gel implants may rupture although it is silent and MRI should be performed every 2-3 years to determine the integrity of the shell of the silicone bag. Saline implant rupture can be determined clinically by simply having a deflation of the chest wall.
Erik A. Hoy, MD
Plastic Surgery
The main differences are in texture, and movement. Silicone implants, filled with a viscous gel, more closely resemble the texture of fat and breast tissues than saline. As a result, silicone implants tend to move more like breast tissue, and overall appear more realistic than do silicone implants of the same volume. Saline implants tend to be firm, and some surgeons combat this by underfilling the implant. However, this causes the underinflated implant capsule to wrinkle and fold, and makes the implant more vulnerable to rupture long term. Therefore, breast implant manufacturers warn against underfilling saline implants. The manufacturer fills silicone implants to the recommended volume.

There is somewhat added risk if the implant ruptures with a silicone implant. The contents are relatively inert, but can cause local tissue reaction and contamination, and necessitate removal. A saline implant contains saltwater, a natural component of the body's tissues and while a ruptured implant still needs to be replaced, there are fewer adverse effects.

State of the art cohesive silicone implants, colloquially termed "gummy bear" implants due to their cohesive nature, may alleviate many of these concerns with the less viscous silicone implants. These implants are also referred to as "form-stable" devices, and help solve the problem of excess superior-pole fullness with implants, which may impart an unnatural appearance to the breast. Form stable implants are anatomically shaped and have a gently sloping superior pole, which does not tend to change with position changes of the patient or implant.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.