Introduction In 2017, there have been a quarter of a million women who have undergone breast augmentation surgery using implants, and that was only in the US. Worldwide, this number is way over 1,500,000 women. The reality is that women today are becoming more and more confident, and sometimes, part of this confidence is the ability and freedom to choose to look as good as they want. For some people, this discomfort with a part of their body might cause real confidence issues, so the obvious solution is to go and fix this issue. It has been proved that an augmentation surgery can consistently improve the quality of life for someone who has been suffering from lack of confidence. Thanks to the internet, the advantage nowadays is that you can get informed on every aspect, risk and possible complication of such a surgery. Thus, you would become an educated patient with reasonable expectations and you will make your surgeon’s job easier. What are implants made of? One of the most important things you need to choose when it comes to implants is their type. The good news is that there are only two known implant types: silicone and saline. The bad news is that they both have a lot of advantages and some disadvantages, so it will be a bit difficult to choose. Once more, being informed will help you reach the best solution for yourself. Let’s first discuss what these implants are made of. Both silicone and saline implants are made of a silicone shell. The role of this silicone shell is to contain the core, the substance they are filled with, and at the same time to prevent this from spilling. It also means making sure that the life of your implants is as long as possible. This silicone shell might be filled with a sterile saline water solution, a substance similar to the IV used to hydrate patients. This is water and salt, basically, but sterilized since it needs to be bacteria-free because it will go into your body and stay for a long while. A silicone implant is filled with cohesive silicone. This is, of course, a much thicker substance than water. In the last year, a new generation of silicone implants has appeared. These new implants are also filled with the same polymer, but it is a form-stable silicone. Due to its consistency that resembles those of gummy sweets, they are also nicknamed “gummy bear” implants. Safety Both implants have the same shell, but they are filled with different substances. Saline implants appeared at first from a general fear of silicone implants. It was the ’90s scare that made all women fear implants and led to FDA forbidding the use of silicone implants in the US for 14 years. During this time, the FDA conducted various studies to determine if the claims that silicone implants were unsafe to be used for augmentation purposes were valid. A TV show in 1990 claimed that women who had silicone implants developed a myriad of strange symptoms usually associated with autoimmune diseases. So, in the era of Pamela Anderson, a whole hysteria started that resulted not only in banning the use of silicone implants but also in a great number of lawsuits. For a while, only saline implants could be used and only for reconstruction purposes. It was in 2006 when the FDA approved the use of an already new generation of silicone implants. It was not only that the FDA that found no evidence of silicone being the source of any autoimmune disease or any other type of disease for that matter, but also a panel of 13 doctors from the Institute of Medicine of American National Academy of Science. These 13 doctors issued a statement about the safety of silicone use back in 1999. Still, some effects of this scare are still in place today. Therefore, some women will choose saline implants for this very reason: they still do not trust silicone ones to be safe. If you want to have a breast augmentation surgery, you need to be at least 18 years old if you choose saline water implants, but at least 22 if you choose silicone implants. The chosen age of 18 is because it is the age when most girls have their breasts fully formed. Advantages and disadvantages As already discussed, there is no scientific evidence of silicone being less safe than saline water implants. Saline water implants might need a smaller incision than silicone ones. Some such implants come deflated, and they have a valve through which they are filled with water solution during the surgery. Therefore, for this type of implant, the incision can be smaller since the volume of the implant will be smaller. Water is very liquid, so if the implant suffers rupture, it will easily flow into your body. This has two advantages. One is that a rupture will be very easily spotted because the breast will deflate either immediately or in a very short time. The second is that the water will just be absorbed by your body, and there will be no risks to develop any symptoms. In the case of silicone implants, if they rupture chances are the cohesive substance will not leak at all; it will just stay put or leak very slowly. This is a disadvantage of silicone implants due to their consistency. This is also called a silent rupture, and it can only be noticed during a doctor’s exam or an MRI scan. It is why the FDA recommends all women with silicone implants to undergo an MRI after the first 3 years from the operation and then once a year. The slow leakage of silicone that is not detected can lead to pain, inflammation, and deformation of the implant. The good news is that silicone implants are guaranteed for up to 10 to 15 years, whilst saline implants are guaranteed only up to a maximum of 10 years. In truth, most saline implants rupture in the first 5 to 7 years, while silicone ones can last even up to 20 years. Since water is a liquid and lacks real consistency, silicone implants have a more natural feel. The cohesive silicone gel is very similar to human fat that is a natural part of a woman’s breast. Silicone implants seem to feel and act very similar to human breasts. Sometimes women with saline implants say they hear the sound of whooshing water and complain about having cold breasts. Water will not get to body temperature when it heats up, but silicone does. Therefore, both women and surgeons tend to prefer silicone implants. Saline implants have a higher risk of rippling, meaning they will look like a wrinkle under your skin. If the shell is not filled correctly, it might produce this effect. This again is due to the consistency of water in comparison to silicone. Silicone will adhere much easier to your tissue than water. Another important aspect related to the type of implant to choose is the original size of your breasts. Silicone implants need little breast tissue. If you are a thin person with little fat and small breasts, then silicone is the best solution as silicone emulates the feel of natural human fat. To use saline implants, you will need more breast tissue to start with, so this kind of implant will be best fit for a natural B cup or higher. One other thing that differentiates the two types of implants is the cost: saline implants are cheaper than silicone ones. There is a small difference in cost, but it is worth considering. Innovation With the incredible advance of medicine and research in recent years, new types of implants are starting to be produced. The need for making these devices even safer and to be able to emulate real breasts as close as possible is forever present, especially in this digital century. “Baffling” saline implants are made from a channel structure distributed in layers that allow water inside these channels to flow in different directions. This structure makes saline implants more similar to silicone feel and structure and less prone to rippling. Silicone implants are now produced with a various degree of cohesiveness; some are more liquid so they feel softer, and others are stiffer. The ones that are softer might be very easily used for a normal augmentation, and the ones that are more cohesive and stiffer can be used for breast reconstruction. Conclusion In order to be able to get the best from your augmentation, you need to have an informed opinion on what you need and want from this surgery. After studying all viable information on types of implants and techniques and sizes, etc., you will need to decide on a good, certified and experienced plastic surgeon. He or she will answer all your questions and correct the information you got wrong, and that is how you will know you are in good hands.