Pros, Cons and Protocols

Silicone or saline? Few women have the choice under current FDA rules that restrict the use of silicone-gel breast implants.

Silicone has a more natural look, feel and softness, but only a few women who have had mastectomies or others with damaged implants qualify under current protocols.

The alternative is saline-filled implants encased in a silicone shell, which some women complain produces a disconcerting swishy sensation.

Dr. Dennis Thompson, a Santa Monica plastic surgeon, prefers silicone for its texture and its positioning. It can be implanted behind the breast tissue on top of the muscle, whereas saline implants in most cases “need to be put behind the muscle to get the best visible result.”

Placement behind the muscle is more uncomfortable for the patient and can look more distorted when the muscle contracts, such as when a woman is lifting weights at her gym, he says.

When saline-filled implants leak and deflate, the patient knows it. When silicone leaks, breast fullness is maintained.

But when saline leaks, it’s absorbed and generally passes harmlessly through the body. If silicone leaks, it’s usually contained in the capsule of scar tissue the body forms around the implant. Sometimes, however, it can spread into breast tissue and other parts of the body.

Dr. Jon Perlman, a Beverly Hills plastic surgeon, said rippling and waviness in saline implants can be more visible in a small-breasted woman or in a woman with very thin breast tissue and thin skin resulting from pregnancy.

“For many women, that’s acceptable--to have the reassurance of knowing they don’t have a controversial substance in their body.”