Since the reintroduction of silicone implants for breast augmentation, patients now have a choice of implants. So what implants should one choose? Some plastic surgeons use silicone implants almost exclusively. I believe that the choice of implants depends on a number of factors.
First, how flat is the chest? The flatter the chest the more I would recommend silicone implants because there is little breast tissue to camouflage the breasts. Therefore the use of silicone implants will provide a more natural feel.
Second, what is the quality of the skin? If it is thin, especially if it has many stretch marks, I would use silicone implants because it will result in less visible and/or palpable rippling. Also, the breasts will feel more natural.
If the breasts are larger, then I believe that either silicone or saline will lead to a good result because there is good breast tissue for coverage, especially if the implants are place below the muscle.
In the case of breast asymmetry, it may be preferable to use saline implants (assuming there is adequate breast tissue) because the breasts can be more accurately corrected since the saline implants are inflated in the chest and are not pre-packaged. Therefore, smaller differences in size can be more accurately accounted for.
If the patient states that no matter what, she would like to have the most natural “feel” of the breasts, then silicone implants would be a better fit.
There are other considerations including: cost (saline is cheaper), leakage detection (easier with saline) and silicone phobia which is no longer warranted.
Ultimately, a thorough open discussion with your plastic surgeon who is open to using both type of breast implants should lead you to a very satisfactory result.