As its name suggests, saline breast implant is filled with sterile saltwater; for this reason it provides a less favorable cosmetic outcome for women with little breast tissue and fat. By contrast, patients with an ample amount of tissue will usually enjoy a more natural result because of the “thicker coverage.”
The reason why women with almost no breast tissue will have unnatural result with saline implants is that there is little coverage. In fact, the implants will be easily felt through the skin, regardless if these are positioned under or over the muscle, particularly in the lateral side and bottom of the breasts.
And instead of having a teardrop-shaped breast, it would end up being unnaturally round. So for women with little amount of tissue, silicone breast implants, which are filled with a cohesive gel that mimics the feel of glandular tissue and fat, are the best options for them.
(However, using teardrop-shaped implants, which are always available in textured surface to prevent them from flipping over, are not advisable for women with a very small breast because of the higher risk of rippling.)
Another concern of using saline implants on women with limited breast tissue is the higher risk of rippling and wrinkling of the shell, which is caused by “lack of coverage.” This problem may be even aggravated with the use of textured implants with large “graininess.”
On the other hand, patients with moderate to significant amount of glandular tissue—particularly those with firm breasts—will likely enjoy a more natural result with saline implants. In fact, regardless of the type of implants they would use, it is easier for them to achieve a favorable cosmetic result.
But despite having more amounts of tissue and fat, women should still limit themselves from using large saline implants (filled with more than 500 cubic centimeter or cc) because it can lead to a higher risk of downward displacement than silicone implants with the same size.
Meanwhile, women with a modest amount of tissue will achieve a result somewhere in-between. They will most likely feel the implant shell through their skin with saline implants, although the shape of their breasts will appear natural as if they have used the silicone version.
In general, silicone breast implants are still the best option for these patients to achieve a more natural feel. (When plastic surgeons mention the word “feel,” they are talking about the sensation of the breast as it is being touched by fingers.)