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Breast Implant options in 2021

Posted by Laurence Weider on August 3, 2021

Almost nine years ago I wrote two blogs about saline and silicone gel filled implants. As you can imagine, a few things have changed since then. So, I thought it would be a good idea to revisit the topic with the latest choices and information. 

Anyone who is considering breast augmentation surgery with implants will have to decide which implant to use. In the broadest terms, the choice comes down to saline filled or silicone gel filled implants. However, there are additional options within those two broad categories.

Currently in my practice in Dallas, the majority of women chose silicone gel implants, but a significant number opt for saline filled implants as well. I will try to highlight the unique features of each to help you decide. Of course, during your consultation at Weider Plastic Surgery, we will review these choices in addition to letting you hold and examine the different implant options that are available.

Let’s start with saline filled implants. Just like silicone gel filled implants, they have a silicone elastomer shell. The current generation of implants has a thicker shell than earlier generation implants.  The thicker shell makes them stronger, more durable and less susceptible to leakage.

Saline filled implants are filled with sterile salt water (saline). Because they are filled in the operating room, the surgeon is able to vary the amount of fill in each implant to correct small discrepancies in breast size. The silicone gel filled implants, on the other hand, are prefilled during the manufacturing process, so their fill volume cannot be adjusted.

Another key difference between the two types of implants is leakage detection.   While both types of implants have low leakage rates, the saline filled implants will deflate when they leak, typically making the leakage easy to detect for the patient and the surgeon. The saline is absorbed by the body and is harmless.  If a silicone implant leaks, it is likely that the patient won’t be aware of it.  This is because the gel will typically stay in the implant or in the pocket around the implant.

Because of this, the FDA has recommended that women with silicone gel filled implants undergo an MRI three years after surgery and every two years after that in order to detect asymptomatic (silent) implant leakage.  It is concern about a silicone leakage that could go undetected that many women site as the reason they chose saline implants instead of silicone gel filled implants.

Currently, there are two types of saline filled implants on the market. Allergan and Mentor make standard saline filled implants. They have a single lumen surrounded by an outer shell and one fill port. While price and easy leakage detection are advantages of the standard saline filled implants, the risk of rippling and unnatural feel are the main downsides.

Several years ago, the second type of saline-filled implant received FDA approval for breast implant surgery. These are called Ideal Implants. The Ideal implants have two lumens and multiple internal baffles. Their design allows for a more form stable implant than the standard saline implants.

The advantage to the patient is that Ideal Implants provide more of the shape and feel of a silicone gel-filled implant but without the risk of gel leak or a silent rupture. The downside to the Ideal Implants is that they are expensive, and they don’t feel quite as natural as silicone gel especially in someone with minimal breast tissue.

Unlike silicone gel-filled implants, leakage of an Ideal Implant should be detectable on examination.

 Silicone gel-filled implants have one large advantage over saline-filled implants which is that they feel more natural, and in some cases, look more natural than saline implants.  This is because the cohesive gel fill material more closely mimics the feel of breast tissue.

Cohesive means that the fill material is viscous.  It is more like a gel than a liquid.  While the cohesiveness of the silicone filler helps to provide a more natural feel, the significance of the fill material varies greatly from patient to patient.

Slender women who have minimal breast tissue will notice the most benefit from silicone gel-filled implants. In addition, some implant makers such as Allergan and Sientra offer more than one type of gel. They have softer implants that are less cohesive in addition to more cohesive (gummy bear-like) implants that are a bit firmer but hold their shape better. The gel fill that is best for you will depend upon your anatomy but also on your priorities. My staff and I will of course help you make the best choice for you.

Cost is another key factor that differentiates these two types of implants.  A pair of silicone implants cost about $1000 more than a pair of standard saline-filled implants.  The price difference reflects the additional cost charged by the implant manufacturers.

However, the silicone gel-filled implant also includes a much better warranty than the saline implants. It includes coverage for leakage and also for capsular contracture. It also includes a stipend to cover replacement costs.

Due to the many great choices, choosing the right implants can be confusing. However, my team and I at Weider Plastic Surgery are ready to help you make the best choice for you. Should you wish to discuss breast augmentation or any other procedure please call Weider Plastic Surgery today at (972) 566-8444.

Dr. Weider, a native of Southern California, is a Board-Certified Plastic Surgeon who has maintained a private practice in Dallas, TX since 1999. After attending Stanford University, he obtained his medical degree (M.D.) from Baylor College of Medicine in Houston. He then completed a one year surgical internship in Los Angeles at Harbor-UCLA Medical Center, followed by a four year general surgery residency in Dallas at Methodist Medical Center, and a two year plastic surgery fellowship in Cleveland at Case Western Reserve University.

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  • Dallas Society of plasctic surgeons

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