Many patients are confused about the choice of implants to use in breast augmentation.  There are two types of implants available for use in the United States – silicone gel and saline.  Both types have the same silicone outer shell.  There was some controversy about silicone gel implants back in the 1990’s when the FDA removed them from the market for use in first-time breast augmentations.  Interestingly, they were never removed from the market for breast augmentation revisions or breast reconstruction.  They were once again approved for use in breast augmentation in 2006, but only for women over the age of 22. The main complaint that most patients have about saline implants is that they can sometimes feel and see rippling of the implant below the skin.  This is more evident in thinner women and those who have less breast tissue of their own.   Many also think that they also do not feel as natural as silicone gel implants. I have been using silicone implants for breast augmentation in almost all of my patients since 2006.  I think they look and feel natural and even though a slightly longer incision is needed for insertion, this is well hidden in most cases.  It is important that each patient make her own decision regarding the type of implant to use, but my recommendation is usually silicone gel.