Board Certified Plastic Surgeon, David P. Rapaport, MD has over 20 years of experience working with both silicone breast implants and saline breast implants. The NYC plastic surgeon has been a participant in the FDA Adjunct Study, which permitted silicone breast augmentation under certain, limited circumstances. Since late 2006, when the FDA gave its approval for the use of Silicone Breast Implants for cosmetic augmentation in all women over the age of 22, Dr. Rapaport’s use of silicone implants has been consistently rising.

Saline and Silicone Breast Implant Tradeoffs

Dr. Rapaport understands that many potential patients will respond to the approval of silicone breast implants by believing that silicone must be a better product — both because it is “new”, and its arrival has been anticipated and praised by nearly all plastic surgeons. In fact, in the Board Certified Plastic Surgeon’s view, the issue is more complicated. As he explains, choosing the type of breast implant always involves trade-offs. These issues are discussed with each patient after she is examined in the doctor’s Manhattan, New York surgical facility.

In general, Dr. Rapaport recommends and uses saline breast implants in approximately 20-30% of his patients. As stated above, the choice of saline or silicone involves tradeoffs, and these are made on a patient by patient basis. The following generalizations may help a woman understand which implant may be best for her and what these tradeoffs are.

Now that the FDA has approved the use of silicone gel breast implants for breast augmentation on women (age 22 and over), many patients are again asking which type of breast implant is best for them.
Saline implants offer several advantages. Firstly, because they are filled after being placed into the body, they are rolled up when inserted and can therefore be inserted through a smaller scar. Dr. Rapaport, who has pioneered the underarm approach for endoscopic placement of breast implants without any breast scar, typically can place saline implants via a scar that is less than one inch long and located in a preexisting underarm crease. Because this short scar can be hidden in a crease in many cases, even early after surgery there is a sense of there being no visible scar at all. Many patients both young and old derive great satisfaction from this fact.

Another advantage of saline implants can be summed up with the phrase, “peace of mind.” While it is very clear, according to the FDA, that there is no cause and effect relationship between silicone and any disease outside of the breast, knowing that one’s breast implants are filled with sterile salt water doesn’t even require that convincing. When a saline implant ruptures, the sterile salt water is absorbed by the body and there need not be any concern regarding health risks. Furthermore, the replacement operation with saline is typically extremely straightforward, especially if the woman with a ruptured saline implant presents soon after the rupture for replacement. When a silicone implant ruptures, usually the scar tissue surrounding the implant must be removed with any silicone gel that is in the breast pocket, and this is commonly a much more involved operation. To complicate the equation further, saline implants actually rupture more frequently than silicone. Each patient will view this information differently as they make their choices.

For those who value a “natural feel” above everything else, then silicone is almost always going to be their choice. “A saline implant, when placed behind adequate breast tissue such as a B cup breast, can appear absolutely identical to a silicone implant,” says Dr. Rapaport. The feel is also virtually identical, and he says that having been examining both kinds of implants for over 20 years. The differences in feel in a woman with adequate fat and breast tissue are extremely subtle and would not be appreciated by most people. In fact, when he examines a woman with a good saline result, it is sometimes impossible for even him to know if she has saline or silicone. In general, he likens a silicone implant to the feeling of squeezing a down pillow and a saline implant to squeezing a foam pillow. They are both soft, but the saline bounces back more quickly. The problems with saline implants relate mainly to people who are thin and/or have little breast tissue, and in these cases one can feel the ripples of the implant more clearly and sometimes even can see ripples through the skin. It’s for this reason that most patients are recommended to have silicone implants. A final advantage of silicone is that even though a silicone rupture involves more complicated surgery, the actual incidence of rupture with silicone implants is far less than with saline.
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