Saline Breast Implants

Reviewed by Walter Erhardt, MD

Saline or silicone? That is the question. There is no right or wrong answer. Weighing the pros and cons of saline and silicone breast implants, along with your preferences, is the best way to approach this decision.

Anatomy of a Saline Breast Implant

Understanding the anatomy of a saline breast implant may help you make your decision. Breast implants can be filled with saline or silicone gel; however, the casing or outer shell for both is composed of silicone.

Like silicone gel-filled implants, saline breast implants come in different sizes, shapes and profiles. The surface of the outer shell is another component of breast implants. It can be either smooth or textured.

Saline-filled breast implants can be placed in any of the various implant placement positions. These positions include subglandular (over the muscle), partial submuscular (the top two-thirds is covered by the muscle) and complete submuscular (under the muscle). Another part of the equation is incision type and location. There are several options, including inframammary (crease where the breast and chest come together), periareolar (nipple), transaxillary (armpit) or TUBA (belly button).

Placement of saline breast implants tends to involve shorter incisions than those used with silicone implants. This is because saline implants are filled after placement, whereas silicone implants are pre-filled. For the same reason, saline implants often can be adjusted after surgery; the doctor can use a syringe to put in more liquid or take some out. In contrast, the size of standard pre-filled silicone implants is permanent.

Saline Breast Implants: Rupture Risks

The main advantage of the saline-filled breast implant is that if it ruptures, the saline (saltwater solution) is harmlessly and seamlessly absorbed by the body. Another rupture-related advantage of saline breast implants is that it is obvious if a saline implant ruptures because it deflates immediately. This is not true with silicone gel-filled implants. The silicone gel leaks out slowly, which is why the Food and Drug Administration (FDA) recommends that women with silicone gel-filled implants undergo magnetic resonance imaging (MRI) to check for ruptures three years postoperatively, and then every two years after that. Both implant types should be removed if they rupture.

The controversy surrounding silicone gel-filled implants centered largely around what happens to the gel filling if the implant shell ruptures. A group of women alleged that this errant gel caused autoimmune and connective tissue diseases. The FDA removed silicone-filled breast implants from the market in 1992 as a result of these claims. After a thorough investigation, the FDA could find no connection between silicone breast implants and connective tissue or autoimmune disease. As a result, the agency re-approved silicone gel-filled implants in 2006. Now, silicone breast implants are approved for women of all ages who need breast reconstruction and for women aged 22 and older seeking breast augmentation.

Saline Breast Implants: The Touch, The Feel

The main disadvantage of saline-filled implants is their feel. Many women prefer the more natural-feeling silicone gel to the water balloon-like feel of saline-filled implants. That said, newer surgical techniques, such as placing the saline implant behind the chest muscle and slightly overfilling it, may make the implant feel more like real breast tissue.

Saline Breast Implants: The Ripple Factor

Saline implants also are more likely to show rippling or wrinkling than silicone gel-filled implants. Rippling occurs when the saline fill and the elastic silicone polymer shell interact. This effect may be more pronounced in women with thin skin and very little breast tissue because the small ripples in the implant may be more visible through their crepe-like skin.

Saline Breast Implants: The Cost

Breast augmentation with saline implants costs approximately $1,000 less than with silicone gel-filled implants. There are many reasons for the difference in price, including the cost of the implant-filling material.

Discuss the Benefits and Risks of Saline Breast Implants with a Surgeon

The bottom line is that deciding which implant is right for you is personal. Lots of factors should be weighed, including your anatomy, your desires, your budget and any concerns you have regarding the two types of fills. Discuss your options with a board-certified plastic surgeon who has extensive experience with both saline-filled and silicone gel-filled implants. Start your search for a local surgeon now.