I often get asked about which is better, saline or silicone implants. I also discuss this thoroughly for those patients that come in for a breast augmentation consultation.
It is important to understand that there is not a good breast implant or a lousy breast implant. Women can get wonderful results with both types. I would also add, that those people (usually men) who say that they can tell by looking at the woman if saline or silicone implants were used, I would say, “rubbish.” I have seen many women in follow up, by which time I cannot remember whether I used saline and silicone on them. I examine them and, based on my exam, believe they have silicone, when in fact they have saline implants.
The biggest advantage of saline implants is that they cost less than silicone implants. The other advantage they have, is that they come empty so I can roll them up into a cigar shape and slip them under the muscle with a very small incision. they are then filled with a connecting tube which is removed. This makes it very easy to use the periareolar incision.
There are two major advantages of silicone implants. The most important is that they definitely feel more natural. The density of silicone is much closer to fat (which is a significant component of breasts) compared to saline (fill up a sandwich bag of water and that is what saline implants feel like). The other advantage of silicone is that they are less likely to show rippling especially in thin, small breasted women.
The silicone implants come already filled. It used to be that inserting them required a large incision. However for the past several years, I have been using a Keller funnel, which allows me to insert it through a much smaller incision. I can usually insert silicone implants through a periareolar incision. Note that the Keller funnel cannot be re-used on a different patient, so they are discarded after they are used on you.
This advantage of silicone becomes less important for those women who already have a moderate amount of breast tissue. Conversely, for those women with very small breasts and who also have very low body fat, the advantage of a more natural feeling silicone implant becomes greater.
Note that I almost always put my implants under the muscle, which makes them less likely to get hard (capsule formation) and they feel and look more natural.