Types of Breast Implants

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.