Saline or silicone?
Most plastic surgeons have a distinct preference, but like with most decisions, there are advantages and disadvantages with each choice. Surgeons who use primarily one type of implant will tout its advantages and describe the deficits of the other, but rarely will you get a balanced view.
Changes in breast implants over time
Silicone implants have improved dramatically over the past 30 years. They have been studied extensively to ensure that they are safe for patients. They feel quite natural, and are less likely to wrinkle than saline implants. There are some disadvantages as well. Silicone implants come pre-filled, and therefore are not adjustable as are saline implants. Many radiologists recommend MRI scans rather than mammograms, which can be expensive, since insurance coverage of these scans is not likely. Also, while a silicon implant definitely “feels” more natural than a saline implant when sitting side-by-side on a table, when implanted under the chest muscle in most women, the difference is negligible.
Safety of breast implants
Saline implants are very safe. If a leak ever occurs, the body simply absorbs the saline. The manufacturers all offer a lifetime warranty and will replace the implant in the event of a failure. Saline implants are adjustable in the operating room, allowing for the surgeon to provide better symmetry and a higher chance of giving the patient the size she requested. Unless the patient is quite thin, rippling is almost never an issue. And for thin patients there is an alternative saline implant that can solve this problem. Finally, since the implant is placed under the muscle, it is breast that is visible and palpable, not implant. The implant (whether saline or silicone) is merely pushing the breast forward.
Feel free to discuss the pros and cons of each type of implant with your surgeon to determine which is best for you.