Silicone or saline is usually the first choice people ask about, and it is a smaller difference than it sounds. Both implants have a silicone outer shell. What fills the shell decides how the implant feels, how a leak shows, and what checks you will need over the years.
Breast Augmentation NYC is a free referral service, not a clinic or medical practice. This article is general information; your surgeon will explain what suits you.
Saline implants
ASPS describes saline implants as a silicone shell filled with sterile salt water. If one leaks, the implant collapses and the body absorbs the saline, so a leak does not stay hidden. The FDA has approved saline implants for breast augmentation in women 18 and older.
Structured saline implants are a variation: saline with an inner structure inside the shell, which ASPS says is meant to give a more natural feel.
Silicone gel implants
Silicone gel implants are filled with silicone gel, which ASPS says feels closer to natural breast tissue. If one leaks, the gel may stay inside the shell or in the pocket around it. This is called a silent rupture, because you may not notice it. The FDA has approved silicone gel implants for breast augmentation in women 22 and older.
Form-stable implants, often nicknamed gummy bear implants, use a thicker, highly cohesive gel that holds its shape. ASPS notes that shaped versions can rotate and may need a longer incision. Cleveland Clinic says about 60% of implants placed in the U.S. are silicone gel.
Side by side
| Saline | Silicone gel | |
|---|---|---|
| What fills the shell | Sterile salt water | Silicone gel |
| Feel (ASPS) | Structured saline aims for a more natural feel | Closer to natural tissue |
| If it leaks | Collapses; the body absorbs the saline | Gel may stay in the shell or pocket: a silent rupture |
| Checks over time | Ask your surgeon | ASPS: MRI or ultrasound at 5 to 6 years, then every 2 to 3 years |
| FDA age for augmentation | 18 and older | 22 and older |
| Lifetime device? | No (FDA) | No (FDA) |
Screening for a silent rupture
Because a silicone leak can go unnoticed, screening is part of having silicone implants. The FDA says MRI is the most effective way to find a silent rupture, and ultrasound is an acceptable alternative for people without symptoms. ASPS suggests a first scan 5 to 6 years after surgery, then every 2 to 3 years. Ask the surgeon what they advise, and ask your insurer whether it pays for screening.
Smooth or textured: a separate choice
The surface of the shell is a separate choice from the fill. ASPS says smooth implants feel softer and may ripple, while textured implants are designed to stay in place. The surface matters for one specific risk: the FDA says BIA-ALCL, a T-cell lymphoma, “appears more often in patients with textured breast implants.” Ask which surface the surgeon suggests for you, and why.
What both have in common
Whichever you choose, the FDA’s warnings apply. Since October 27, 2021 every breast implant has carried a boxed warning, and your surgeon must go over a patient decision checklist with you, which you both sign. The FDA says: “Breast implants are not considered lifetime devices.” ASPS says implants are typically exchanged or removed about every 10 to 15 years.
Both also share the same list of surgical risks. ASPS names anesthesia risks, bleeding, fluid collection, changes in sensation, capsular contracture, leak or rupture, infection, persistent pain, poor scarring, wrinkling of the skin, an implant in the wrong position and the possible need for revision surgery. The FDA also says: “Symptoms such as fatigue, memory loss, rash, ‘brain fog,’ and joint pain may be associated with breast implants.” These are still being studied.
Or neither
If the idea of an implant is what gives you pause, fat transfer breast augmentation uses your own fat instead, for a smaller change. And if what bothers you is the position of the breasts rather than their size, read about a breast lift.
Questions to ask a surgeon
- Which fill do you suggest for me, and why?
- Which surface, smooth or textured, and why?
- What screening do you advise for silicone, and how often?
- Which maker’s implant do you use, and what warranty comes with it?
- How many more implant operations should I expect over my life?
Costs differ by implant as well as by office. The cost guide shows the national surgeon’s fee range and what a full quote should include, and how long breast implants last covers the years after.
This page gives general information, not medical advice. Only a surgeon who examines you can say whether an operation suits you and what it involves. In an emergency, call 911.
Questions people ask
Is silicone or saline better?
Neither is right for everyone. They differ in feel, in how a leak shows and in screening. A surgeon who examines you can say which suits you.
What happens if a saline implant leaks?
ASPS says it collapses and the body absorbs the saline.
How do I know if a silicone implant has ruptured?
You may not, which is why the FDA calls MRI the most effective way to find a silent rupture, with ultrasound an acceptable alternative.
How old do you have to be for silicone implants?
The FDA has approved silicone gel implants for breast augmentation in women 22 and older, and saline implants for women 18 and older.