The decision to undergo breast augmentation often involves a choice between the two primary types of implants available in the United States: saline and silicone gel. Both are medical devices approved by the Food and Drug Administration (FDA) and are used for both cosmetic enhancement and reconstructive procedures. While both options are generally considered safe and effective, they differ significantly in their internal composition, the surgical process required for insertion, and the long-term monitoring necessary for maintenance. Understanding these fundamental differences is important for determining the best choice for a patient’s personal goals and health profile.
Material Composition and Tactile Experience
The primary difference between the two implant types is the material used to fill the outer silicone shell. Saline implants are filled with a sterile saltwater solution, which is chemically similar to fluid found naturally in the body. This liquid-filled structure generally results in an implant that feels firmer and may be more prone to showing visible rippling or wrinkling beneath the skin, especially in patients with minimal natural breast tissue.
Silicone implants are filled with a cohesive silicone gel, often referred to as “gummy bear” implants because they hold their shape even if the outer shell is compromised. This gel is designed to mimic the consistency and movement of natural breast tissue, providing a softer, more natural feel. The gel’s cohesive nature and higher viscosity reduce the likelihood of the implant’s edges being visible or palpable, particularly in individuals with less existing breast tissue.
Surgical Procedure and Incision Size
The physical properties of the filling material directly influence the surgical technique and the size of the incision required. Saline implants are inserted into the body as empty silicone shells. Once positioned, the surgeon fills the shell with sterile saline solution through a small valve.
This filling method allows for a notably smaller incision, typically only 2 to 3 centimeters long, which can lead to less visible scarring. Silicone implants come pre-filled with cohesive gel and must be inserted in their final size and shape. This requires the surgeon to create a longer incision, often between 4 and 5 centimeters, to accommodate the device’s insertion.
Safety, Rupture, and Monitoring Requirements
Both types of implants have an expected lifespan, often requiring replacement within 10 to 20 years. The implications of a rupture differ greatly based on the filling material. If a saline implant ruptures, the sterile saltwater is harmlessly absorbed and expelled by the body. The deflation is immediate and visually obvious, allowing the patient to quickly recognize the failure.
Silicone implants present a different challenge because the highly cohesive gel often remains contained within the scar capsule that forms around the implant, resulting in a “silent rupture.” This type of rupture may not cause any noticeable change in the look or feel of the breast, meaning it can go undetected. Because of this risk, the FDA recommends routine monitoring for silicone implant recipients.
The FDA suggests that women with silicone implants undergo their first Magnetic Resonance Imaging (MRI) scan to check for silent rupture three years after the initial surgery, followed by a scan every two years thereafter. MRI remains the most effective method for detecting these asymptomatic ruptures, although ultrasound is a more accessible alternative. This long-term monitoring requirement is an important consideration for the patient’s ongoing maintenance costs and schedule.
Regulatory Eligibility and Age Restrictions
The FDA maintains distinct minimum age requirements for cosmetic breast augmentation, reflecting the differing safety and monitoring profiles of each implant type. For cosmetic enlargement, saline implants are approved for patients who are 18 years of age or older. The easier detection of a leak is one reason for this lower age restriction.
In contrast, silicone gel-filled breast implants are approved for cosmetic augmentation only for individuals who are 22 years of age or older. This higher age requirement is primarily due to the risk of silent rupture and the necessity for long-term monitoring. For breast reconstruction following a mastectomy or for correcting congenital deformities, both saline and silicone implants are approved for use at any age.