One of the first questions that comes up when you’re researching breast augmentation is which type of implant to choose. Saline or silicone? They sound similar, but the differences are significant and don’t suit everybody or surgery. Understanding them will help you have a much more productive conversation with your surgeon.

Here’s what you need to know.

Key Insights

• Both implant types have an outer silicone shell; they differ in what’s inside
• Silicone is by far the most commonly used implant in Australia
• Saline has a small number of specific advantages, particularly for breast reconstruction
• Surface texture (not fill material) is the primary BIA-ALCL risk factor, according to the TGA
• The right choice depends on your body, your goals, and your surgeon’s recommendation

What’s the Difference Between Saline and Silicone Implants?

Both types of breast implants share the same outer shell made of silicone. The difference is what’s inside.

Saline implants are inserted empty, then filled with sterile salt water (sodium chloride) once they’re in position. Because they go in deflated, the incision can be smaller. The fill volume can also be adjusted on the table, which gives some flexibility in achieving symmetry.

Silicone implants arrive pre-filled with a cohesive silicone gel, a thick, jelly-like material that closely resembles the feel and movement of natural breast tissue. Because they’re pre-filled, they require a slightly larger incision to insert. But that trade-off is worth it for most patients: silicone implants look and feel significantly more natural, particularly in women with less natural breast tissue.

Why Silicone Is the Standard in Australia

The vast majority of breast augmentation procedures in Australia now use cohesive silicone gel implants. The reason is straightforward: silicone more closely mimics the consistency of natural breast tissue, resulting in a softer, more natural feel.

Saline, by contrast, can feel firmer and more like a fluid-filled pocket, which is especially noticeable in women with thinner skin or less breast tissue. Saline implants are also more prone to rippling, where the folds of the implant shell become visible or palpable near the edges of the breast or in the cleavage.

Both implant types are regulated by Australia’s Therapeutic Goods Administration (TGA), which assesses safety and performance before any device can be supplied in Australia.¹

What Happens If an Implant Ruptures?

Rupture is a reasonable concern, and the behaviour differs significantly between the two types.

With a saline rupture, the implant deflates visibly and quickly. You’ll know immediately because the breast changes shape. The salt water is safely absorbed by the body, but you’ll need surgery to remove the shell and, usually, replace the implant.

With a silicone rupture, the gel tends to stay within the scar tissue capsule that naturally forms around the implant. This is called a “silent rupture”, and it may cause no obvious symptoms and can only be detected by ultrasound or MRI. Leaking silicone gel isn’t linked to long-term health problems, but the implant will still need to be removed and replaced in time.

Neither type offers a lifetime guarantee. Most implants last 10–15 years before requiring removal or replacement for various reasons.

Is Saline Ever the Better Choice?

Yes, in specific circumstances. Saline implants are often used in breast reconstruction after mastectomy, where the ability to adjust volume after surgery is useful. A port allows the surgeon to fine-tune the fill over several months, and the implant can later be exchanged for a permanent silicone device once the ideal size is established.

Saline is also typically less expensive than silicone, which is worth knowing if cost is a consideration.

A Note on Implant Safety and BIA-ALCL

You may have heard about BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma), a rare immune system cancer associated with certain breast implants. It’s worth understanding, not panicking about.

All reported Australian BIA-ALCL cases involve textured implants, not smooth ones. Importantly, BIA-ALCL is not linked to the fill material (saline or silicone) but rather to the surface texture of the implant shell, which appears to be the key risk factor. The higher-risk macro-textured and polyurethane-coated implants are no longer available for use in Australia.

If you’re considering breast augmentation, your surgeon should discuss implant surface options with you as part of informed consent.

So, Which Should You Choose?

For most women considering breast augmentation, silicone will be the stronger choice. It looks and feels more natural, suits a wider range of body types, and is the implant of choice for the overwhelming majority of Australian surgeons.

But “most women” isn’t you. The right implant depends on your anatomy, the amount of natural breast tissue you have, your aesthetic goals, and the nuances of your individual case. That’s exactly what a thorough consultation is for.

If you’d like to explore your options with a specialist surgeon at ourSydney breast clinic, we’re here to help you work through the decision. Book a consultation with Dr Yunaev by calling (02) 9819 7449 or emailing info@bbclinic.com.au.

This article is for informational purposes only and does not constitute medical advice. Please consult a qualified surgeon to discuss your individual circumstances.