How to Decide Between Saline & Silicone Implants

Making the decision to get a breast augmentation is a big one. Whether you need reconstructive surgery or simply want a body that feels more “you,” your implants will be with you for a long time. While they are not permanent, as some believe, they are made to last decades. That’s why it is important to choose the right type upfront, to avoid future surgeries you wouldn’t otherwise need to have.

As your needs and aesthetic preferences are taken into consideration, you and your plastic surgeon will choose the right implant based on several criteria, including the size, projection (how far the implant sticks out from the chest wall), the shape, and fill. However, before narrowing down the options, you’ll first have to decide whether to get saline or silicone.

While both have their upsides and downsides, one is likely to fit your needs better than the other. Below, you can learn more about the benefits of each, and a few reasons it might not be the best option for you. If you have further questions after reading, please feel free to get in touch.

First, a note on safety.

The Truth About Safety, Saline and Silicone

For decades, many people were convinced that silicone was not as safe as saline for implants. Saline is simply a solution of water and salt, the concentration being similar to that of tears, blood and body fluids. Intuitively, it does seem as though saline would be safer, as your body consists of a huge portion of it anyway. However, while popular belief for years held that silicone was related to health risks and immunological diseases, there is no evidence to support this claim today.

The only known medical risk of implants is breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), which is an extremely rare type of cancer that develops only around textured breast implants.  BIA-ALCL is a highly treatable cancer; most patients have an excellent prognosis following the removal of the breast implants and surrounding capsule.

Overall, both implants appear equally safe, according to current medical literature. The chance of rupturing is not greater in one than the other, either, although the response to and detection of ruptures is different (covered below). The bottom line with safety is that, while you need to be aware of certain issues with both implants, neither wins out on risk factor – so you can read on with a clear head.

Saline: The Pros and Cons


Saline is simple, sterile saltwater. Your body already contains a ton of it, so it’s pretty much guaranteed to be safe. Many women still feel more comfortable knowing that the substance inside their bodies will be natural. However, it should be noted that even saline implants are contained within a silicone outer covering.

Another benefit is that when saline implants break, it is very obvious. Because the body absorbs saline through the barrier that forms around the implant capsule, the breast will rapidly “deflate” if the implant breaks. Within just a few days, the breast will have lost all the fullness associated with the implant. Thus, no detection system is needed.


Saline, because it is water, ripples with movement. This can look very unnatural, especially if a woman does not have a significant amount of existing breast tissue to cover the implant. For some women, this might make them less likely to feel confident wearing swimwear or revealing clothing.

Silicone: The Pros and Cons


The main pro of silicone is that it looks and feels more natural than saline. Silicone keeps its shape, unlike rippling water. This is especially useful for the teardrop-shaped implants that mimic the natural breast shape, eliminating the appearance of roundness at the top of the breast with normal round implants. Some women choose the teardrop shape for this reason.

Contrary to unfounded claims, there is no medically determined increase in risk of capsular contracture, or the hardening of breast tissue around the implant, when you opt for silicone. To date, researchers have not yet conducted meta-studies to see which type results in more breast hardening, but most physicians will tell you they don’t see a statistically significant difference between implant types in their patients.


The main con regarding silicone breast implants is that it is impossible to detect when they rupture without an ultrasound or an MRI. Because silicone does not penetrate the barrier around the implant (which is good, since it doesn’t enter the body), the breast does not lose shape. Therefore, a woman could conceivably have a ruptured implant for years and not notice it.

For that reason, the FDA recommends magnetic resonance imaging scans (MRIs) three years after implant placement and every two years thereafter. This scan likely won’t be covered by insurance for elective breast augmentation making silicone possibly more expensive long-term. However, screening alternatives to MRI like ultrasound are becoming more mainstream.

The Takeaway: Talk to a Plastic Surgeon

Of course, even if you have a pretty good idea of which implant type you want, you’ll still need to discuss your options with your plastic surgeon. They will help clarify any outstanding questions, assess the benefits for your lifestyle and make the choice that works for you long-term. If you’re ready to learn more about having a San Francisco breast augmentation procedure, Dr. Sieber would love to hear from you!

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*Disclaimer: Results may vary from person to person. Editorial content, before and after images, and patient testimonials do not constitute a guarantee of specific results. All images feature models except for before and after images.

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