How to Choose the Correct Breast Implants: Silicone vs. Saline

Posted July 22, 2009 in Breast Augmentation, Breast Implant Options, Breast Implant Revision Surgery, Capsular Contracture, Home

Pictured above are a silicone filled breast implant (left) and saline filled breast implant (right)

Pictured above are a silicone filled breast implant (left) and saline filled breast implant (right)

So which filler is better Silicone or Saline?

That has been the question since the introduction of the modern breast implants in the 1960’s. All the latest breast implants are made with a silicone shell. The difference is what is placed inside the shell to give the desired boost in breast volume.

The first breast implants were developed in 1962 by two Texas plastic surgeons Thomas Cronin and Frank Gerow with Dow Corning. These were smooth tear dropped shaped silicone implants filled with a cohesive silicone gel. They had a Dacron patch on the back to fix the orientation. This was necessary because they were smooth and could spin, thus losing the desired orientation.

Saline filled implants followed a few years later. A French plastic surgeon, Henri Arion, was the first to use them. He was trying to make an implant that could be placed through a smaller incision. Unlike silicone breast implants which are pre-filled, saline filled breast implants are filled after insertion. The shell can be inserted through a smaller opening without the risk of damaging the implant. A filling tube is left attached to add the desired volume. A valve built into the implant allows the tube to be removed without the saline leaking.

Since the mid sixties little has changed. The shells are more durable and less leaky. Texturing was added, eliminating the need for the Dacron patch for shaped implants. The cohesiveness of the silicone gel has been modified. The implants have received ongoing FDA approval and remain safe and effective for augmenting the breast.

In my Walnut Creek breast augmentation practice I am often asked which is better – saline or silicone gel? If there was a clear advantage then in a free society the better implant would be used more frequently. In the case of breast implants, even with the recent silicone gel breast implant controversies the use is about 50:50 with the edge going to saline.

In other words, about half the San Francisco breast augmentations patients are choosing saline and half are choosing silicone gel breast implants. This is because both implants have advantages and disadvantages. I go into detail about saline breast implants vs silicone gel breast implants on, but here are the top five advantages and disadvantages of saline and silicone gel filled breast implants.

Saline Breast implants


  • Peace of mind for those who are unsure of silicone gel
  • Leaks are easily detactable
  • Increased projection when desired
  • For purely cosmetic breast augmentation can be used at age 18
  • Slightly lower capsular contracture rate


  • Higher risk of rippling
  • More easily palpable (feels less natural in most cases)
  • Increased projection when not desired
  • Stiffer result
  • Slightly higher leakage rate

Silicone Gel Breast Implants


  • Softer more natural feel
  • Lower risk of rippling
  • Decreased projection when desired
  • Moves more like a natural breast
  • More profiles (shapes) available


  • Leaks are harder to detect
  • Decreased projection when desired
  • Slightly higher capsular contracture rates
  • Body makes scar in response to a leak
  • For purely cosmetic breast augmentation can be used at age 22 or older

There are other aspects to consider in specific situations so it is important to discuss these differences with your Board Certified Plastic Surgeon during your initial consultation. Board certification can be checked easily on-line for free on the American Board of Medical Subspecialties site. Also all members of the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) are Certified by the American Board of Plastic Surgery.

These are the premier surgical societies for plastic surgery in the United States and I am proud to be an Active Member of both ASAPS and ASPS. I also have Certified and maintain Board Certification with the American Board of Plastic Surgery and with the American Board of Surgery. When I add a post about how to choose a plastic surgeon, I will add the link here, but I consider Board Certification, and Membership in the ASAPS and ASPS three of the most important prerequisites. It is also a good idea to check you Plastic Surgeon’s standing with your state’s medical board. Here is the link for the physician license lookup for the Medical Board of California.