saline vs. silicone vs. cohesive gel

Aug 09, 2012

Decisions, Decisions . . . Saline, Silicone or Cohesive Gel?

For some women, choosing breast implants is easy. For others, the choice isn't quite so clear. The look and feel of an implant, placement considerations and safety concerns are only a few the factors that will help you decide. Today, with new cohesive gel implants available, you have even more options to choose from. As you weigh the pros and cons of the three types of implants, you and your surgeon will talk about:

Incision size and implant placement: 

If you're concerned about visible incision lines, saline implants may be the best option. Because saline implants can be filled after insertion, the empty shell can be placed in the smallest of incision points. Saline implants are usually recommended for transaxillary (under-the-arm) or trans-umbilical (TUBA) placement. It may be easier to place a saline implant through a peri-areolar (around the outer edges of the nipple) incision if your nipples are small. With traditional silicone or cohesive gel "gummy bear" implants, the incision will need to be longer to accommodate a filled implant.

Texture and feel: 

Many plastic surgeons and their patients believe that silicone implants simply feel more like natural breasts. The weight, texture and cohesion of silicone gel are similar to breast tissue, while the sterile solution inside a saline implant feels more like its primary ingredient: water. The new cohesive gel silicone implants offer extra form stability for women seeking firm breasts that retain their shape.


Women who prefer a the look of rounded, "perky" breasts may prefer the appearance of saline, while women who want fuller, more voluptuous-looking breasts often prefer silicone or cohesive gel. Silicone implants tend to feel more supple and lie more naturally on the chest, while saline implants may give the breasts a more youthful profile.

Implant sizing: 

Because saline implants can be filled with sterile solution by your plastic surgeon, their size can be adjusted to suit your frame. Some saline implants can be expanded for up to 6 months after your original surgery.

Potential complications: 

Complications like contracture, rippling and rupture are more obvious with saline implants. Capsular contracture, or the hardening of the pocket around the implant, may be easier to see and feel with saline implants. Saline implants are also more likely to wrinkle after placement, giving the breasts a rippled or puckered look.

Risk of leakage: 

Either type of implant can break, but when a saline implant tears, the fluid leaks out quickly and is absorbed by your body's tissues. The gel in silicone implants—especially the new, form-stable gel products—seeps out of a damaged shell very slowly. After a saline implant breaks, you'll notice a sudden deflation, which leads to noticeably uneven breasts. If a silicone implant breaks, the cohesive gel will usually remain in the capsular pocket, and you may not see any immediate changes. The FDA recommends that women with silicone implants have regular MRI (magnetic resonance imaging) screening to check for these "silent" implant ruptures.


Choosing silicone implants over saline will raise the price of breast augmentation. Like the surgery itself, the cost of implants will vary from one plastic surgeon to another, but in general, silicone implants may increase your costs by several hundred to one thousand dollars or more. On the other hand, when you're making decisions that affect your body image, your satisfaction is the most important consideration.