Deciding on which breast implant you want for your breast augmentation is an exciting and important decision. It’s important to know the facts – the good and the bad – about each implant type so you can make the right decision for you. 
Today’s breast implants come in 2 main types: silicone and saline. While silicone implants are still the most common ones patients choose, it is crucial to know each implant’s advantages and disadvantages to make the right decision for you.
Silicone and saline implants have a shell made of silicone rubber (yes, even saline implant shells are made of silicone rubber). Think of it as the container or bag. What makes them different is the implant ‘filling’. Silicone implants get filled at the factory with cohesive gel silicone. Saline implants come empty from the manufacturer and are filled by the surgeon with saline during the operation.
Silicone implants have two main advantages over saline. First, silicone implants feel softer than saline implants. Second, silicone implants tend to have less ‘rippling’ than saline implants. Rippling is essentially wrinkling of the surface of the implant because the implant is soft. Silicone implants tend to have less rippling because they are filled with a semi-solid rather than a liquid. Think of it like jello. It feels soft but can still hold a shape. Since saline implants are filled with saltwater (and not a semi-solid like the silicone), you can get more rippling with saline implants. But whether the rippling is visible from the outside depends on other things, too, including how much of your own breast tissue you have to hide the implant, the size of the implant you chose, and whether the implant is above or under the muscle.
Most women end up choosing silicone implants because of the softness and lower amount of rippling. But silicone implants have disadvantages too. Since silicone implants come already filled from the factory, the surgical incision’s size sometimes needs to be longer compared to saline. Silicone implants have a slightly higher rate of capsular contracture (hard scar tissue around the implant) compared to saline. Although the implant rupture rate (breaking) is only 1% per year, it can happen, and the surgery to replace a ruptured silicone implant is generally more involved compared to replacing a deflated saline implant.
Even though saline implants tend not to be as soft as silicone implants and can be prone to more rippling, saline implants have some significant advantages. Since they come empty from the factory and are filled during surgery, you can often use a smaller incision to them in. You can also fill each breast implant slightly differently during surgery if someone has mild differences in breast size beforehand. Saline implants are also easier to monitor. If the saline implant deflates (which occurs only 1% per year), you can usually tell right away, and there is rarely a need for any imaging. The surgery to replace a deflated saline implant is also more comfortable than surgery to replace a silicone implant. Finally, studies have shown that saline implants have a lower capsular contracture rate (hardening of scar tissue around the implant) compared to silicone.