Saline vs Silicone

Saline implants offer several advantages. Firstly, because they are filled after being placed into the body, they are rolled up when inserted and can therefore be inserted through a smaller scar. Dr. Rapaport, who has pioneered the underarm approach for endoscopic placement of breast implants without any breast scar, typically can place saline implants via a scar that is less than one inch long and located in a preexisting underarm crease. Because this short scar can be hidden in a crease in many cases, even early after surgery there is a sense of there being no visible scar at all. Many patients both young and old derive great satisfaction from this fact.

Another advantage of saline implants can be summed up with the phrase, "peace of mind." While it is very clear, according to the FDA, that there is no cause and effect relationship between silicone and any disease outside of the breast, knowing that one’s breast implants are filled with sterile salt water doesn’t even require that convincing. When a saline implant ruptures, the sterile salt water is absorbed by the body and there need not be any concern regarding health risks. Furthermore, the replacement operation with saline is typically extremely straightforward, especially if the woman with a ruptured saline implant presents soon after the rupture for replacement. When a silicone implant ruptures, usually the scar tissue surrounding the implant must be removed with any silicone gel that is in the breast pocket, and this is commonly a much more involved operation. To complicate the equation further, saline implants (with the exception of the Ideal Implant, which seems to have a rupture rate below both silicone and traditional saline implants) actually rupture more frequently than silicone. Each patient will view this information differently as they make their choices.

Now that we are experienced with using the Ideal Implant, the decision is sometimes even more complex. Both the look and the feel of the Ideal Implant are closer to silicone than the traditional saline implant. “I am seeing an increasing percentage of women opting for saline in the form of the Ideal Implant,” says top NYC plastic surgeon Dr. Rapaport. “I think that the ‘peace of mind’ factor is a big contributor to this trend. Because the Ideal Implant resembles silicone more than any prior saline implant, the choice of saline, in the form of the Ideal Implant, has become a more compelling one for many women.”

For those who value a "natural feel" above everything else, then silicone is almost always going to be their choice. "A saline implant, when placed behind adequate breast tissue such as a B cup breast, can appear absolutely identical to a silicone implant," says Dr. Rapaport. The feel is also virtually identical, and he says that having been examining both kinds of implants for over 25 years. The differences in feel in a woman with adequate fat and breast tissue are extremely subtle and would not be appreciated by most people. In fact, when he examines a woman with a good saline result, it is sometimes impossible for even him to know if she has saline or silicone. In general, he likens a silicone implant to the feeling of squeezing a down pillow and a saline implant to squeezing a foam pillow. They are both soft, but the saline bounces back more quickly. The problems with saline implants relate mainly to people who are thin and/or have little breast tissue, and in these cases one can feel the ripples of the implant more clearly and sometimes even can see ripples through the skin. It’s for this reason that most patients are recommended to have silicone implants. A final advantage of silicone is that even though a silicone rupture involves more complicated surgery, the actual incidence of rupture with silicone implants is far less than with saline.