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Breast Augmentation: The Pros and Cons of Silicone and Saline Breast Implants

Male-to-female (MTF) Breast Augmentation is a transgender surgery that uses saline or silicone implants to enhance the size and shape of your breasts, bettering the alignment of your body and internal sense of self.

One of the decisions that you will need to make about your Breast Augmentation surgery is the type of breast implant that you want. While this is best decided in consultation with Dr. Rumer, the following information will help you learn more about which implant might be more suited to your needs ahead of your appointment.

Silicone Breast Implants

Silicone breast implants have an outer silicone shell and are filled with a thick medical-grade silicone gel. Silicone breast implants are FDA-approved for augmentation in women age 22 or older.


  • Silicone gel implants are softer and feel more like breast tissue.
  • Recommended for women who are very thin or have little natural breast tissue to cover the implants.
  • Risk of leakage is lower compared to silicone implants made in the 80s and 90s or saline implants.
  • A leaking silicone implant will not collapse* like a saline implant.


  • *A leaking silicone implant will not collapse. This is referred to as a “silent rupture”. The FDA recommends patients receive a MRI every two years to detect any possible defections of the implant.
  • While a ruptured silicone breast implant won’t deflate it may cause pain or changes in breast shape.
  • Some silicone implants are shaped rather than round. These implants have more projection at the bottom and if one accidentally rotates, it can cause an unusual appearance of the breast.
  • Silicone implants are inserted pre-filled, which requires a larger incision.
  • Twice the price of saline implants.

Saline Breast Implants

Like silicone breast implants, saline implants have an outer silicone shell and are filled with sterile salt water. Saline breast implants are FDA-approved for augmentation in women age 18 or older.


  • In the event of a leakage*, the saline inside the implant will leak out and be harmlessly absorbed by the body.
  • Saline implants are initially empty and are filled after they are implanted. This requires a much smaller incision, resulting is less scarring.
  • Because saline implants are “custom filled,” they’re ideal for women with visible breast asymmetry.
  • There are more options as to where incisions are located with saline implants.
  • Saline implants are approximately half the price or silicone implants (and follow-up MRIs are not required.)


  • *In the event of a leakage, a saline implant will quickly deflate, visibly changing the appearance of the breast. Most women would want this to be fixed immediately with a replacement implant.
  • Like silicone, saline implants can shift, change shape, harden and ripple.
  • Saline implants are firmer and feel less like natural breast tissue compared to silicone.
  • While leakage is relatively harmless, saline implants have a higher risk of leaking.

In MTF Breast Augmentation, both saline and silicone breast implants have advantages and disadvantages. Your decision about which implants best suit your goals will depend on your physique and preferences, balanced by your willingness to accept both the pros and cons of whichever implants you ultimately choose.