Saline vs. Silicone implants: Why I’m happy silicone implants are back!

A hand pressing down on a implant on a table.

In my last blog post, I went over briefly how the silicone implant moratorium came about. This week I’ll tell you why it is such a good thing that silicone implants are back as a choice for all Breast augmentation patients.

Remember, silicon implants weren’t really banned, as we have been using silicon implants for cancer patients, those with congenital defects, and patients needing a breast lift. Over the past 14 years they were just not available for cosmetic surgery patients. However, now all patients will have the choice to use saline or silicone implants.

So how do silicone implants stack up against saline implants?
Let me tell you by listing some of the features of each…

How the implants feels

In my breast implant consultations, I have patients try on the different sizes of implants in front of a mirror. In the exam room I have a mix of various saline and silicone implants. The patient gets the chance to handle the implant and feel its consistency. Inevitably, they pick up the silicone implant for sizing. I have to tell them that what they are handling is not a saline implant, but a silicon implant, then in some cases I proceed to show them a saline implant.

Everyone who has touched the silicone always comments on how they like the feel of it. I have never, in all my years of practice, heard anybody say they preferred the feel of the saline implant. By far, the best feature of the silicon implant is how it feels.

The saline implant doesn’t quite feel like a water sac once inside the body because it is surrounded by various amounts of skin, fat and muscle. Thus the comparison between the implants you hold in your hand is not completely fair. But it is absolutely true that the silicone implant, once in place, still feels better than the saline implant.

How the implant looks

As far as the way the implant looks there is no particular advantage to silicone versus saline, except for one circumstance: rippling. Breast implant rippling occurs when folds in the implant shell are visible through the skin. Silicone implants have much less tendency to show rippling, especially in slender patients.

There are two main factors that determine whether rippling will show through the skin. One is the tissue surrounding the implant. If there is a good cover of muscle or subcutaneous fat, rippling, even if it occurs, may not show through the skin. The other main factor is the implant filling. Since saline water has very little consistency, the implant shell can fold easily against the saline, but since silicone is thicker, the shell doesn’t fold as easily. Therefore, silicone implants can sometimes make a visual difference, particularly for slender patients.

The likelihood of capsular contracture

Capsular contracture occurs when the protective scar capsule that the body uses to isolate the implant tightens or contracts. Imagine holding a water balloon in your hands and tightening the grip. The balloon wall, which felt like it had no resistance, will begin to feel harder as you tighten your grip. An implant with a capsular contracture likewise “feels hard” even if the fill material itself is watery (saline) or gel like(silicone).

There is no evidence that I’m aware of that states that saline or silicone filled implants have more of a tendency to develop capsular contractures. I do a few contracture releases a year, 2-3, which is much less than I used to see as a resident (operating with a number of private physicians in the University setting). Placing the implant under the muscle is much more of a factor in preventing capsular contracture than whether the implant is saline or silicone.

Implant wear-and-tear

You may have heard implant manufacturers or doctors say that you should plan on “changing” your implants every 10 years. I don’t think so. They may be saying that to protect themselves from lawsuits, and I don’t blame them. However, I have been in practice for 18 years and I would already be on my second round of re-do’s of all my previous implants.

That is nowhere near my experience. I see less than five ruptures per year. They have occurred almost exclusively with textured saline wall implants. When a saline implant ruptures, you get a ‘flat tire’ as it deflates as the saline leaves the implant. The patient notices soon thereafter, and there is no remedy but to surgically replace the implant.

When a silicon implant ruptures, the patient may not even notice. As a matter of fact, the vast majority of silicone implant ruptures are diagnosed when the patient gets an MRI for another purpose. However, if you do have a ruptured silicone implant, the cohesive nature of the silicone will allow the implant to stay together. You do not necessarily have to get them removed as the silicone does not ‘leak.’ Likewise, silicone is an inert material and the FDA has determined that silicone does not pose medical risks or cause diseases. However, a ruptured silicone implant can certainly be surgically replaced.

Surgical scars

Here is the only area where I think the saline implant is superior to the silicone implant.
Silicone implants are inserted into the breast in their full gel form (just as you see them in the office). Saline implants are inserted empty and then filled with saline after they are placed into your breast cavity.

Therefore I can use a smaller incision for a saline implant compared to a silicone implant of the same size. The saline implant can be rolled up empty to a tight cylinder and inserted into the breast pocket through a very small incision. This is especially useful in women with very small breasts where incisions below the breast fold may show, and where the areolar complex is small so an areolar incision has to be correspondingly small. Silicone implants do require a larger incision in order to fit the full gel implants into the breast.

Saline VS. silicone summary

All in all, silicone implants feel better and are likely to last longer without having to exchange implants. I guess the best endorsement I can make is that if my wife asked for implants, I would advise her to get silicone implants.

I am especially happy that the FDA has clarified once and for all that the whole controversy over implant safety was just that, a controversy, and not a real fact. I have seen many women’s lives and sense of well being improved by breast augmentation, and I’m glad they now have the full range of choices available.

By Dr. Ricardo L. Rodriguez MD Board Certified Plastic Surgeon Cosmeticsurg Baltimore, Maryland Ricardo L. Rodriguez on American Society of Plastic Surgeons.

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36 thoughts on “Saline vs. Silicone implants: Why I’m happy silicone implants are back!”

  • Mary says:

    47 years old, 67 kgs, 167 cm tall in good health. Very flat buttocks with fat around tummy, waistline, love handles and back. Looking for a big round and perky butt with implants slim waistline and flat tummy.
    • Dr. Ricardo L Rodriguez says:

      Mary: We can definitely help you achieve all your goals and it looks like you are a good candidate because of your good health. Let's set up a virtual consultation. I will let Kelly know of your interests. Thanks for contacting us! I am looking forward to meeting you.
  • ALEJANDRA says:

    Hello Dr. Rodriguez, I already have my surgery scheduled for June 1st, 2012... After reading your article I have definitely decided to go for silicone. Now, my last concern is whether to go moderate or high profile. I am 5'10'' and weight 180lbs, large frame. I am just wondering if high profile is going to give me a perkier look than moderate. I like the look of high profile but I'm worried that bc of my body type they're not going to look as good on me bc I know that moderate profile are a little wider but high profile point out a little more... idk... I would really love your advise. Thank you very much for taking the time this.
    • Dr. Ricardo L Rodriguez says:

      Alejandria, that is something best decided between you and your surgeon in front of a mirror trying the different types of implants. We do this routinely in our practice. Ask your surgeon to do it for you. Good luck!
  • Anita says:

    Dr. I have always wanted to get breast implants I am20 years old and overwhelmed with the choices. For example oval or round? I am very confused with all the deatails. How do I break down the deals? Thank you.
    • Dr. Ricardo L Rodriguez says:

      Anita: The best way is to get a consult. Come with a full set of questions written down so you don't forget anything. After that consult you will have more of a foundation and you will get to touch and feel the implants themselves. Then go and get a second consult. Now you will have a more comfort level and will be able to focus more on whether you like this doctor or the previous one. Don't stop getting consults until you find the surgeon you are totally happy with. Check out this procedure information page with other links to read so you can get a lot of good info before your new consult. Good luck and let other friends know about our website!
  • catherine says:

    Hi Dr Rodriguez, im 29 years old mother of 5 kids i been wanting to have a mommy make over surgery for a long time. One of the main reasons why i have not done it, is because im scared but ur blog has help me a lot it looks like silicone is the way to go. I made an appt with a doctor for march 14,2012 i would like to have the surgery in may. how long do u think it would take to recover im planning to do a tummy tuck plus a lift with implants
    • Dr. Ricardo L Rodriguez says:

      Catherine: Generally I recommend 4 weeks off work, but that depends a lot on the technique the surgeon uses. You should ask your surgeon very specifically and also find out on your own about getting help with your kids. Also ask about the scars he will use for the breast lift. Nowadays you should be able to get it done with just a lollipop scar or a periareolar scar I do 90% of my Breast lift/Augmentations now with a periareolar scar.
    • Dr. Ricardo L Rodriguez says:

      Jen: There are two possible problems. One is pain from your back if you pick very large implants. I don't think it would be an issue with small implants. The other is the spleen. How did you lose your spleen? I don't think it would be a problem, but that is something that would have to be discussed with your internist. Another possibility is fat grafts, taking the fat from another part of your body and putting it in your breast to increase your breast size. Contact Kelly at for more info!
  • Mya says:

    I've been debating forever now about getting a breast augmentation.I am 22 and would live to be a natural full c, even though I am a b.everyone tells me to wait and do it after having a baby. What do u think?
    • Dr. Ricardo L Rodriguez says:

      Mya: There is no right answer to this question. If you get a breast augmentation now, and if you get pregnant later, there is a risk that the skin will stretch during the pregnancy. This includes the period of milk feeding. Once the pregnancy or breast feeding is over, it is possible the skin over the implant might sag a little. In that case, one could come back later and do a little skin tightening to correct the problem. It would be a minor surgery. We have many young patients that have breast augmentations and later on have babies. It is not a health risk to you or the baby. Many of them do not need another surgery. If you really want this, I don't think it is a problem, but in the end you have to make your own decision.
  • niccole zech says:

    I am 37 mother of 5 children and I breast feed all my children. I am not happy with my breast but surgery scares me, and I hear horror story about breast surgery but I feel it is my only choice to make myself happy again about my body
    • Dr. Ricardo L Rodriguez says:

      Niccole: Actually, Niccole, you have another alternative, which is to have fat injections to the breasts. It changes your figure because you do lipo in other areas of the body, so it is a total body enhancement. It is your own body tissue and it is completely natural. The results are permanent. If you want more information, contact Kelly at, she'll be happy to help you!
  • Mariah says:

    Dr Dr. Ricardo L Rodriguez, I've been wanting to get a breast augmentation ever since I've had my son.. My boobs before were nice and perky, not big, but a nice b cup.. Now after I've had my son, i am smaller than an a cup and there saggy.. I'm only 18 but am very uncomfortable with my body.. Should i wait or get them soon?
    • Dr. Ricardo L Rodriguez says:

      Mariah: You are 18 and a mother, yet legally, you are not in a position to make the decision alone. We'd love to help you, and we can get it done, but you will need a person over 21 who is your adult guardian (father, mother, husband, if he is over 21). After age 21 you do not need an adult guardian to help you, but that might be more than you want to wait. In any case, we're here to help you whenever you want to make your decision.
  • Brenda says:

    I've had saline implants since 1993. One has 330cc and the other is 360cc. The larger implant has always caused pain. It seems like it was always too big for my breast cavity. About 6 yrs ago I started keeping a log because the larger implant would turn red, it felt like I had a fever in that breast, the pain was tremendous and I felt like I was getting the flu. My MD would put me on antibiotics and several times had to put me on two at the same time in order to get well. He diagnosed me with cellulitis but I've never had a cut or scrap on my breast that would allow the infection to enter my system. After reading your article I wonder if I have capsular contracture. I truly believe that all the pain I have been feeling over the past years is directly related to my implant. This week I went to a plastic surgeon who told me that I had a lot of scar tissue and told me he would like to remove the implants, clean out the scar tissue and put in new implants. My fear is that after I pay for this procedure, will the same thing continue to happen. Any thoughts that you can share with me? Thank you. Bevo
    • Dr. Ricardo L Rodriguez says:

      Brenda: The size of the implant probably does not have to do with your symptoms. There is a possibility that you may have had a low grade infection, but this would be hard to prove. A capsular contracture is characterized by the appearance of the implant being very rounded and the implant feeling very hard. Pain can be associated with contractures, but not necessarily. If you want to minimize the chances of this happening again, I would remove the implant, then wait a few weeks before putting a new implant in. This is to make sure that if there was an low grade infection, it could be cleared out by the body before you put a new implant in. Hope this helps!
  • jenny says:

    I want to get breast augmentation so bad, since mine 18's a have dreamed with it, and now I am 26. I am small and lean and my breast is small and look like a fry egg, however it has not a round format and this bother me a lot. So please help me, which implant could suit better on me? Thanks a lot!
    • Dr. Ricardo L Rodriguez says:

      Jenny: It sounds like you would like a high profile implant, which gives a rounder look. Do it now that you are young and enjoy the changes in your figure!
  • Jon-Eric says:

    My wife is going to be getting breast augmentation and we both are doing research on which is the best choice, saline or silicone. I have read the above article and have gain some vital information. From what I have gathered thus far it seems saline is known for offering a smaller cut so thusly a smaller scar, cheaper, easier to detect if there is a leak but on the down side saline are more prone to rippling and feeling uncomfortable. On the other hand there is silicone which comes across as being the best feeling and are less prone to ripple but the draw backs seems to be mounting...cost more, harder to detect if there is a leak, the need to have an MIR every three months to check for a leak, if there is a leak the operation to fix it is more extensive, there needs to be a larger cut for the implant so a larger scar is to follow. It seems to me the real draw back for saline, where it looses to silicone, is the feel and rippling. Cant this be lessened by placing the saline implant sub muscular and over filling the implant by 25cc or so? thank you Jon-Eric
    • Dr. Ricardo L Rodriguez says:

      Jon-Eric: Scar- the scar with saline implant is small but not that much smaller. We are talking about a 1 inch scar vs a 2 inch scar Removal of silicone: That used to be more complicated with the older type silicone. The newer implants have what is called "cohesive" gel which, as the name implies, is more like gummy bear candies than viscous fluid(which is what it was before). MRI- No, you do not have to get MRI on any specific interval. As a matter of fact, I don't get MRI unless I think there is a problem, and that is very rare. Check out this blog for the issue of wrinkling.
  • mickey says:

    I really liked your site! I wish I had asked more questions? The problem that I'm having is that I had my saline implants almost 18 years ago and my now new surgeon who I was referred to requested that they needed to be changed, I needed a tummy tuck due to my c-sections skin just hanging over almost between my legs, and I'm not over weight just my belly from the skin just sagged so that's when I went to the surgeon for the consult he also suggested that I should get new implants too. I never had any problems with my old ones except they got harder, so I had both surgeries done almost 4 years ago and just recently my new saline implant on my left side ruptured (don't know why) and now my right breast deflated quite a bit. Many of my friends have saline but under the muscle, they have been told by their surgeons that it will look more natural and will protect the saline. Is that true? Is it a fact? My surgeon told me that I had beautiful tissues so there was no need to go under the muscle. I also told him that I was planning to lose more weight. I had lost 30 lbs addition after my surgeries. Now I also have a cochler implant in my ear, but I cannot have any MRI's unless it's an emergency that they would have to take it out if nessasary. My problem now is that after paying for the breast implant and breast lift which for that I paid $12,000. for less than 4 years ago he is now telling me that it will now cost me $6,800 to go under the muscle with saline which I don't have to pay out like that bc I have a family to raise. If you can see my first salines I had done 18 years ago I never any problems. The words my surgeon used was this isn't fault but he's giving me a family discount. I don't know what to do now. It has made me sadder than ever and I feel selfish money wise to have them redone. I just wanted to feel happy and confident, so that my kids can see a happy mom and teach them their confidence and to be happy. I have an 8 year old son who has had 6 surgeries and 4 open heart surgeries and his scars are bothering him too. I don't want him to be concience of it. Is there any clinics that do testing on new implants, and or what should I do? I'm clueless! My surgeon is arragant and confiedence, and they way he talks to be it's always comparing like getting new tires. I live in New Jersey, Please,Please help me with information I need, and or what should I do! I thank you so much and I'm looking forward to hearing back from you! W
    • Dr. Ricardo L Rodriguez says:

      Mickey: You have a lot of questions, and you really need a second opinion to do justice to all of your concerns. I will answer a few questions briefly. Any implant that is under the muscle will have the upper pole of the implant disguised by the muscle, thus, it will be a more natural slope on the upper part of the breast. This is specially more important if the patient has a lower body fat content. Check out this blog post regarding under the muscle placement. Only you can give yourself happiness and confidence. If you feel you are not communicating well with your doctor, maybe you should seek a second opinion. Finally, most university Plastic Surgery sections have a clinic where surgery is done at a reduced price. You do have to realize the surgery will be done by the residents under supervision of a fully boarded Plastic Surgeon. I hope this helps. If you are interested in a consultation, contact Kelly at Cheer up, things have a way of working out in the end.
  • Jill andrus says:

    Thank you for these nice information and these are very helpful. Another technology is Saline Implant. Saline implants look faker? This rumor was born after the popular television celebrity Pamela Anderson famously enhanced her appearance with a pair of saline breast implants. What you probably didn’t hear was that her reported size was 1000 cc. If you don’t want to look like a celebrity sex icon, don’t get 1000 cc implants. Women getting 700 cc and lower implants shouldn’t be concerned about looking “fake” (unless you desire the “Pam” look, of course).
    • Dr. Ricardo L Rodriguez says:

      Jill: Saline implants and silicon implants look the same. They are shaped the same way. The FEEL; however, is different. I have had many patients who had saline implants replaced by silicon implants (after a saline implant rupture) that the silicon implants FEEL much more natural. A 1000cc implant will look artificial wether it is made of saline, silicone, or vegetable oil. Smaller sizes too can look artificial, if the woman has very little tissue of her own, because the majority of what you see is the implant. Likewise, a 700cc implant will be very well disguised in a woman with very large breasts. Hope this helps. BTW, great site you have, very informative.
  • Karina says:

    I just had my surgery on December 17th, 2010. Ladies...Let me just say, this was the best decision I have ever made in my whole entire life getting Sillicon Implants. My husband was with me at all time. The nurses at the hospital treated me like home. Over all....The doctor did an amazing job. I LOVE THEM and so does my husband. The first day I felt pain but after taking the meds required as needed, the pain slowly went away. Now im only taking Diazepam as needed in the evening and ibuprofen during the day with lots of water. ALL antibiotics have to be taken. I am soo happy with my SILICON implants. I couldnt of made a better choice. It doesnt give me a exaturating round bump like Saline looks NATURAL...of course, with time, they will look more natural and PERFECT. MERRY CHRISTMAS TO MY HUBBY...and i love him dearly for supporting me with my decision. Again, Thank you so much Dr. Rodriguez. you have made my decision so easy. -Karina Abedalqader. PS- 25 yrs 5'7'' about 140lbs from a 34A cup to a 34Full C small D. I LOVE THEM!!!!!!
  • mike says:

    My fiance is getting them march 29th 2011 and im paying for half of them. Im just a little worried about the recovery time and I've heard anywhere from 3 days to 3 weeks. Is there anything we can do to speed this process up or is there anything I should do to make her feel comfortable? We are definitely going silicone the dr. Highly recommended it and they are going through her armpit.
    • Dr. Ricardo L Rodriguez says:

      Mike: Pain Pumps help a lot because the recovery period is so much better. Secondarily, since patients are not in as much pain they mobilize quicker. Good Luck to your better half!
  • Karina says:

    I am having my surgery on the 17th of Dec of 2010. It will be a christmas gift from my husband. I am doing this for my own and not for anyone else. My husband already paid to get my surgery with silicon implants. I was actually wanting to back up from the surgery after hearing my female friends talk about their saline implants and how its a risk to have silicon on..I kept reading about the risk and how the silicon implants were taken off the market, but are back now. After reading on what you had to say, I feel a whole lot better. My doctor does choose silicon over saline anytime. I am going for it, In hope that nothing will go wrong... Thanks so very much...
    • Dr. Ricardo L Rodriguez says:

      Karina: Good luck! God bless you and go foward with your choice. Don't be afraid. Please let us know how it turns out, it will help other patients who are trying to make up their minds.
  • Wanda says:

    I want to thank you so much for posting this information about silicone implants, I've been racking my brain, trying to decide if I want saline or silicone implants. I first wanted to do saline because it was safer but after reading this info about silicone, I have decided to go with silicone. Again thank you very much.
    • admin says:

      Keep reading our blog! If you have any questions feel free to ask them, I'm always on the lookout for themes.
  • Kemameal says:

    Thanks doctor for this useful comparison. VERY helpful. I am planning to get a butt enhacement and I was told by a lab techician that silicon was out and dangerous that I am better off with the saline. But thanks to the information you provided I see that silicone is not really bad. You made my decision much easier and I feel more comfortabe with silicone now. THANKS SO MUCH
  • ELP says:

    I was just waffling on whether to go with saline or silicone. I have been set on silicone, but now that surgery is only a month away, I've been questioning what I really want. The last part, where you said what you would recommend to your wife, really sealed it for me. Thank you for putting this in such easy to understand terms! much appreciated!!