Breast implants are medical devices that are implanted under the breast tissue or under the chest muscle to increase breast size (augmentation) or to rebuild breast tissue after mastectomy or other damage to the breast (reconstruction). They are also used in revision surgeries, which correct or improve the result of an original surgery.
What types of breast implants are available?
Saline breast implants are filled with sterile salt water. Should the implant shell leak, a saline implant will collapse and the saline will be absorbed and naturally expelled by the body.
Saline breast implants provide a uniform shape, firmness and feel, and are FDA-approved for augmentation in women age 18 or older.
Structured implants are filled with sterile salt water, and contain an inner structure which aims to make the implant feel more natural.
Silicone breast implants are filled with silicone gel. The gel feels a bit more like natural breast tissue. If the implant leaks, the gel may remain within the implant shell, or may escape into the breast implant pocket. A leaking implant filled with silicone gel will not collapse.
If you choose silicone implants, you may need to visit your plastic surgeon regularly to make sure the implants are functioning properly. An ultrasound or MRI screening can assess the condition of breast implants.
Silicone breast implants are FDA-approved for augmentation in women age 22 or older.
Form-stable implants are sometimes referred to as gummy bear breast implants because they maintain their shape even when the implant shell is broken.
The consistency of the silicone gel inside the implant is thicker than traditional silicone gel implants. These implants are also firmer than traditional implants.
Shaped gummy bear breast implants have more projection at the bottom and are tapered towards the top. If a shaped implant rotates, it may lead to an unusual appearance of the breast that requires a separate procedure to correct.
Placement of gummy bear implants requires a slightly longer incision in the skin.
Round breast implants have a tendency to make breasts appear fuller than form-stable implants. Higher profile options can achieve even more projection.
Because round implants are the same shape all over, there is less concern about them rotating out of place.
Smooth breast implants are the softest feeling. They can move with the breast implant pocket, which may give more natural movement.
Smooth implants may have some palpable or visible rippling under the skin.
Textured breast implants develop scar tissue to stick to the implant, making them less likely to move around inside of the breast and become repositioned.
Texturing offers some advantage in diminishing the risk of a tight scar capsule.
Implant manufacturers occasionally introduce new styles and types of breast implants, so there may be additional options available.
Whether you choose saline or silicone implants, it is important for you to monitor your breast implants and follow-up with your plastic surgeon for appropriate checkups.
How you prepare
You’ll consult with a plastic surgeon about your preferences for size, feel and appearance of your breasts. The surgeon will describe specific types of implants — smooth or textured, round or shaped like a teardrop, saline or silicone — as well as options for surgical techniques.
Carefully review written information, such as the patient information from the manufacturer of the implant you’ll be getting, and keep copies for your records.
Before you decide to have surgery, consider the following:
- Breast implants won’t prevent your breasts from sagging. To correct sagging breasts, you might need a breast lift in addition to breast augmentation.
- Breast implants aren’t guaranteed to last a lifetime. The average life span of an implant is 10 years. Implant rupture is a possibility. Also, your breasts will continue to age, and factors such as weight gain or weight loss might change the way your breasts look. These issues will likely lead to more surgery.
- Mammograms might be more complicated. If you have breast implants, in addition to routine mammograms, you’ll require additional, specialized views.
- Breast implants might hamper breast-feeding. Some women are able to successfully breast-feed after breast augmentation. For others, however, breast-feeding is a challenge.
- Insurance does not cover breast implants. Unless it’s medically necessary — such as after a mastectomy — breast augmentation isn’t covered by insurance. Be prepared to handle the expenses, including related surgeries or future imaging tests.
- You might need additional surgery after breast implant removal. If you decide to have your implants removed, you might need a breast lift or other corrective surgery to help restore your breasts’ appearance.
- You might need an MRI scan. The FDA recommends routine monitoring with MRI after three years. However, recent studies show that there’s little data to support routine screening unless you have symptoms.
You might need a baseline mammogram before your surgery. Your doctor might adjust certain medications before the surgery as well. For example, it’s important to avoid aspirin or other medications that can increase bleeding.
If you smoke, your surgeon will ask you to stop smoking for a time before the surgery. Arrange for someone to drive you home after the surgery and to stay with you for at least the first night.
What you can expect
Breast augmentation can be done in a surgical center or hospital outpatient facility. You’ll probably go home the same day. The procedure rarely requires a hospital stay.
Sometimes, breast augmentation is done during local anesthesia — you’re awake and your breast area is numbed. Often, though, breast augmentation is done during general anesthesia, in which you’re asleep for the surgery.
During the procedure
To insert the breast implant, your surgeon will make a single cut (incision) in one of three places:
- In the crease under your breast (inframammary)
- Under your arm (axillary)
- Around your nipple (periareolar)
After making an incision, the surgeon will separate your breast tissue from the muscles and connective tissue of your chest. This creates a pocket either behind or in front of the outermost muscle of the chest wall (pectoral muscle). The surgeon will insert the implant into this pocket and center it behind your nipple.
Saline implants are inserted empty and then filled with sterile salt water once they’re in place. Silicone implants are pre-filled with silicone gel.
When the implant is in place, the surgeon will close the incision — typically with stitches (sutures) — and bandage it with skin adhesive and surgical tape.