There really is no simple answer to saline or silicone whether the choice is for a reconstructive or cosmetic patient. For me it comes down to discussing the pros and cons of each with the patient and trying to help them decide which is best for them.
A recent article in the journal Cancer suggests that reconstructive patients are more satisfied with silicone implants over saline. Upon looking at the information closer, it is an ever so slight increase in satisfaction as to be laughable.
Colleen M. McCarthy, MD, MS, of Memorial Sloan-Kettering Cancer Center in New York City, and colleagues conducted a multicenter, cross-sectional survey of 482 postmastectomy, implant-based reconstruction patients. A total of 672 women were asked to complete the BREAST-Q (Reconstruction Module), but only 482 completed them (176 women had silicone implants and 306 chose saline).
BREAST-Q Reconstruction Module scores satisfaction in 15-items including breast shape, feel to the touch, appearance, feelings of "normalcy," and integration into self. The score averaged 58.0 for silicone implants versus 52.5 with saline implants on a 100-point scale in a univariate analysis.
Why are the scores so low (58.0 and 52.5)? This study wasn’t planned to discern those answers though it did note that the addition of radiation to the mix lowered the satisfaction scores.
The article by Scott Spear, MD is a wonderful review of the pros and cons of each. It is well worth reading. He summarizes at the end of his article:
As implant choices have evolved, certain concepts have proven useful. When the main determinant for patient satisfaction is the shape and feel of the implant (and in cases where the implant might be especially visible), a silicone gel implant is the better choice. In cases where the primary concerns are safety (real or perceived), minimal access incisions, and ease of monitoring, saline may prove to be a better choice.
Silicone vs Saline Breast Implants (March 4, 2008)
Patient Satisfaction with Postmastectomy Breast Reconstruction: A Comparison of Saline and Silicone Implants; McCarthy CM, et al; Cancer 2010; DOI: 10.1002/cncr.25552.
Breast Implants: Saline or Silicone?; Spear, Scott L., Jespersen, M. Renee; Aesthetic Surgery Journal July/August 2010 30: 557-570, doi:10.1177/1090820X10380401