Breast Blog
Saline vs Silicone Breast Implants
There’s an opinion asserted by breast implant manufacturers and by many plastic surgeons that silicone gel breast implants are better than saline breast implants.
In my opinion, “It ain’t necessarily so.”
I’ve performed more than 7,000 breast augmentation surgeries, many of them with saline implants. My patients who chose saline have reported a high degree of satisfaction; it’s been rare for a woman to request that I change her saline implants to silicone.
Silicone gel implants may be stealing the spotlight, but saline breast implants still have much to offer. Here are seven reasons why:
A Natural Feel and Appearance
When you hold a saline implant in one hand and a silicone gel implant in the other, the silicone gel implant feels softer, but that’s not where breast implants will be! When I place breast implants behind the muscle, saline and silicone implants feel the same. In slender women who have very thin skin, less breast tissue, and little or no muscle coverage around the side and underneath their breasts, there’s a higher chance that either implant can be felt in these locations.
The evidence isn’t all anecdotal. Using ultrasound scans and patient outcome surveys, Dr. Eric Swanson compared saline and silicone gel implants placed behind the pectoral (chest) muscle and discovered that the rippling seen in both implants is similar. He also reported that there was no statistically significant difference for each group of women in feeling the rippling. His findings are published in Plastic and Reconstructive Surgery (June 4, 2020).
Availability
Silicone gel implants are recommended by the FDA and the manufacturers for women 22 and older. Saline implants are available to women ages 18 and up. Although the majority of my patients fall in the latter range, young women who have not developed often tell me that they feel self-conscious when they are on the beach and that they can’t find clothing or swimsuits that fit. They don’t want to wait several years for surgery.
Incision Size
A saline implant, which comes empty, can be folded and placed through a smaller incision. It’s filled after placement. A silicone gel implant comes prefilled and therefore requires a larger incision.
Implant Size
There is a limit to how large an implant can fit behind the chest muscle, and it’s dependent on the width of each breast. A saline implant acts as a tissue expander, which means a woman can sometimes get a slightly larger size than she could with a silicone gel implant. Read: “How to Choose Your Breast Implant Size.”
Correction of Tuberous Breast Deformity
Saline implants, which are inserted empty and then filled, can expand and correct a constricted breast in a one-stage procedure. Silicone implants, which are prefilled, cannot. My surgical approach to correcting TBD has recently been published online in the American Journal of Cosmetic Surgery.
Implant Rupture
When a saline implant shell breaks, the body safely absorbs the saline (salt water) and it’s urinated out. The breast returns to its original size. In Dr. Eisenberg’s experience, the saline deflation rate at 8 years is less than 2%. Read my recent article on this topic, which appeared in the international Aesthetic Plastic Surgery journal.
When a silicone gel implant ruptures, the cohesive gel inside sticks together. Women might not notice a change in breast size. In 2020, implant manufacturers Allergan and Sientra reported a 10-year silicone rupture rate of ≈10%, while Mentor Corporation reported its 10-year rate at approximately 24%, of which 75% were silent. To check silicone gel implants for rupture, the FDA and manufacturers currently recommend that you get an MRI 3 years after surgery and every 2 years thereafter. This might not be covered by health insurance.
Cost
Silicone gel implants cost about $1000 more per pair than saline implants.
When you are choosing your breasts implants, consider all the facts. Although silicone implants get most of the attention, saline implants produce an equally aesthetic result.
In the September 2022 issue of the Aesthetic Plastic Surgery journal, Dr. Eisenberg details the advantages that saline implants offer to both the patient and the surgeon. Read “The Underappreciated Saline Breast Implant” here.
What to Expect After Breast Implant Surgery
What Happens After A Breast Augmentation FAQ’s
When I call my breast augmentation patients the day after surgery or examine them at their first post-op visit, they want to know one thing: Is this normal?
They phrase that question in many different ways:
Is it normal for my implants to be so high?
When will my implants drop and fluff?
Will my implants soften up and squish together?
Is it okay that one of my breasts is up higher than the other?
Is it too soon to be judging my final shape and size?
Did you give me the implant size I asked for?
My answer to all of the above: Yes!
At this point in your breast augmentation recovery, it’s way too soon to be evaluating breast implant size and position. When breast implants are placed beneath the pectoral muscle, the muscle 
presses the implant flat (like your hand could compress a sponge ball or a balloon) and the implant needs a place to go.
The implant’s space is limited on three sides – by the breastbone, the outside edges and the bottom of the breast – so it moves toward the area of least resistance: the collarbone and the armpit. That’s why your breasts are up “so high.”
One breast often heals at a different rate from the other, and one side might feel harder and be pressed up higher than the other.
Breast implants need time to “drop and fluff.” The term refers to what happens to your implants as your skin stretches and your muscles relax. The implants move downward and outward sloooowly – about 1 percent a day. Watching their progress is like watching your hair grow. You don’t see a difference in your hair growth daily, but all of a sudden you need a haircut. Watch our “drop and fluff” video.
It’ll be about six weeks before your breast implants even begin to settle down and take on a more natural shape. Your breasts will be close to 80 percent settled and softened at three months.
It’s best to wait at least eight weeks before making a major investment in new bras. It takes that long for your augmented breasts to begin to settle 
into their new size and shape. At that time, you will be able to more accurately determine your postoperative size and get a truer fit.
Read our blog: “What to Expect the First Week After Cosmetic Breast Surgery.”
Be patient after surgery. Think of it like those road signs you sometimes see: “Temporary inconvenience; permanent improvement.” Give yourself a few months to see the final result. The permanent improvement will be worth the wait! Till then, here are some comments from breast augmentation patients who have completed the journey:
- “I used to hate lingerie and bathing suit shopping. Now I love it. In fact, all my old bathing suits looked brand new this summer.”
- “I love my new figure. It is so nice to not have to worry about padding my bra anymore.”
- “Now I can wear anything I want and feel comfortable, sexy and once again confident.”
- “I look as good underneath my clothes as I do in them.”
- “Friends know something is different about me but they can’t pinpoint what it is. They say things like, ‘You look great. Are you just back from vacation?’ or ‘That’s a cute outfit. Is it new?’ I like to keep them guessing.”
How to Choose Your Breast Implant Size
Through the years, Dr. Ted Eisenberg has answered hundreds of questions from women who have come into his office for a breast augmentation consultation. He has also answered more than 3,000 questions about breast implants on RealSelf, an online cosmetic surgery forum.
Although women ask it in many different ways, their most burning question before surgery boils down to this: How do I know what size breast implants to get? In his own words, here’s how Dr. Eisenberg, who holds the Guinness World Record for most breast augmentations performed, answers:
Breast Implant Size FAQs
A sampling of their questions:
What size implants would look best? I’m 5-foot tall and 103 pounds.
What size should I get if I want to look proportional?
Would a 32 or 34 C cup fit my body but still make me look natural?
What size implants do you suggest for a full D cup?
My girlfriend got 375 cc implants. Can I get that size, too?
My answer to all of the above? It depends.
In order to choose breast implants that will achieve the look you want, you need to know your true starting size, which includes 
your height and weight, frame (small, medium or large-boned), breast diameter and skin elasticity. Read our blog: “Can You Make Me a Full C Cup?”
Most women think that being proportional means wearing a C cup bra. By and large (pun intended), they tell me that they want to be “a full C cup.” But a C cup can mean one thing if it’s made by Victoria’s Secret and another if it’s made by Vanity Fair. There is no standard bra cup sizing system. Breast implants are measured in cubic centimeters (ccs), not cup size.
You can’t compare yourself to a girlfriend or to women who you see online. You need to compare apples to apples, so to speak. If you’re starting with a full B cup and another woman started with a mid-A, you won’t end up the same size when you both get 375 cc implants. You’ll be about one cup-size bigger – the extra cup you started with. Watch our “Can You Make Me a Full C Cup? video.
To figure out which breast implants are right for you, you need to have an in-person consultation with a plastic surgeon. Here’s what happens when you come into my office: After I measure you and we discuss your goals, we look at before-and-after photographs of women who started out similar to you in height, weight, frame size and breast volume. Every photo notes the size of the implants that were used. It’s like you are looking through a magic mirror into the future. You get to vote on the breast sizes you see and tell me: “too big,” “too small” or “just right.”
In my experience, women are consistent with their votes. They know what breast size they want, and I know what size implants will achieve their goal.
Before women leave the office, I tell them to consider that they are the expert on what size is right for them. They should cover their eyes and ears and disregard other people’s well-meaning advice. They shouldn’t let their girlfriends and Internet forums confuse them.
Part II: What’s the No. 1 question women ask the first week after their breast augmentation? Read “Is This Normal?”
What to Expect First Week After a Breast Lift
“From small beginnings come great things.” – author unknown
From resting and eating to lifting and love-making, here’s what you can expect – and do – from the first day after your breast augmentation or breast lift surgery to your first post-op visit one week later. Top tip: Listen to your body.
RECOVERING
How will you feel after getting breast implants? Women most often describe the feeling as discomfort, not pain. Those who have had children say they feel like they did when their breasts were fully engorged with milk after childbirth. Women who haven’t had kids describe the feeling as tightness, burning or pressure. After breast lift surgery, patients report to us that they have minimal discomfort. That’s because a breast lift involves removing only loose, stretched skin. Post-op discomfort usually starts to ease up on the fourth day after surgery. Until then, you can take the medications that are prescribed to make you comfortable during the recovery period.
RESTING
You’ll be home the same day after your surgery, and you need time to rest and heal. That doesn’t mean
you have to stay in bed, but you should take it easy for one week. Listen to your body and my instructions – not to the voice in your head that tells you the living room needs vacuuming. If you need an excuse note from chores, I’d be happy to write one for you!
♥ “I was so scared of having extreme pain and I only had a little discomfort. It’s just been 8 days and I feel great, sexy and beautiful.” ♥
EATING
Although patients very rarely report nausea and vomiting after their surgery, it’s best to start off with clear soups the first evening. Although it might be tempting to order a pizza, avoid fast foods the first day. By lunchtime the day after surgery, you can eat whatever you want – even a big meal.
Read more: Is this normal? When will my breasts drop and fluff?
DRESSING
Generally, my breast augmentation patients wear a sports bra day and night the first week after surgery, except for when they take a shower. The band at the bottom of the bra helps to re-establish the crease under the breast. Breast lift patients may have to wear a bra for a longer period of time; everyone gets individualized instructions to maximize their results.
♥ “The recovery was way faster then I thought.” ♥
SLEEPING
You don’t have to sleep on your back or sit up all night after cosmetic breast surgery. You can sleep any way you want from the night of surgery on, including on your stomach, if you are comfortable enough. You won’t pop or displace your implants by sleeping on them; they are extremely durable. [WATCH OUR VIDEO: Do I Have to Sleep on My Back?]
WASHING
You can take a shower the day after surgery, but you should wait until the third week to take a bath. If you soak in a tub, the water could penetrate the incision and cause an infection. By contrast, the shower water runs off the incision and doesn’t soak into it.
♥ “I went home shortly after surgery, had absolutely no nausea (ever!) and ate dinner regularly. The next day I was up and walking around, even left the house to get a mani pedi. The recovery has been incredibly easy.” ♥
DRIVING
Anesthesia stays in your system for at least 24 hours after surgery, which means you’ll be a little groggy. You might also be taking medication for discomfort the first few days. If you aren’t taking any narcotics, you can probably drive as early as Day 3.
LIFTING
For the first few days, you will need to depend on someone else to lift your baby or toddler. On the third day (if you had surgery on Monday, Day 3 is Thursday), you can pick up your child to transfer them to a crib, high chair or car seat. This rule is to ensure your comfort and minimize the risk of bleeding around the implants. You should not carry your child for extended periods until a couple of weeks after surgery
LOVE-MAKING
No sex for a full week. Sexual activity could raise your blood pressure and cause bleeding around the implants. At the first postoperative visit, I’ll examine you to make sure you are healing well – before I give you the go-ahead.
♥ “My recovery was smooth with very little discomfort.” ♥
WORKING
More than 90 percent of my patients are back to work in office setting by the fifth day after surgery. Patients who use their arms a lot – including hairstylists, waitresses and nurses – are comfortably back to work by the end of the second week.
Can I Get a Breast Lift With Implants?
Yes! While some doctors prefer to do two separate operations – the breast lift first followed a few months later by the breast augmentation – Dr. Ted Eisenberg performs both procedures at the same time. It’s called a simultaneous augmentation mastopexy. He uses his groundbreaking I.D.E.A.L. Breast Lift technique, which has simplified this challenging procedure. He teaches his technique to doctors from around the world. Having one surgery rather than two reduces the time that you are under anesthesia. It is a safe operation that takes about 3-1/2 hours.
In 2010, Dr. Eisenberg was interviewed for an article in New You magazine about the technique he created, which he also uses for breast lift surgery. Below is an excerpt.
Perk Up: Pregnancy, Weight Loss and Aging Can Get the ‘Girls’ Down, But Breast Lift Surgery Can Restore Their Joie de Vivre
By Rochelle Nataloni
For 26-year-old Rachael L. (not her real name), breast lift surgery came to the rescue following a weight loss that left her with breasts that didn’t suit her otherwise fit and youthful body. “I had lost some weight that I had put on in college, and I wanted to be perkier again,” explains Rachael, who considered a breast lift (or mastopexy) for a little over a year before deciding to move forward with the procedure.
Rachael opted to have the surgery performed by Dr. Ted Eisenberg, a board certified plastic surgeon whose name is synonymous with cosmetic breast surgery in Philadelphia and the surrounding Delaware Valley. Watch one woman’s video blog of her experience before, during and after her breast lift surgery.
Dr. Eisenberg’s practice is dedicated entirely to cosmetic breast surgery; he’s performed over 7,000 breast surgeries including lifts, 
augmentations, and a combination of the two. Because he focuses exclusively on breasts, he’s developed improvements to the conventional breast lift technique. [WATCH OUR VIDEO: Do I Need a Lift?]
The traditional plastic surgery approach is to remove the excess skin on one side and tack it back together to see how it looks. Surgeons repeat the process on the other side and compare. If the breasts aren’t even, they go back and forth and back and forth, trimming skin until they get it right.
“After years of using this approach, I had an ‘aha moment’ and thought: What if I tacked the skin together first?” Dr. Eisenberg explained.
His innovation, which he calls “previsualization,” relies on the use of surgical staples to temporarily fasten or “tailor tack” the breasts into their new higher position, enabling him to see exactly how they’ll will look before he makes a single incision.
“With this technique, I know precisely how much skin needs to be removed. It takes the guesswork out of the procedure,” he says, adding, “The staple-first technique exemplifies the expression: Measure twice, cut once.”
During this breast lift procedure, Dr. Eisenberg makes an incision around the nipple-areola, vertically down and then along the underside of the breasts. The stretched skin is removed, the nipple/areola is lifted, and dissolvable stitches are placed to hold the breasts in their new perky position.
“The I.D.E.A.L. Breast Lift increases precision for the surgeon and offers significant benefits for the patient, as well,” explains Dr. Eisenberg, who had taught his approach to doctors from around the world.
“It cuts down on anesthesia time because I don’t have to go back and forth readjusting the amount of tissue that needs to be removed. It also creates the maximum amount of symmetry and lift in the shortest period of time.”
The approach is especially beneficial for women who have a moderate to severe degree of droopiness. They can achieve good results regardless of their breast size or the difference in size of their breasts.
Stellar surgical technique is necessary for a successful outcome, but Dr. Eisenberg points out that the consultation is perhaps equally critical. “I always ask a patient to tell me how she feels when she looks at herself in the mirror in her bra. If she likes the way her breasts fill out her bra, then a lift is the right procedure, but if she wishes she had more volume, I can add an implant and do a combination augmentation lift with saline or silicone gel breast implants,” he explains.
During consultation, Dr. Eisenberg explains that significant weight gain and/or pregnancy are the main factors that can affect the newly lifted breasts and could possibly cause them to droop again. Read “7 Things to Consider Before Breast Lift Surgery.”
“Many women who are planning to have children sooner than later wait to have the surgery until after giving birth,” said Rachael. “But since I’m a long way off from that stage of my life, I decided to get it done now and enjoy the results.”
Women who consider the procedure often worry about the loss of nipple sensation or their ability to breastfeed in the future. Scarring is a concern as well. Dr. Eisenberg explains that while not all women are capable of breastfeeding, the surgery may not impact their ability one way or the other. As far as sensation, Rachael says, “I have all the sensation after surgery that I had before.”
“Dr. Eisenberg told me that the degree of scarring varies from person to person, but that most women heal nicely. I’ll always have some signs of the breast lift when I’m naked, but for me it’s minimal and worth it considering the great results,” Rachael said.
To read more: I Used to Have Perky Breasts: What Happened?
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