Saline vs. Silicone: New Twist on an Old Debate

The Myths Surrounding Silicone Implants

The popular perception is that silicone breast implants are always a better choice than those filled with saline. The foundation of this belief is twofold: that silicone implants feel better and look better than saline implants. While the former assertion is true in many cases, the latter is not. Both types yield the same aesthetic result (Figure 1). Furthermore, many women believe that breast augmentation with silicone implants is a once in a lifetime event, particularly those who have had them in place for a long time. This is far from true.

saline vs silicone new twist on an old debate 5f7c41906d140
Figure 1: One of these patients has saline
implants and the other has silicone. It is not
possible to tell which is which by appearance.

What are the Disadvantages of Silicone Implants?

The viscous nature of silicone gel causes two problems. First, rupture of old silicone implants is a silent event that is not detectable by physical examination alone. Second, unrecognized rupture eventually leads to capsular contracture. Capsular contracture causes hardening of the breasts and shape distortion. This is because the exposed silicone irritates the scar tissue surrounding the implant, causing it to thicken. Due to these issues, it is mandatory to obtain MRI breast scans at least every other year beginning five to seven years after surgery (recommendations vary). These scans are not typically covered by insurance. Moreover, few are diligent about following through as time goes on.

Why are Saline Implants a Good Option?

It has been my observation following decades of experience that saline results are very stable over the long term. They typically look just as good 20 years later as they do soon after surgery. Saline is bio-inert and rarely causes late capsular contracture. Furthermore, implant failure reveals itself on physical examination without the need for MRI scans. These devices are not perfect though, the chief objection being that they wrinkle far more than silicone gel implants (Figure 2). Additionally, early failure after only a few years can occur in 5%, presumably due to an unrecognized manufacturing defect.

saline vs silicone new twist on an old debate 5f7ae9ef3b1bd
Figure 2: (Top) The saline implant on the left looks virtually the same as the silicone implant
on the right when viewed flat, as if the patient is lying down.
saline vs silicone new twist on an old debate 5f7ae9f0084eb
Figure 2: (Bottom) Upright the saline implant exhibits more wrinkling but the silicone implant
also wrinkles. Fortunately these heavy wrinkles on the top of the implants are effectively
concealed by placing the implants under the pectoral muscles.

Silicone or Saline, Which to Choose?

Very thin women with scant breast tissue are the best candidates for silicone implants, as are postpartum women with thin, stretched tissues. Nulliparous women with more ample breast tissue to start with will be equally well served by either type. Older women seeking to minimize the need for future surgery, or those having a simultaneous breast lift and needing only a small implant, are good candidates for saline implants. Given our practice experience that saline implants commonly last twenty years or more, the choice boils down to best breast consistency (silicone) or the desire for maximum implant longevity with no need for MRI scans (saline). Baseline tissue volume and body habitus will otherwise favor one over the other.

Contact Us

Hours: 9am - 5pm

Monday - Friday

“Deep plane” has come to be more of a marketing term than an accurate descriptor of what facelift technique is all about. The SMAS layer is always tightened by facelift surgeons and mobilizing it by any technique means going under it, hence entering a “deep plane”. The trademark “deep plane lift” means lifting the skin and SMAS together as a unit and releasing all of the ligaments in the face to completely mobilize it. As this case illustrates, not everyone needs that. Moreover, not separating the skin and SMAS can cause bunching in front of the ear that requires a sideburn and temple scar to remedy the issue. Pure SMAS techniques separate skin and SMAS so that each can be moved in different directions to avoid skin bunching. Moreover, SMAS techniques offer a range of options from those that release “all” of the ligaments, just like the classic deep plane, to those that tighten the SMAS only where needed to just correct jowls, like this case.  SMAS techniques can therefore be tailored to individual anatomy whereas classic deep plane lifts apply the same solution to every patient. All of that said, surgeons have their own preferences and all of these techniques can produce great results. 

#face #lift

...

249 9
Upper eyelids are very straightforward. Lower eyelids, in contrast, are highly variable and often require a combination of procedures. These include fat removal, fat repositioning to soften circles (both done from an incision behind the eyelid), skin removal (outside incision), chemical peel for fine lines, and sometimes tightening the eyelid itself when droopy. In any event surgery takes about 2 hours and recovery is largely complete by 2 weeks.  Discomfort is minimal. 

#eyes #lift #fat #skin

...

728 6
Pleased to be included in the annual Newsweek national rankings of best plastic surgeons.  True validation that one can be an expert in more than one specialized area!  I have always believed that the technical aspects of different procedures are subordinate to a well developed aesthetic vision. 

#plasticsurgery #aestheticsurgery #newyorkcity

...

1581 54
Not mentioned is that the hip-to-hip scar is a trade-off for the procedure benefits. While prominent early on these scars keep improving. By 5 years they are often barely perceptible. Abdominoplasty is a big procedure for sure but has a high satisfaction rate. Revisions and “touch-ups” are rarely indicated. 

#abdomen #skin #muscle

...

184 6
Scroll to Top