The filling: silicone or saline
Breast implants are made up of a silicone shell, but what changes is the material inside it. There are two broad categories: silicone gel and saline.
Highly cohesive silicone gel implants
These are the most used today. The gel inside has a consistent, elastic texture resembling natural breast tissue. High cohesiveness means that, even if the implant ruptures, the gel stays compact, without leaking or moving.
Advantages:
- A more natural feel and appearance.
- Different degrees of gel cohesiveness according to each patient’s characteristics.
- A lower risk of visible ridges (rippling).
- A wide variety of shapes and projections.
- High durability.
These implants are preferred by most surgeons because of how stably they behave over time and the quality of the aesthetic result.
In particular cases — generally patients seeking large volumes and with a tendency to breast ptosis or drooping — we can use lightweight implants in which the cohesive gel is mixed with microspheres.
Saline-filled implants
These consist of a silicone shell filled with saline once it is in place in the body. That allows them to be inserted through smaller incisions, since they go in empty and are filled afterwards.
Advantages:
- Smaller incisions.
- If they rupture, the body absorbs the saline without risk.
- Lower cost.
They do, however, have a less natural feel and a greater possibility of gradual deflation over time. The risk of visible rippling is higher, particularly in slim women or those with little breast tissue.
The second major factor in choosing an implant is its shape. Here too there are two main types: round and anatomical.
Round implants
They distribute the volume evenly, giving more fullness in the upper part of the breast. They are ideal where a more pronounced cleavage or a fuller result in the upper part is wanted.
Advantages:
- They visibly enhance the cleavage.
- There is no risk of rotation.
- A predictable result, easy to adjust in theatre.
They are indicated in women with sufficient breast tissue, or where a more striking effect with marked projection is wanted.
These days we frequently speak of ergonomic implants, meaning round implants with softer cohesive gels that tend to give more natural results in the upper pole, keeping the low risk of rotation characteristic of round implants while achieving an upper pole that looks more natural and resembles the results of anatomical implants.
Anatomical (teardrop) implants
Their design mimics the natural shape of the female breast, with more volume in the lower part and a softer transition in the upper pole.
Advantages:
- A more natural result in profile.
- Suitable for breast aplasia, some tuberous breasts and reconstruction after mastectomy.
- Better visual integration in slim bodies where high projections are chosen.
Having a specific shape, these implants can rotate, which counts as a complication. They therefore require very precise placement and usually have a textured surface to prevent movement.
The surface texture: smooth or textured
The outer surface of the implant also affects how stably it behaves within the body. Implants are divided essentially into smooth or textured according to their outer covering. In cases of recurrent capsular contracture we may also opt for implants with a polyurethane covering.
Smooth-surfaced implants
They have a soft shell that allows some movement within the breast pocket.
Advantages:
- Simpler placement.
- Less friction with the tissues.
- Quicker internal healing.
They are particularly indicated when placed by the submuscular route, since the muscle acts as an anchor and limits movement.
Rough-surfaced (textured) implants
They have a rough surface that helps them adhere to the surrounding tissue, reducing the risk of rotation and of capsular contracture.
Advantages:
- Better fixation.
- A reduction in certain postoperative complications.
They are currently used with caution, choosing microtextured models that have demonstrated clinical effectiveness and safety, always to strict criteria.
The choice of implant is not made in isolation but as part of an integrated assessment that includes:
- A study of the anatomy of the chest and the breast.
- The amount and quality of breast tissue available.
- The patient’s aesthetic wishes and lifestyle.
- Analysis of body proportions and symmetry.
- The plastic surgeon’s experience and judgement.
At the consultation the specialist shows physical models and images of real cases to help with the decision. The long-term behaviour of each type of implant and possible future revisions are also explained.
Textured surfaces and implant-associated lymphoma (BIA-ALCL)
There is one fact a page about types of implant cannot leave out: the textured surface has been associated with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). It is not breast cancer: it is a lymphoma that appears in the scar capsule surrounding the implant and which, detected in time, is treated by removing the implant together with that whole capsule.
And not all textures are the same, which is the part usually told badly. The international standard classifies the surface by its roughness into smooth (below 10 µm), microtextured (10 to 50 µm) and macrotextured (above 50 µm), and the risk follows that scale. In the Australian and New Zealand series, the risk was 14.11 times higher with macrotextured Biocell implants and 10.84 times higher with polyurethane ones, compared with a microtextured implant (Siltex).
That is why what was withdrawn from the market in 2019 were Allergan’s macrotextured implants — the Biocell range — which accounted for most of the cases. The surfaces used today, micro- and nanotextured, carry a much lower risk.
On the absolute magnitude it is worth being honest: the published figures vary enormously according to how the denominator is calculated — from hospital series to implants sold — so giving a single number is misleading. The systematic review of the US epidemiology, for instance, estimated 109.4 cases per 100,000 women with a textured implant; other approaches put the figure orders of magnitude lower. What is established is the gradation: the more surface, the more risk.
Hence the surface is not chosen out of fear but on indication. There are operations — a breast lift, for example — in which a micro- or nanotextured implant gives behaviour that improves the result, and that is worth it. What is no longer used are the macrotextured ones.
And one practical recommendation for anyone who already has implants: an increase in volume or swelling of one breast only, years after surgery, should be checked rather than waited on. That late fluid collection around the implant is the usual way it presents.
Why the quality and the make of the implants matter
At the Instituto de Cirugía Plástica del Mediterráneo we work exclusively with implant makes of international standing, which meet every European health certification and offer a manufacturer’s warranty. That guarantees not only greater safety but also peace of mind in future should an exchange or revision be needed.
Choosing a quality implant is an investment in health and in lasting results. That is why we always give priority to the traceability of the materials and to transparency with every patient.
Choosing the right breast implant is a key part of achieving a successful augmentation. There is no single ideal option, but a choice that has to rest on individual anatomy, aesthetic goals and medical assessment.
Understanding the differences between silicone and saline implants, between round and anatomical, and between smooth and rough surfaces, allows an informed and considered decision.
At our clinic in Valencia we offer an individual and honest assessment so that every patient finds the safest, most harmonious and most lasting solution. If you are considering a breast augmentation, we invite you to book a first consultation where we will answer all your questions rigorously and approachably.
