Medically reviewed content from Don R. Revis, Jr., MD, FACS, double board-certified plastic surgeon

It’s one of the first decisions in planning a breast augmentation, and it shapes a lot of what follows — incision size, look and feel, and what happens if the implant is ever compromised. Here’s a straightforward comparison of saline and silicone implants.

How Saline and Silicone Implants Differ

Saline implants are inserted empty and filled with sterile saltwater once positioned in the body. Silicone gel implants arrive pre-filled from the manufacturer and are generally considered to feel and look more like natural breast tissue.

Look and Feel

Silicone gel is generally regarded as producing the most natural look and feel, since its consistency more closely mimics natural breast tissue. Saline implants tend to have a firmer, more rounded appearance and can feel less natural in patients with thinner tissue, though modern saline implants have narrowed this gap compared to older generations.

Incision Size and Insertion

Because saline implants are filled after placement, they can be inserted through a smaller incision. Silicone implants, arriving pre-filled, generally require a longer incision — though techniques like the Keller Funnel, a no-touch insertion device, have reduced the incision length typically needed for silicone placement.

What Happens If Each Type Ruptures

If a saline implant ruptures, the body simply absorbs the saline, and the breast visibly deflates within a day or two — making rupture obvious. Silicone rupture is often less noticeable, sometimes called a “silent rupture,” since the gel can remain contained within the surrounding scar capsule; this is part of why periodic imaging (MRI or ultrasound) is recommended for silicone implants to check for rupture that isn’t outwardly apparent.

Are Silicone Implants Safe?

Silicone gel implants were approved by the FDA in November 2006 after roughly 15 years of dedicated research, and have since been studied in more than a million women without an established link to disease. Modern cohesive silicone gel — sometimes called “gummy bear” gel — also holds its shape more predictably than earlier generations if the shell is compromised.

Implant Profiles Explained

Both saline and silicone implants come in different “profiles,” describing how far the implant projects forward relative to its base width:

• Moderate profile: widest base, least forward projection for a given volume
• Moderate plus: a step up in projection with a slightly narrower base
• High profile: narrower base, more forward projection
• Ultra high / extra profiles (silicone only in most lines): narrowest base, maximum projection

Which One Is Right for You?

There’s no universally “better” option — the right choice depends on your natural tissue, goals, and how you weigh factors like incision size against look and feel. Saline implants also allow for a saline volume that can be adjusted somewhat in the operating room, which can help fine-tune symmetry, while silicone implants above roughly 800cc aren’t generally available (saline implants can be filled beyond that where extra-large augmentation is the goal).

Frequently Asked Questions

Which implant type feels more natural?

Silicone gel is generally considered to feel more like natural breast tissue, particularly in patients with thinner tissue coverage.

Do silicone implants need to be replaced on a schedule?

Not on a fixed schedule, but periodic monitoring — sometimes via MRI or ultrasound — is recommended to check for silent rupture, since silicone implants don’t have a set expiration date but also don’t always show obvious signs if compromised.

Is it obvious if a saline implant ruptures?

Yes — the breast visibly deflates within a day or two as the body absorbs the saline, making rupture straightforward to identify.

Can I switch from saline to silicone (or vice versa) later?

Yes, this is a common part of revision surgery — implant exchange between saline and silicone, or to a different profile or size, can generally be done as part of a straightforward revision procedure.

Are textured implants still used?

Textured implants are used less frequently than in the past following specific safety reviews tied to certain macro-textured styles; smooth-shelled implants are the more common choice today.

Not sure which type fits your goals? Schedule a consultation to go through the options in detail.