American Society of Plastic Surgeons
For Medical Professionals
5 years ago

Breast reconstruction, gel versus saline

I would like to know your opinion regarding cohesive gel versus saline implants after tissue expanders are removed . They are posterior to the pectoralis muscle. My pre bilateral mastectomy implants were silicone meme textured implants. I am considering rippling, natural feel/look and of course systemic health. Thank you Kelli

Procedure: Breast Augmentation
Location: Colorado Springs, CO

Replies 8

Debra Johnson
ASPS Surgeon

After mastectomy, most women have little subcutaneous tissue to camouflage the feel of an implant. Saline implants tend to show more rippling in the upper breast, and scalloping on the outer aspect where there is less muscle coverage. For that reason, many patients prefer silicone. There are both cohesive gel and highly cohesive gel implants. Highly cohesive gel implants have the least rippling, but are a little sturdier feeling. Another option to consider if you want to avoid silicone is the baffled saline implant called Ideal. This implant has two saline chambers with internal walls in each chamber. This construction allows the implant to hold its shape better. There is less rippling and more of a silicone-like feel. The advantage of saline implants is that, in case of a failure, the replacement is a relatively easy swap-out, whereas a failure in a silicone implant requires capsulectomy which is a bigger operation.

Steven Wallach
ASPS Surgeon
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Silicone gel implants are an excellent alternative to the implants that you had. If your tissues are thin I would recommend keeping them behind the muscle and perhaps also using an ADM to provide a thicker soft tissue coverage. You may also require fat injection as well to minimize the visibility of the implants.

Daniel Allan

The current recommendations from the FDA and the implant manufacturers are that a woman who has gel implants should have a breast MRI three years after surgery (whether for reconstruction or cosmetic augmentation) and every two years thereafter, because an implant leak may be silent. With saline implants, no such monitoring is necessary because the saline is harmless and in the event of a leak, the body will absorb it and you will just urinate it away. You will also be quickly aware that you have a leak. Placement behind the pectoralis will give you excellent coverage of the upper half to two-thirds of the implant. Whether you would benefit from any other measures depends on the thickness of the mastectomy flaps.

Nelson Castillo

Thank you for sharing your excellent question. For all the concerns you listed I do believe that cohesive gel implants offer superior results to saline and should be used in reconstructive patients. Hope this helps.

Edward Domanskis

Silicone implants are definitely superior in feel, appearance and don't deflate. The incidence of capsular contracture in my practice is about same with either saline or silicone. I would recommend staying away from textured implants for their is an association with lymphomas. My feeling is that saline is a thing of the past!

Dr. Edward Jonas Domanskis is Certified by the American Board of Plastic Surgery

Newport Beach, San Francisco,Miami, EU, Anguilla

Assistant Clinical Professor of SurgeryWOS-Plastic,University of California (Irvine)

Orange County’s Physician of Excellence/America’s Top Physicians/Top Doctors

Plastic Surgery- 2005-2018

President,American Society of Bariatric Plastic Surgeons

Organoderm Skin care/ScaRxTape

Jon Ver Halen

Hello and thank you for your excellent question. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. In general, results with gel implants are more natural than saline, but this is a personal choice that only you can make. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. If you have any questions, call our office for assistance. Good luck!

Akeber Nacira Ibanez Okamell
ASPS Int. Surgeon


I only use cohesive silicone gel for breast reconstruction. However you need a personalized consultation with a Breast Reconstuctive Surgeon and chose a better tecnique in your case. In a video call I can see and to give a opinion more accurated.

Lisa Cassileth
ASPS Surgeon
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Ask your PS to feel saline and the silicone implants, they should have samples at the office. There is also a newer saline implant on the market, called the "ideal"implant, that is far less likely to ripple than traditional saline, but a little firmer than silicone. I let my patients feel the different implants, and most decide that the cohesive gels are safest and most realistic. There is a rare breast cancer called ""BIA-ALCL" that appears to be associated with textured implants, so although unlikely, most patients are choosing the smooth round to avoid the risk. When you swap the expander, ask your surgeon to perform fat grafting. I perform typically 100cc of fat grafting per side, which make s the breasts softer, hides the implant, and warmer! Make sure your surgeon is very comfortable with grafting, as I've found some surgeons perform this more than others.


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