Breast implants: Saline vs. silicone

Breast implants are used for people who want larger breasts, also called augmentation. And breast implants can be used for those who want to rebuild a breast after cancer surgery or injury, also called reconstruction. If you're thinking about breast implants, here's some information to help you choose between saline-filled and silicone gel-filled implants.

What's the difference between saline and silicone breast implants?

Saline and silicone breast implants both have an outer silicone shell. The implants differ in what they're filled with and how they feel.

Saline breast implants

Saline implants are filled with sterile salt water. They're usually put into the breast empty and filled when they're in place.

Saline breast implants are available to people ages 18 and older to make breasts larger.

Silicone breast implants

Silicone implants are made with silicone gel filling. Most people believe that silicone breast implants look and feel more like natural breasts.

Silicone breast implants are available to people age 22 and older for augmentation. They are available at any age for breast reconstruction.

What are the risks of breast implants?

Saline and silicone breast implants have similar risks, including:

• Scar tissue that changes the shape of the breast implant — a condition called capsular contracture
• Breast pain
• Infection
• Changes in nipple and breast feeling, which is often temporary
• Leaking or tearing

More surgery, either to remove or replace the implants, might be needed for any of these issues.

With certain breast implants there is a low risk of developing a type of cancer known as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Implants with a textured outer silicone shell and a certain type of plastic shell called polyurethane seem to have the highest risk. As a result, some of these implants are no longer available in the United States and some other countries.

Although BIA-ALCL affects the breast, it isn't breast cancer. But it can spread, and a small percentage of people who have it require chemotherapy or radiation therapy to treat it. It's important to see your health care provider if you have swelling around a breast implant, a lump in your breast or armpit, or changes to your breast skin.

Some people associate certain symptoms, such as fatigue and joint pain, with breast implants. This is referred to as breast implant illness. The cause hasn't been proved. In some cases, removal of the implants stops the symptoms. More studies are needed.

What happens if an implant ruptures?

If an implant tears, the approach might depend on whether the implant is saline or silicone.

Ruptured saline implant

If a saline breast implant tears, the implant will flatten. This will change the size and shape of the breast.

Leaking saline solution isn't a health risk. But removing the silicone shell requires surgery. A new implant can likely be inserted at the same time.

Ruptured silicone implant

A tear in a silicone implant might not be noticeable at first — or ever — because the silicone tends to stay trapped in the scar tissue that forms around the implant. This is known as a silent rupture.

Leaking silicone gel isn't thought to cause health problems, but it can travel to other parts of the body. Silicone found outside of the breast is often not removed due to the risk of damaging other tissues.

A torn silicone breast implant might cause breast pain, breast thickening or changes in the shape of the breast. If this happens, surgical removal of the implant might be needed. A new implant can usually be put in at the same time.

Is the safety of breast implants watched?

Both saline and silicone breast implants are considered safe. Research on how safe both types of implants are and how well they work is ongoing.

What might I consider before getting breast implants?

If you're thinking about breast augmentation or reconstruction, it's important to understand what it means to have breast implants. Keep in mind:

• Breast implants won't prevent breasts from sagging. Correcting sagging breasts might require a breast lift as well.

• Breast implants aren't guaranteed to last a lifetime. Implants often need to be replaced for a number of reasons, including rupture of the implant and scar tissue that forms as a result of the surgery.

  Also, breasts continue to change after surgery. Certain factors, such as aging and weight gain or loss, might change the look of the breasts. Any of these issues might lead to a need for more surgery.

• Mammograms might be more difficult. For people with breast implants, routine mammograms might need specialized views. Tell the health care provider who does your mammogram that you have breast implants.
• You might need an MRI scan. For people with silicone implants, the Food and Drug Administration recommends routine monitoring with ultrasound or MRI after 5 to 6 years, then every 2 to 3 years afterward. However, there's little data to support the need for routine screening unless there are concerns.
• Breast implants might get in the way of breastfeeding. Some people can successfully breastfeed after breast augmentation, but others can't.
• Insurance might not cover breast implants. Breast surgery that's done only to make breasts look different without a medical reason isn't covered by insurance. Be prepared to handle all expenses, including future surgeries and imaging tests, related to breast implants.
• You might need more surgery after breast implant removal. If implants need to be removed, you might need a breast lift or other surgery to adjust the way your breasts look.

What's the bottom line?

Based on your breasts, body type and other factors, your surgeon might recommend one type of implant over another for better results. But the choice between saline and silicone is up to you.