Once you’ve weighed the pros and cons of breast augmentation and know you want to go forward with the procedure, you might think the decision-making is over. But breast augmentation is not a one-size-fits-all procedure. You will have a few more decisions to make along the way.

The Three F’s of Implants

One of the first sets of options you’ll have to weigh is whether you prefer silicone or saline filled implants. Both silicone implants and saline implants have flexible silicone shells. It’s what’s inside of the implants that varies.

Silicone implants are filled with silicone gel, while saline implants are filled with sterile saltwater. This filling is responsible for some key differences between the two implant types. Consider the Three F’s – Feel, Flexibility, and Follow-up – as you decide which implant is right for your specific circumstances:


Most people agree that gel-filled silicone implants feel more like a woman’s natural breasts than saline implants do. If you are starting out with more breast tissue, this difference won’t be so noticeable.

However, women who start off with smaller breasts might notice that saline implants don’t feel quite the same as their natural breasts. They may have a more “watery “ feel. They also have a little higher potential for developing visible rippling.


Silicone implants are already filled when inserted into the breast. This means the size is fixed and there is no way to adjust it.

Saline implants are inserted empty and then filled. This gives the surgeon some adjustability in the size of the implants. This can compensate for the natural differences in breast size that many women have.

This flexibility increases the risk that a saline implant will ripple or fold once inserted, resulting in an unpleasing appearance. Understanding the risks and benefits of these choices is key to getting the results you want.


Both types of implants have been known to rupture, but a rupture in a silicone implant might not be noticeable. This is because the silicone gel is “cohesive” and tends to cling together. As a result it often does not leak out of the implant unless there is a large tear. If it does leak, it usually remains contained in the scar tissue capsule that forms around the implant. This is what is known as a “silent rupture.” A leaking silicone implant is not dangerous to your health, but if identified the implant should be replaced.

Identifying a ruptured silicone implant by examination alone is difficult if not impossible. Often times an MRI is required to make the diagnosis. For this reason, the FDA recommends that women with silicone implants have an MRI every three years to check for leakage. This is only a recommendation and not a requirement. Insurance does not typically cover these MRIs. If there are no symptoms that might hint at a possible rupture (change in breast shape or new pain) then Dr. Slack does not push for an MRI unless a patient is worried about it.

If a saline implant ruptures, the water leaks out fairly quickly and the body absorbs it with no ill effects. In this case, the implant will deflate, causing a noticeable change in the size and shape of the breast within a day or two. Since this is easily noticeable, MRIs are not necessary to find leaks in saline implants.

Silicone Safety

In 1992, FDA investigated silicone implants because of increasing safety concerns. They concluded that there was inadequate data to assess the safety of silicone implants, and restricted their use to certain circumstances.

However, time and research demonstrated that there was no association between silicone implants and the health problems that prompted their restricted use. In 2006, the FDA approved the use of silicone implants for the general public once again.

This does not mean that silicone implants are free of risk. As the FDA explains, it simply means “the benefits and risks of breast implants are sufficiently well understood for women to make informed decisions about their use.”

If you are concerned about the safety of silicone implants or any aspect of breast augmentation, it is best to have a discussion with your surgeon about the risks you might face as a result of the surgery.

The most important thing to remember as you make the decisions about your breast augmentation is that you are unique. Your choices should reflect what is best for you and your particular circumstances.

Dr. Slack is available to help you sort through all of your options. Schedule a consultation today to discuss saline, silicone, and any other questions you might have about breast augmentation.