Saline breast implants are filled with a salt-water solution. Saline is much like the fluid that makes up most of the human body. The outer shell of the implant is made of a silicone elastomer (a rubber-like material) and the fill material is the same sterile salt-water solution that is used for intravenous administration.
The breast implant is placed while empty and then filled with saline after it is in the breast. Saline breast implants have existed for decades and were the only breast implants available for routine breast augmentation during the silicone gel breast implant moratorium from 1992 to 2006. All women over the age of 18, that are suitable candidates for breast augmentation surgery, are eligible for saline-filled breast implants.
Saline Versus Silicone Gel Breast Implants
Millions of women have had successful breast augmentations with saline and silicone breast implants. So, which breast implant is best for you? There is no single universal answer to this question and the decision must be customized to each woman’s unique characteristics and desires. We break down the issue into four key points. One is the actual aesthetic appearance achieved. Two is the feel the breasts have after implantation. Three is the implications of implant failure. And, four is the impact of the implants on the maintenance of breast health.
Appearance Of The Augmented Breast
In most women with thick breasts, the overall shape and look of the breasts will be similar with either round saline or round silicone gel breast implants. However, there is a key distinguishing feature; the risk of implant visibility. When we talk about implant visibility, we are referring to the visibility of the implant edges through deformation of the skin. Irregular appearing skin of augmented breasts is due to the ripples that are present on all implant edges. Also, ripples can occur due to the internal traction from the implants on the skin, especially when one leans forward. Such visible implant rippling is most common at the outer part of the breasts, but it can occur anywhere.
During your consultation, we will show you saline and silicone gel filled breast implants and have you compare the ripples inherent to each type. On direct comparison, you will find that saline implants ripple more than silicone gel implants. So, do all women need silicone gel implants to avoid having visible ripples? The answer is no. In patients with moderate or thick soft tissue padding (that is, the skin, fat, and breast tissue layers) over the implants, visible ripples probably won’t occur even with saline filled breast implants. In very thin patients, ripples probably will occur with saline implants and may even be seen with silicone gel implants. Based on your examination, soft tissue thickness and the size of implants you desire, we will be able to give you an estimate regarding your risk of visible implant ripples with both types of breast implants.
Feel Of The Augmented Breast
The second key issue is: how do saline and silicone gel breast implants compare in terms of the feel of the augmented breast? In everyday life; when showering, dressings and exercising, both silicone gel and saline breast implants are soft and fluid and have a similar feel. The difference will most likely be noticed during a self-breast exam or by your partner during intimate encounters.
In patients with thick soft tissue padding over the implants, the breasts will have a similar feel, though the mushier silicone gel implant may feel a bit softer and more natural than saline. In patients with thin or moderate soft tissue coverage, saline implants will be easier to feel than silicone gel implants. What is felt is the implant shell, which can feel like an irregular, bubble-edged bag within the breast. In most cases (except in thin patients) the shell of a silicone gel implant cannot be easily felt within the breast.
Breast Implant Failure
The third issue to consider is the difference in saline and silicone gel breast implants regarding the implications of implant failure. Both types of breast implants are very durable devices, but they are not perfect devices, so it is wise to assume that one or both implants will leak at some point in a woman’s life. If a saline breast implant breaks, saline will leak from the implant. This saline is then absorbed naturally by the body. The implant will deflate rapidly and the smaller, deflated breast will usually be obvious in a day or two. When failure of a saline breast implant occurs, the tissues surrounding the implant are generally not affected. The deflated implant shell is very easy to remove during implant replacement surgery.
While there is little concern about complications due to saline implant failure, failure of a silicone gel breast implant may lead to reactions in and around the breast tissues. Older generation silicone gel implants had a more liquid-like gel which was prone to run throughout the soft tissue pocket surrounding the implant and, in some cases, even seep into the surrounding tissues. Such seeping of gel could lead to tissue reactions, such as formation of a nodular, silicone granuloma. The current generation of silicone gel breast implants are less likely to cause such local complications because the silicone is much thicker. If a current generation silicone gel implant breaks, the silicone gel inside the shell will bulge from the implant, but generally not run into the surrounding tissues. Therefore, local complications in and around the breast tissue from a leaking modern generation silicone gel implant, though perhaps possible, are unlikely to occur.
Maintenance Of Breast Health
The fourth issue is the difference between saline and silicone gel breast implants in terms of maintenance of breast health. There is a great difference between saline and silicone implants in ease of detection of an implant failure. With a saline breast implant a leak is usually obvious, since the implant deflates and the breast shrinks. The salt water from the implant is absorbed by the body naturally and is harmless. Therefore, special radiological studies, such as a MRI, are generally not needed to monitor or inspect saline filled breast implants.
However, when a silicone gel breast implant breaks, the breast usually maintains its shape, so the leak will not be obvious to the patient or a physician. In most cases, silicone gel implant failure can only be determined with an imaging study, such as an MRI. Since an MRI is the only reliable way to detect implant rupture, the FDA recommends that women with silicone gel implants obtain a MRI of their breasts three years after augmentation and every two years thereafter. And, since the FDA has not found the evidence to be conclusive that ruptured silicone gel implants are universally harmless, if a ruptured implant is detected, the FDA recommends for the implant to be removed and replaced (if desired by the patient).
Replacement of a silicone gel implant is similar to a saline implant, except that with silicone gel, some of the sticky gel material may need to be removed and cleansed from the soft tissue capsule around the implant. If this is necessary, it is generally not problematic to remove the free gel and it is of little consequence to the soft tissue capsule.