Silicone vs. Saline Implants for Breast Augmentation
A Clear, Science-Guided Guide Based on Research and Dr. Frew’s Approach
Both silicone implants and saline implants can create beautiful, natural results when the choice is matched to your anatomy and goals. Most people notice that silicone feels more like natural breast tissue, while saline offers a smaller incision and an easy-to-detect rupture.
Long-term success depends most on surgical planning, pocket control, implant position, and follow-up, not just the fill material.
What Dr. Frew Discusses With Every Patient
Before every breast augmentation, Dr. Frew takes time to explain how silicone and saline implants differ in feel, incision, and long-term care so patients can make an informed and confident decision.
Look and feel
- Silicone gel often feels softer and more tissue-like, especially in thin patients or with very low body fat.
- Saline can look excellent in the right pocket and plane. In patients with very little soft tissue, there may be a slightly higher chance of visible ripples, although good pocket support and under-the-muscle placement help minimize this.
Incision and placement
- Saline is filled after insertion, so the incision can be smaller.
- Silicone is pre-filled, so the incision is usually a little longer.
- Placement behind the muscle and precise pocket control help both look smooth and natural.
Follow-up and maintenance
- Silicone requires periodic imaging to check for silent rupture.
- Saline rupture is obvious as the breast deflates and the saltwater is absorbed by the body.
By understanding how each implant type behaves, looks, and ages, you and Dr. Frew can choose the option that best complements your body, lifestyle, and goals for natural, lasting results.
Breast Augmentation Before & After
The Factors That Matter More Than Fill
While the choice between silicone and saline matters, long-term success depends even more on surgical planning, precision and follow-up care.
- Pocket planning and support to keep the implant centered and smooth
- Plane selection behind the muscle for coverage when needed
- Size and profile that match your chest width and soft tissue
- Meticulous technique to reduce bacteria and lower contracture risk
- Follow-up to protect long-term results
This is where Dr. Frew spends the most time with you, so what you choose fits your anatomy, lifestyle and goals.
Silicone Implants: Who They Fit Best
Silicone implants are often the top choice for women who want the most natural look and feel, especially when their goal is soft, balanced, and long-lasting breast enhancement.
- You want the most natural feel, especially if you are thin or choosing a moderate size
- You are comfortable with periodic imaging to check implant integrity
- You prefer fewer chances of visible rippling in low-coverage areas when compared to saline in similar conditions
With Dr. Frew’s precise planning and technique, silicone implants can provide a smooth, natural contour that moves and feels like your own tissue while maintaining long-term integrity.
Pros
Soft, tissue-like feel. Often the most natural look with less visible rippling in thin patients. Wide range of cohesive gels and profiles.
Consider
Slightly larger incision. Routine imaging for silent rupture. Pocket control and soft-tissue support are still essential.
Saline Implants: Who They Fit Best
Saline implants are a good match when simplicity, smaller incisions, and straightforward monitoring are priorities.
- You want a smaller incision with fill after insertion
- You prefer a rupture that is obvious and easy to diagnose
- You have adequate tissue coverage or plan under-muscle placement and support
If you have adequate tissue or will use under-muscle support, saline can deliver a natural look with easy long-term peace of mind.
Pros
Smaller incision. Easy rupture detection without routine MRI. Flexible fine-tuning of fill volume intraoperatively.
Consider
A greater chance of visible rippling in very thin patients if pocket control and tissue coverage are limited, though research shows rippling rates can be similar when surgical variables are optimized.
Safety, Screening, and Longevity
Every breast implant requires thoughtful long-term care, and understanding how to monitor your results helps ensure safety and peace of mind.
- Silicone: ultrasound or MRI starting 5 to 6 years after surgery, then every 2 to 3 years, even if you feel fine. MRI is best for silent rupture.
- Saline: rupture is noticeable as the breast deflates. Replacement is straightforward.
- Surface choice: BIA-ALCL risk is associated mainly with textured implants. Smooth implants are most common for aesthetic augmentation in the U.S. today.
By following recommended screening guidelines and choosing modern smooth implants, most patients enjoy years of confidence and beautiful, healthy results.
Start Your Transformation
What The Research Says
Scientific studies continue to refine what we know about breast implants, helping patients and surgeons make choices that balance aesthetics, safety, and long-term satisfaction.
Capsular contracture
Contracture is the most common long-term implant complication. Recent analyses are mixed, and technique matters.
A 2025 meta-analysis found no significant overall difference in capsular contracture rates between silicone and saline across augmentation studies, while a 2024 reconstruction meta-analysis reported lower contracture odds with saline in that specific population.
Surgical factors and implant surface play major roles.
Rippling and “feel”
In a prospective series using exam, ultrasound, and patient surveys, visible rippling was reported in roughly one in five patients and palpable rippling in about one in three, with no significant difference between saline and silicone when controlling for placement and body habitus.
Lower BMI increased the chance of ripples regardless of fill.
Patient-reported satisfaction
BREAST-Q studies show high satisfaction after augmentation and reconstruction overall, with some reports of higher satisfaction for silicone in reconstruction cohorts.
Expectations, size selection, and soft-tissue coverage strongly influence satisfaction.
Rupture and surveillance
MRI or ultrasound screening is recommended for silicone implants starting at 5 to 6 years after placement and every 2 to 3 years after.
MRI is the most sensitive for silent rupture. Saline rupture is typically obvious clinically and easier to diagnose.
How Dr. Frew Personalizes Your Plan
Every breast augmentation at Balikian Plastic Surgery is approached as a collaboration. Dr. Frew combines detailed measurements, artistic judgment, and advanced planning to create results that feel natural and fit your body beautifully.
- Listen and measure: your goals, chest width, skin quality, and soft-tissue coverage
- Model and size: pick a range that fits your frame without overwhelming it
- Select the device: silicone or saline based on feel preferences, coverage, and follow-up comfort
- Choose the plane: often behind the muscle for coverage in thinner patients
- Protect the result: precise pocket control, gentle handling, and a clean technique to lower contracture risk
By focusing on precision, proportion, and comfort, Dr. Frew personalizes every step of your procedure to deliver results that enhance your confidence and reflect your unique shape.
Your Journey Begins Here
Breast Implant FAQs
Silicone or saline: which feels more natural in real life?
Most patients describe silicone gel as softer and more tissue-like, especially in thinner individuals. Saline can also look and feel very natural when pocket support, plane selection, and sizing are planned carefully with your anatomy.
How does Dr. Frew help me pick the right implant size and profile?
He measures chest width, skin quality, and soft-tissue coverage, then uses sizing and modeling to narrow choices that fit your frame. The goal is balanced proportions that match your lifestyle and long-term comfort.
Will I need imaging after silicone implants?
Yes. Current guidance recommends ultrasound or MRI beginning about 5 to 6 years after surgery and every 2 to 3 years afterward to screen for silent rupture. Saline rupture is usually obvious because the implant deflates.
Can breast implants affect future mammograms?
You can still have routine breast screening. Tell the imaging center you have implants so they can perform implant-displaced views. Dr. Frew can advise on optimal timing after surgery.
What really lowers the risk of capsular contracture?
Meticulous technique matters most. This includes careful pocket creation, minimizing bacterial contamination, precise implant handling, and matching implant size and plane to your tissue. Non-smoking, good aftercare, and follow-up also help.
Do silicone implants always need a larger incision than saline?
Silicone implants are pre-filled, so the incision is typically a bit longer. Saline implants are placed empty and filled once inside, so the incision can be smaller. In both cases, Dr. Frew hides incisions where they are least noticeable and closes them carefully.
I am very thin. How do we reduce visible rippling?
Dr. Frew prioritizes soft-tissue coverage, often places the implant behind the muscle, and selects a device and profile that fit your chest width. These steps help reduce rippling regardless of fill type.
How long do implants last and when might I need a replacement?
Implants are not lifetime devices. Many patients keep their implants for years, but changes can occur over time such as rupture, contracture, or shape changes. Regular checkups help decide if and when an update makes sense.
Will implants affect breastfeeding or nipple sensation?
Many patients breastfeed successfully after augmentation. Sensation typically returns as swelling subsides, although temporary changes can occur. Implant position, incision choice, and your natural anatomy all play a role and are planned with you.
How soon can I work out after surgery?
Most patients resume light walking within days, desk work within about a week, and gradually progress to full activity over several weeks. Upper-body lifting returns more slowly. Your plan is personalized to protect healing and shape.
What if I also want a lift or body contouring as part of a Mommy Makeover?
Dr. Frew can combine augmentation with a breast lift or body procedures when it is safe and in your best interest. He sequences surgeries and recovery so results look harmonious and the overall plan fits your life.
Elite Surgical Skill in Breast & Body Aesthetics
Dr. Tyler Frew is a board-certified plastic and reconstructive surgeon specializing in aesthetic surgery of the breast and body.
He is known for delivering natural-looking results through advanced techniques in breast enhancement, tummy tuck, liposuction, and mommy makeover procedures.
Dr. Frew combines surgical expertise with compassionate, patient-focused care, helping each individual restore confidence and achieve their personal aesthetic goals.
Learn More About the Art of Plastic Surgery
Richard V. Balikian, MD, FACS
Double Board-Certified Facial Plastic Surgeon
Balikian Facial Plastic Surgery: Richard V. Balikian, MD, FACS
Tyler Frew, MD
Board-Certified Plastic Surgeon
