Silicone or Saline: That is the Question!

As I have learned, recovery from FBC comes in stages (tsunami waves may be a more appropriate description for me). The next step on my FBC journey is surgery to exchange my expanders to implants. I’ve been avoiding this surgery for, well, as long as I possibly could. Now, however, it’s time to deal and deal again I/we will.

Why have I been in avoidance mode you ask?  Well I believe that it is related to the muscle memory developed from my double mastectomy and reconstruction during which I initially had non-existent pain management which extended my recovery and delayed starting chemotherapy. See what I mean about avoidance?

After doing a lot of research & talking with many doctors & surveying lots of women who have had this procedure done, I’m still feeling indecisive. Indecisiveness is not how I usually roll, which is making me a tad edgy. I think that the indecisive edginess goes right back to the aforementioned nasty muscle memory.  The bottom line is that I just don’t want to go through another surgery. However, as we say to our daughter a/k/a Sweetly Six, “It’s not a choice.”

The surgery is on February 21st and I need to decide whether to have saline implants or silicone (gummy) implants.

Below is some of the research that I have compiled to help me navigate this confusing maze.

Implants are named according to what fills them. In other words, saline implants are filled with saline (sterile saltwater), and silicone implants are filled with liquid silicone gel, which has the consistency of molasses.

Regardless of what breast implants are filled with, they all have a solid silicone shell. Solid silicone, or silastic, has been implanted in millions of people in pacemakers, artificial joints, heart valves, penile implants, and artificial lenses for the eye. Solid silicone is a very different substance than silicone gel, which fills silicone gel implants.

It is helpful for me to think of breast implants as being similar to balloons. A balloon may be filled with water, helium, or air, but has the same pliable plastic outer layer regardless of what is placed inside.

Silicone Gel Implants: Pros and Cons

The advantage of silicone gel implants is primarily aesthetic: they look and feel so soft and natural that they typically cannot be distinguished from breasts without implants. They also have a lower rate of rippling and wrinkling. Also, because silicone is lighter than saline, the risk of downward displacement due to gravity is lower. In other words, they don’t droop as much.

There are disadvantages of silicone gel breast implants. They impose a higher cost (by about $900- $1000) and a longer scar. The longer scar is necessary as silicone gel implants are pre-filled by the manufacturer, so they must be able to fit through the incision.  In general, larger implants require longer scars. This doesn’t really pertain to me because my scar is as big as it could get and I’m definitely NOT going with large implants (Silver Lining – sort of).

Also, the risk of capsular contracture ( an abnormal response of the immune system to foreign materials in the human body) may be slightly higher with silicone.

Finally, silicone gel implants might rupture “silently”, such that there is no outward evidence that a rupture has occurred. Physical exam by a plastic surgeon will identify only 30% of ruptures, whereas MRI will identify about 90% of ruptures, so women with silicone gel breast implants may have to get MRI scans. The FDA recommends routine MRIs for women with silicone breast implants, but this is not consistent with all plastic surgeons.

Gummy Bear Implants

The two main silicone gel implant manufacturers (Mentor & Allergan) tout that their silicone gel breast implants are made with cohesive silicone gel. Being cohesive, the gel supposedly has a tendency to stay together rather than disband in the event of a rupture. They have been likened to Gummy Bears, the soft candy that feels as though it is filled with liquid, but which has contents that do not run out if cut open.

There are varying degrees of cohesiveness in the silicone gel implants. Type I are the least cohesive and are used to make round silicone gel implants. Types II and III are referred to as Gummy Bear Implants and considered to be more cohesive meaning that they hold the shape into which they were molded. As such, they tend to feel more like natural breast tissue while offering great breast shape. Currently these implants are being tested across the United States in clinical studies. They are not yet widely available for use.

Saline Implants: Pros and Cons

A key advantage of saline breast implants is the filling itself. Very similar to natural body fluids, saline is easily and harmlessly absorbed by the body should an implant rupture. And since the implant deflates, it’s easy to tell when a rupture has occurred and replacement is needed.

Saline implants are filled after placement into the breast pocket. This generally provides the patient with a slightly smaller incision and scar compared with pre-filled implants. In addition, because the implants can be filled with different amounts of saline once placed, our surgeons are able to precisely tailor the size of each implant in an effort to avoid breast asymmetry.

Finally, the cost is lower (by about $900-$1000 per pair of implants), and there is no need for MRI, as silent rupture is not a concern. If a saline implant shell ruptures, the saline generally leaks out and is absorbed by the body within a day or so, resulting in an obviously smaller breast.

Disadvantages of saline implants are mainly cosmetic. Women are far more likely to report being unhappy with the way saline implants look, as they occasionally result in rippling and wrinkling. Some women believe this implant type does not feel like natural breast tissue, and occasionally patients complain of being able to hear “sloshing” of the solution inside the implant. A cosmetic as well as functional concern is increased saline implant deflation rates over time. Deflation requires surgical correction, though if deflation occurs, saline is harmlessly absorbed by the body and poses no health risk.

This is exactly how my expanders feel (& have felt since the original surgery). And the Silver Lining is that I’m completely used to it. Another Silver Lining to the “stiffness” is that I don’t have to wear a bra, which is awfully nice, I have to say.

Another disadvantage to large saline implants is that they have a higher rate of downward displacement than silicone, as they are simply heavier than their silicone counterparts. Now, I don’t know if I would have that issue since I’m not going for the large ones.  Hmmmm….

The Bottom Line

By all accounts, the best way to decide whether to have silicone or saline implants is to first decide which issue or issues are most important to you. For example, if it is most important to look and feel natural, then choose silicone. I have to say that it’s awfully interesting to contemplate feeling “natural” now. Is feeling “natural” possible after having both breasts removed and knowing that whatever I choose will be an unnatural material? Perplexing to me.

If you instead want lower cost, shorter scar, lower rate of capsular contracture, and no need for MRI, then choose saline.

I’m leaning toward saline based on the aforementioned as well as my plastic surgeon’s description of both: “total safety of saline filled implants versus a (maybe) more natural ‘feel’ of silicone gel.” If I have learned one thing during the past year, it’s that Murphy’s law is absolute with me, which is why I’m now heading toward saline.

For those of you in a similar position of having to choose, first of all, I’m sorry. FBC. Secondly, in addition to considering the advantages and disadvantages of both kinds of implants, it is also important to realize that the best plastic surgeon to advise you is the one who has access to BOTH the silicone gel and the gummy bear implant–making sure that he/she has no set allegience to either. It’s just one of those things that, unfortunately, you have to ask. Silver Lining: now you KNOW to ask it!

Now it’s time for some more Silver Linings:

  1. Writing this post (& articulating pros and cons of my options) helped me move forward in my decision-making process.
  2. This is the LAST surgical step for me.
  3. Though I will have general anesthesia for the surgery, I will not have to spend the night in the hospital.
  4. By all accounts, recovery from this surgery will not be as bad as the original surgery. YAH!
  5. Though I will have to suspend all workouts for 4-6 weeks, I’ll have more time to focus on writing!

I’d love to hear your thoughts, opinions and about your experiences!

Leave a comment


  1. michele says

    saline implants have been known to collect mold inside the implant. they are NOT harmless. they can cause as many if not MORE problems than silicone. they didn’t tell me this, I am having mine removed in 6 weeks. Google saline implants with mold and you will be astonished. no implants are “safer” than others.

  2. says

    Hi Ladies,
    So I am an odd case. I currently have silicone and am now opting to have them swapped out for saliine. Why? Because I have a larger frame (size 16) and the 800cc silicone’s (largest size they can shove in there) simply don’t look like ‘me’. I had to go under again anyway for nipple reconstruction and a slight adjustment to my left (radiated) side so I figured why the hell not?
    I can tell those of you that are in the midst of the decision that the silicone ones are fine. Nothing really to report on the negative side. Still a tad firmer than the real thing but truly not much and not heavy feeling at all.
    I will report back after 12/15 to let you know how the saline ones are vs silicone….it just occurred to me that now that I’ll be experiencing both I may be of some help.
    God bless and keep your smiles on!

    • silverpen says

      Dear Stacy,
      Thanks so much for writing. I’m wondering how you are and what your outcome has been.
      Please take good care!

  3. Kimberly McAteer says

    I am having a hard time trying to decide. Now I have about aspergillosis with saline implants….ruptures….more surgery….ugh the list goes on. I was so sick after my initial reconstruction surgery. I had a flap in one breast and an extender in the other. The expander ruptured and I got sick. Then I had another absess on the incision across my abdominal wall for the flap. Had antibiotics for over a month was just plain sick. This all happened this June through September. Now I have to get another expander in December, then my implant around Easter time. This has been an awful year. This was also the second time I had breast cancer. I am at a loss with choosing an implant. I just don’t know where to turn.

    • silverpen says

      Hi Kimberly,
      Sorry for the delay in getting back to you and all of the difficulties that you have had. Wow.
      I would highly recommend having a long conversation with both your Oncologist and your breast surgeon(s) to figure out – based on your history what is best for you.
      Please continue to breathe.
      Send my very best to you!

  4. stacy hughes says

    i’m so bummed these messages ended in 2012! i have to make my own saline v silicone decision today! i’ve been procrastinating!
    i’m leaning towards saline for all the same reasons, primarily the safety reason, but the esthetic appeal of the Gummies is appealing too! would love to know how you feel about the saline that i’m assuming you chose!

    • silverpen says

      Hi Stacy,
      Hmmm….I’m wondering how/why the messages ended. The main thing is how are you????? With regard to my decision, Gummies may be more aesthetic, but my saline are just fine and they provide me with mental peace. Hoping that you are well!
      I’ll re-add your email to the subscription list (that you’ll have to approve) to see if that helps. Thanks!!

  5. says

    Thanks for all your information. I have had the extenders in since March 5 2014. Trying to to decide, saline or silicone. I am leaning towards silicone.
    Don't want the weight or dimpling affect. Still at this point going back and fourth. I was very lucky in finding my breast cancer at stage 1. MRI did find it in the other breast. Also have not been in any pain through out this whole process. I am so thankfull and looking forward to the end.
    Thanks again an I wish you the best in your decision.

    • silverpen says

      Hi Judy,
      Thank you so much for your comment. The number 1 thing that I always say is: trust your intuition. Sending my very best wishes to you.

  6. says

    Hi Holly, I some how came across you and The Silver Pen, I had written it down, as I have many notes, I tend to forget quite alot since chemo, It will be a year since I got the bad news, but I am doing well, had my reconstructive surgery back in October, everything looks great, they still feel alittle strange, but I'm sure with time they will feel more normal, I am still getting Herception every three weeks till July, it is hard going back to the place where I had my chemo, brings up not such pleasant times, they want me now to get a port put in,they are having a hard time finding a vein,so I usually get poked about 6 times,very painful, I don't want a port , I don't want another procedure as well as something in my body that doesn't belong there, I have to make this decision soon, I just want to thank you for the Silver Pen, I can't wait ot get up and read it, gets my day off to a great start, you are very inspiring, thank you so much.I took your advise on getting the Santa Barbara Magazine, I live in LA and have relatives coming for a visit, I have spent alot of time in Santa Barbara but it's been awhile, I got some great ideas from the magazine. Thanks so much. Sandy Faulkner

    • says

      Thanks so much for your note & kind words, Sandy. I am deeply appreciative.
      Ohhhhh, getting 6 pokes to start your IV sounds pretty awful. To give you a little info & maybe perspective (should you want it!), here is one of my posts about getting a port a cath:
      It was a feasible procedure, though I completely understand NOT wanting anything else done!
      I'm glad that you liked the SB Magazine. I thought it was terrific myself.
      Please take good care and let me know how you do!
      All my best, Hollye

  7. April says

    I just wanted to let you know that I had my reconstuction in December and I had little to no pain.

    God Bless you!

  8. Carolyn says

    I have forwarded this entry to a friend who went through this decision last year. If she has anything to add that could help you in your decision, I know she will write. I love your blog and have so enjoyed following it. Thanks for all the positive energy! You are in my prayers. I will be visiting Santa Barbara in March and will be thinking of you while there.
    –A big fan

  9. Barbara says

    Hi Hollye,

    Lovely thoughts and words on your site. Isn't it true, we all go thru the same reasoning as we make such a difficult decision regarding implants. It was 20 years ago, I was just 37, very few women my age at that time had to make a decision like this…I chose saline and have never regretted it. I believe women should understand that they must pay for the MRI scans themselves, and over the years (I think every 3 to 5 years is the recommendation), this cost can add up.

    With either choice of implant, I suggest the most important thing is the acceptance and love for your new breasts. I think one can't underestimate these feelings in helping your breasts, and you, to heal. They are yours forever, and they represent a gift of life, really.


    • says

      Thanks so much for your comment, Barbara. So very insightful. I have decided to go with Saline and am feeling very comfortable with the decision. Thanks for reading the blog!

  10. Lisa Lechtenberg says

    Hi Hollye,
    Wow, just now came across your blog. Today is my 1 year anniversary of my bilat mastectomy. I am a stage 1, grade 3, clear lymph node survivor! I did 8 rounds of chemo and then started filling my expanders. They were the most awful things. I had 940 cc put in!! One side had scar tissue fromthe mastectomy which caused the expander to fill high. I looked like Arnold Schwarzenegger!! I was so scared that the implants would look and feel like those expanders. I too researched a lot and went with the silcone implants. I have had them for 2 months now and I LOVE them!! They look and feel real. (and my hubby says so too! 🙂 ) I can sleep on my stomach again! The surgery was took less than 2 hours…he had to do a little extra to release some of the scar tissue. I do the daily massages that are supposed to help prevent capsular contraction.. causing the implants to firm. I haven't decided if I'm going to do the nipple recon or not…still researching. Sometimes I wear a bra, sometimes I don't.
    My advice…go with your gut feeling…just as you probably did when you made the choice to have the mastectomy. Good Luck and Gods Blessings!!

    • says

      Thanks so very much for your kind and thoughtful note, Lisa. I sure do appreciate it! Congratulations on being one year out from your surgery! YAH! All my best wishes to you! Please stay in touch.

  11. Kerry Rose says

    Hi Hollye~
    I stumbled upon The Silver Pen last month while online and have SO enjoyed your writing and inspiration. I was diagnosed last summer, Stage 1 -lymph clear margins and had bilat mastectomy as well. I have had my expanders in since last June and I too am in the same position debating over Saline/Silicone. My gut tells me the safe route= Saline. My docs are really recommending silicone. Ive done a lot of research on it. Thank you for writing this post as it helped me sort things out again. I am also going in for surgery the last week in Feb….and am very nervous too! Just brings back all the memories of being diagnosed…my hubby supports me either way and isnt a boob guy either, just wants me to be happy 🙂 Great to hear from your readers that the surgery will be so much better than the first one! Thanks again for all your inspiration and words. I am so strong in my faith and its nice to read your entries and know Im not alone out there….take care 🙂

  12. Amy Wheeler says

    Do what your gut says. Everybody is different! Good luck! ps- I had NO pain with the swap. The expanders making way for the implants makes it much easier than with conventional boobjobs.

  13. Anne Lynn Jarman says

    Big Silver Lining: I read all the way through, as I do, silently saying "Hollye, choose saline, choose saline". And you did.
    I have been spared this dilemma so far, but my medical opinion is that Murphy's Law applies, and I know I don't want more anxiety and suffering for you in the event of a rupture or leak. Saline is the conservative choice, and in light of the recent French débâcle over implants, and they really do have the best medicine in the world, the conservative path is the way to go.
    I want nothing more for you for than Easy Street at this point. Best of luck with the surgery, let's hope this breaks your streak.

  14. Regan Ryan Hunt says

    I am so pleased with my silicone allergen 410s. My plastic surgeon filled them in with my own belly fat (40ccs on each side) using the liposuction/Pure Graft technique. The result is incredible – modest, natural to the sight and touch. Halleluyah that I have not worn a bra in over a year (yes even when I run). My scars are underneath my breasts so they are a non issue. My friend had saline and they collapsed within a month and she had to undergo yet another surgery to replace them with silicone. She is also thrilled with the result! Good Luck!

  15. Nancy Weltchek says

    Hi Hollye,
    Go with silicone! I got saline implants eight years ago because the silicone ones hadn't yet made their official re-debut back on the market. But in 7 or so years, when I need to change these things, I'm going for silicone. The rippling and totally abnormal feel is a turn-off. And the further out you get from the cancer thing, the more you care about having things be as "normal" as can be. Love to you, Nancy (Ann really enjoyed spending time with you in Mexico.)

  16. estee says

    I opted for saline implants for reconstruction after my bilateral mastectomies for all of the reasons you mention causing you to tilt toward saline. I also had another reason. In conversations about swapping out the tissue expanders for implants the implants are often referred to as your permanent implants. They are not however considered permanent. They have an expected lifespan and I was told by my plastic surgeon that silicone implants would need to be replaced within 15 yrs. My understanding is that the MRIs are required to monitor their integrity but they have to be replaced even if they have not failed. That's signing up for another surgery.

    The swap surgery was done using my existing scars and was much easier. I also went smaller. It has taken 1 1/2 yrs for my pecs to really get comfortable with the implants. The bit of sagging that has happened as the implants settle makes them actually look more natural to me as a nearly 60 yr old. My plastic surgeon slightly overfills implants after placing them during surgery to reduce the ripple issue. I can go bra less but often choose to wear a slightly supportive soft bra. I chose nipple construction and no tattoo.

    Another thing to consider in your choice is the current news regarding the bankruptcy of the implant company in France that is accused of using substandard materials in manufacturing silicone implants. Wishing you the best and thanks for your wonderful blog.

  17. says

    I, myself, am leaning toward saline implants . What I look like now, and feel like is becoming "normal" to me. I'm not worried about the wrinkles, and rippling that comes with saline. Who's going to see it? Me, maybe my husband. Thank god, he's not a "boob" man. lol. I just feel that saline would be a safer alternative for me. Thanks for listening.

    • says

      I'm feeling the same way, Patti. The HOTY is also not a "boob" man, which makes the decision so much easier because we are both all about "safety first!" Please let me know how you do.

  18. Jodi says

    Hi Hollye – love your blog! Just wanted to add my 2 cents to your post about saline vs. silicone. I went with Mentor silicone implants for my bilat recon – I'll celebrate (?) my 2nd "Mastectiversary" on Feb 24th, which is the day after 41st birthday. Quite a birthday in 2010 for me. I'm doing great post surgery / chemo – all good check ups so far (Dx: triple negative, stage 1a, clear margins, clear nodes).

    Anyway, back to the silicone implants. They're about the same size as I was before large B, small C. I think they're great! Comfy – check, no bra – check, feel real – check. Love them. They look great. Much more comfortable than the expanders (though I suppose anything might feel better than the expanders). The surgery to swap out the expanders with the implants was easy. So much easier than the bilat mast. I woke up and was like "Is that it? Did you guys do anything?" The incision from the implant surgery was maybe an inch or so smaller than my original mastectomy incision and they did send out the scar for pathology testing (clear). After the implant surgery I went ahead and had nipple recon (local flap on breasts) followed up with tattooing. I'm very happy with the overall result.

    The decision you make will be the right one for you – just listen to your little voice. Best wishes to you on your upcoming surgery…you're almost done!


    • says

      Thanks a million for your thoughtful comment, Jody. I really appreciate and and feel so much more confident after your description of the surgery. I really hope that I have the same comments when I wake up!
      Thanks for reading the blog!

  19. Sara Bennett says

    Loved your article about saline vs silicone. I am celebrating my 5 year anniversary in another month, and since I am still alive, am now pondering reconstruction. Good luck with your surgery.

  20. says

    I am a two-time breast cancer survivor..and I am also positive for BRCA1..GENE. My first surgery of many was a double masectomy and saline 2005. I have no regrets! 500 cc were put in . in 2007 it traveled to my lymph nodes… surgery…chemo …radiation.. Still the implants are fine.. many Ct..PetSCans>Mri 's during that time. After many doctors.. Sloan Kettering..Burzynski Clinic. in Houston, Tx I have made it 5years out on Dec 5th, 2012. My passion is to encourage others in the power of prayer and Alternative treatments ..during and after their treatments.. My husband and I have a Vitamin Doctor Wellness Center in Greensburg, Pa. were we detox patients through PEMF..ionic foot bathes..infared saunas.. coldlaser and whole body vibration therapy.. along with blood work for proper nutrients…this is so important..create a TEAM APPROACH!!!!! God bless You! Ovie Marshall

    • says

      Thanks so much, Ovie. I absolutely believe in the process of detoxing. I'm fascinated to learn more about PEMF, ionic foot baths and whole body vibration therapy. Thanks for sharing!

  21. denise morris says

    I am going through the same difficulty in choosing!I still have time to decide as im only starting my second round of chemo this week. However, my expanders are halfway full! I have just recently discovered your blog through a friend in Los Angeles and i look forward to it every morning!I am very happy for you that you are almost finished!hurray and cheers for you!!Sincerely,Denise Morris

    • says

      Thanks so much for your comment and for reading the blog, Denise. Welcome!
      I'll let you know how things go for me and hope that you will do the same. Please take good care!

  22. Patricia Harkness says

    I had silicone implants for years and loved them. However, after a bad fall on my left side right on my arm/breast area a few years ago; the implant separated from the muscle. It did not rupture, but you could put your hand between the breast tissue and implant. So, about 3 years ago, I had them redone. I wanted to be smaller (yes there are girls who don't want big boobs!) LOL….I chose silicone again and have never been disappointed. They have improved the silicone implants to the point, I think the chance of rupture is small and they are so soft and just seem normal. I wanted to be able to go without a bra, and now, I can.

    I hope to never have to go through the surgery again; but, if I did; I would choose silicone again. The scars fade in time, and after a few years are barely there. I think you will be happy with them.

    Regardless what you choose, you are in my prayers. I hate surgery also and know how stressful and painful it can be. I cannot imagine how hard it has been for you. May God go with you.


    • says

      Thank you so much for your comment, Patricia. I really appreciate it and am so glad to hear that you are doing well now. I also prefer smaller vs. bigger. Just seems like less to contend with. 🙂 Thanks again!