Category Archives: Augmentation Types

Types of Breast Implants

Augmentation Types

Breast implants can either be filled with saline (salt water) or silicone gel (a synthetic material). All breast implants have an outer shell made of silicone. This shell can be “smooth” or “textured.”

Smooth Implants

Smooth implants feel softer and move more easily in the breast. They can be more prone to wrinkling or rippling than textured implants.

Textured Implants

Textured breast implants are less likely to move or become displaced.

Plastic surgeons prefer textured breast implants for reconstruction patients and some augmentation patients, because they believe they are less likely to move or become displaced.

Breast implants can cause Anaplastic Large Cell Lymphoma (ALCL), a rare cancer of the immune system. Most of the patients who developed this cancer had textured breast implants.  Nobody is certain about why, but it may be that textured implants make it easier for bacteria to grow. You can read more about breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) here.

In July 2019, the US Food and Drug Administration (FDA) requested that Allergan recall their Biocell textured breast implants and tissue expanders. The FDA made this request after concluding that the Biocell textured implants are six times as likely as other textured breast implants to cause BIA-ALCL.

This was just 7 months after these breast implants were taken off the European market.   In Europe, breast implants are allowed to be sold if one country provides what is called a CE mark. The CE mark does not require clinical trials and is based on a private company’s review of the product to ensure health, safety, and environmental protection standards are met. The CE mark for Allergan’s textured breast implants was suspended after the company failed to provide French health officials with requested data regarding the textured implants and their link to lymphoma. 1

Following the FDA request for a recall in July 2019, Allergan announced a worldwide recall of their Biocell textured breast implants and tissue expanders. See a full list of recalled models here. The FDA also published an updated safety notice, informing patients to communicate with their health-care professionals if they have any concerns or symptoms of BIA-ALCL.

The controversy about whether other types of textured breast implants should remain on the market has focused on what percentage of women with these implants will develop ALCL.  That is not known, because some women who developed ALCL did not know what brand of breast implants they had.  Other types of textured implants are still being sold in the United States, although the FDA recommends women with textured implants have routine check-ups with their doctors.

In December 2018, Allergan’s textured breast implants were taken off the European market. In Europe, breast implants are allowed to be sold if one country provides what is called a CE mark. The CE mark does not require clinical trials and is based on a private company’s review of the product to ensure health, safety, and environmental protection standards are met. The CE mark for Allergan’s textured breast implants was suspended after the company failed to provide French health officials with requested data regarding the textured implants and their link to lymphoma. 1 This means that, for now, Allergan textured implants cannot be manufactured or sold in Europe and that the textured implants at clinics are being recalled. Textured breast implants are known to increase the chances of developing a rare form of cancer of the immune system known as Breast Implant Associated Anaplastic Large Cell Lymphoma, or BIA-ALCL. The controversy about whether textured breast implants should remain on the market has focused on what percentage of women with these implants will develop ALCL. Despite the well-established increased risk of lymphoma, textured implants are still being sold in the United States, although the FDA recommends women with textured implants have routine check-ups with their doctors.

Saline Implants

Saline implants are made of a silicone envelope that’s filled with saline.

Here are reasons why some women prefer saline implants:

  • Saline implants usually deflate when they leak and the salt water is not usually dangerous.
  • There is no leaking silicone gel that can travel to the breast and other organs, such as the lungs and liver, and cause serious medical problems.
  • There is no need to undergo expensive, periodic MRIs to check for leakage.
  • They are cheaper than silicone implants.
  • There is usually a smaller scar with saline implants than with silicone gel implants because saline implants can be implanted when empty and filled after they are placed in the body.

Here are some common issues with saline implants:

  • Saline and silicone gel implants interfere with mammography.
  • Saline that leaks out of the implant could contain mold or bacteria, which can cause infections.  
  • Textured breast implants (saline- and silicone gel-filled) are linked to Anaplastic Large Cell Lymphoma (ALCL), a type of cancer of the immune system.
  • The silicone envelope surrounding the implant can break over time.
  • They may not look or feel like a natural breast:
    • They don’t feel as warm as the rest of the body in colder weather.
    • The saline solution can slosh within the implant, making audible noises.  
    • They can look round and stiff.
    • They can be heavier than silicone-filled implants and become displaced more easily.
Silicone Implants

Silicone implants are made of a silicone envelope that’s filled with silicone gel. Gummy bear implants are a type of silicone gel-filled implant. The gel in gummy bear implants is thicker than in traditional silicone implants, so they feel firmer. They are not safer than other silicone implants.

Here are reasons why some women prefer silicone implants:

  • They look and feel more natural than saline implants.
  • They weigh less than saline implants.

Here are some common issues with silicone implants:

  • Saline and silicone implants interfere with mammography.
  • Leaks aren’t obvious, so silicone gel can travel to other parts of your body for years before the leak is detected. Silicone gel can be impossible to remove once it travels to breast tissue or other organs, such as the lungs or liver.
  • Leaking silicone can cause pain, swelling, or numbness. It could cause allergic and/or autoimmune reactions.
  • Women with silicone gel implants need regular breast MRIs to check for silicone gel leaks. These are expensive (around $2000) and often aren’t covered by insurance. As of October 2020, FDA now recommends an MRI 5-6 years after the initial surgery and every 2-3 years after that.
  • Textured breast implants (silicone gel- and saline-filled) are linked to Anaplastic Large Cell Lymphoma (ALCL), a type of cancer of the immune system.
  • Silicone gel implants are pre-filled when inserted, so they require a larger incision and leave a bigger scar than saline implants.

All articles are reviewed and approved by Diana Zuckerman, PhD, and other senior staff.

Should I Get Silicone or Saline Implants? 

Augmentation Types, Have Questions?

All breast implants have risks. The most common is when the breast gets hard and painful, known as capsular contracture. Many women with implants have that problem after a few years, but it appears to be more common with silicone gel breast implants than saline implants.

Implant surgery usually costs between $5,000-8,000, including the implants and one follow-up visit. Silicone gel breast implants cost about $1,000 more than saline implants.

However, there are a lot of extra expenses that you need to be aware of.

For example, saline implants and silicone implants both have a high complication rate, and almost half the women will need additional surgery to fix implant problems within 3-4 years. Some problems are cosmetic and some problems are more serious, such as infections, allergic reactions, or auto-immune reactions. That additional surgery often costs $5,000 or more. That is why we suggest that women considering breast implants make sure they have at least $5,000 in their savings that they will save and not spend until they need it for their next implant surgery.

All breast implants will eventually break, but when saline implants rupture it is obvious (they deflate quickly) and when silicone gel breast implants break, there are often no symptoms at first. Having no symptoms might seem like an advantage, but it is actually dangerous because silicone can leak out of the tear in the implant, and get to parts of the body where surgeons can’t remove it. Leaking silicone can cause pain and allergic or auto-immune reactions. When it is removed, the breast may be deformed.

Because of concerns about leaking silicone, the FDA recommends having breast MRIs regularly to detect ruptures that have no symptoms.  When silicone breast implants were first approved, the FDA recommended that all women undergo a breast MRI 3 years after getting breast implants, and every other year after that. However, because of the expense and the reluctance of plastic surgeons to encourage MRIs for silent ruptures, very few women followed the FDA’s advice.  As of October 2020, FDA now recommends an MRI 5-6 years after the initial surgery and every 2-3 years after that. Unfortunately, breast MRIs cost about $2,000 each, sometimes more. That may seem very expensive, but it is the only accurate way to know if your implants are broken or leaking. If they are leaking, it is important to have them removed immediately.

Given the expense and the risks, why would any woman get silicone gel breast implants? There is one advantage: they feel more like a real breast. Saline implants may not feel as warm as the rest of the body in cold weather (A figure skater told us they were painfully cold!). And, women with saline implants sometimes say that they sometimes make swooshing water noises. Most plastic surgeons prefer silicone gel implants because they tend to look and feel more natural. However, many women tell us that does not make up for the added risks and added costs.

It is important to know that all breast implants – saline or silicone – can cause serious health problems. They can even cause a type of cancer of the immune system, known as anaplastic large cell lymphoma (ALCL).

The bottom line: all breast implants will eventually break or cause other complications that will require additional surgery. Some complications can be very serious. But some breast implants are safer than others, and since silicone gel breast implants are more likely to leak unnoticed as they get older, we believe that saline implants are safer.