Ted Eisenberg, DO, FACOS, FAACS
Philadelphia College of Osteopathic Medicine/Nazareth Hospital, Philadelphia, PA

Ted S. Eisenberg, DO, FACOS, DFACOS, FAACS, of Philadelphia, is board-certified in both General Surgery and Plastic and Reconstructive Surgery. He is an Associate Professor of Surgery in the Division of Plastic Surgery at Philadelphia College of Osteopathic Medicine. He has lectured at conferences and universities nationally and internationally, including in Dubai and Nairobi. A frequent contributor to academic journals, Dr. Eisenberg’s article on lowering deflation rates of saline implants through overfilling was published in Aesthetic Plastic Surgery in 2021. He has published on an innovative technique for augmentation mastopexy, the management of PONV in breast augmentation patients, repairing Tuberous Breast Deformity with saline implants, and the use of acellular dermal matrix in breast implant exposure. With his wife, Joyce, he is the author of The Scoop On Breasts: A Plastic Surgeon Busts the Myths (Incompra Press 2012).


When it comes to breast implant selection, saline-filled implants are often considered second best to silicone gel. According to a 2016 survey of members of the American Society of Plastic Surgeons, 82% of respondents preferred silicone gel implants and 22% use silicone implants exclusively. However, saline implants offer many advantages that should make them a frontrunner. Drawing on the latest scientific research and my experience with more than 4,700 augmentation mammaplasty patients who chose saline-filled breast implants, I will detail the advantages of saline breast implants: 1. Palpable and visible rippling of saline and silicone breast implants is similar. 2. In a 2020 Mentor publication, the 10-year silicone rupture rate was approximately 24%, Allergan and Sientra~10%. In my 2021 published paper evaluating 4761 saline breast augmentation patients, the 8-year deflation rate was less than 2%. 3. Unfilled saline implants are placed through a smaller incision than prefilled silicone gel implants. 4. Saline implants are less expensive. 5. Saline implant deflation is obvious; silicone gel implants require ongoing MRI evaluation to detect rupture. 6. Mentor reports the 10-year capsular contraction rate for silicone implants at 10% versus 1% in my experience. 7. Saline implants can be used to correct tuberous breast deformity in a simpler one-stage procedure without needing to score breast parenchyma or lower the inframammary fold. 8. Smaller volume adjustments in asymmetric breasts can be made more easily with saline implants. 9. Breast tissues can be expanded with saline implants and often allow for slightly larger volumes than silicone implants with a comparable diameter. 10. With saline implants there is no worry of any “gel” bleed through the shell which may be associated with health issues.

Take Home Message

Since 2006, silicone gel implants have been the prosthesis of choice for cosmetic augmentation mammaplasty in the United States and Canada. Recent research points to saline-inflatable breast implants as an equal, if not superior alternative. Physicians will be educated about the surgical advantages of using saline implants and improved patient outcomes.