Breast Implants: Everything You Need to Know

You may choose to undergo breast augmentation with implants for either cosmetic or reconstructive purposes.

The former’s goal is to increase your breast and enhance your breast shape, while the latter aims to rebuild your breast, say after a mastectomy.

Breast implants come in various sizes, shapes, profiles, and filling materials, allowing for customization to your individual needs.

Types of Breast Implants

The two main types of breast implants are saline-filled and silicone-filled breast implants. We’ll discuss both and their subcategories to help you better evaluate your options.

• Saline breast implants: These implants have an outer silicone shell containing sterile saltwater. They can either be prefilled or inserted empty and filled during breast augmentation surgery.
• Structured saline breast implants: These are a type of saline-filled breast implants with an inner structure that gives them a natural feel of silicone implants.
• Silicone breast implants: These breast implants have an outer silicone shell filled with silicone gel that closely mimics the fill of breast tissue. Silicone implants get pre-filled before being inserted into the created pocket.
• Gummy bear breast implants: Also known as form-stable breast implants, gummy bear implants are silicone-filled implants with a thicker consistency than traditional silicone breast implants. They also tend to be firmer and hold their shape in case of a leak. Gummy bear breast implants commonly come in a teardrop shape, i.e., tapered at the top and projecting at the bottom.
• Round breast implants: Round-shaped implants provide an equal upper pole and lower pole projection, which makes your breasts appear fuller than teardrop-shaped breast implants. Those with a higher profile can further boost your breast projection.
• Smooth breast implants: These types of implants feel soft and natural because they can freely move around the breast implant pocket.
• Textured breast implants: Textured implants have a rough surface and feel firmer than smooth implants. They are also less likely to shift positions as they adhere to surrounding breast tissue, preventing them from moving around the breast pocket.

Pros and Cons of Breast Augmentation with Breast Implants

Overall pros of breast implants

• Increase breast fullness and projection.
• Improve natural breast size asymmetry.
• Enhance balance of your breast to hip contour ratio.
• There are various options to choose from, depending on filling material, shape, profile, size, and texture, allowing for customizable breast augmentation.
• Boost your self-confidence and self-image.
• Allow for the reconstruction of your breasts following mastectomy or injury.
• Correct or improve the unsatisfactory results of previous surgery.
• Designed to last more than ten years but can last 20 years or more with proper care.

Overall cons of breast implants

• When saline breast implants rupture they deflate, changing your breast size and shape. On the other hand, it’s hard to detect a ruptured silicone breast implant because it doesn’t collapse. A leaking silicone implant can result in changes in breast shape, breast pain, and breast thickening.
• With every passing year, the risk of rupture increases by 1%, so the longer you’ve had your implants, the more likely you will need breast implant removal or breast implant replacement surgery.
• Your insurance company will likely not cover the cost of cosmetic breast augmentation, the cost of implant removal or implant replacement, and, in some cases, the cost of treating breast conditions in patients with breast implants.
• Breast implant removal may result in breast dimpling, wrinkled breast skin, breast volume, sagging breast skin, loss of feeling in your nipples, among other outcomes.
• You may experience various risks and complications, such as capsular contracture, asymmetry, scarring, and infection.
• There may be a risk of developing a rare cancer of the immune system called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).
• May hinder breastfeeding by affecting your capacity to produce breast milk. However, most women can still successfully breastfeed after getting breast implants.
• You will require routine screening to evaluate the health of your breasts and the condition of your breast implants. Your insurance may not cover these medical examinations, such as a magnetic resonance imaging (MRI) scan and an ultrasound.
• Complicates mammography, which helps detect early signs of breast cancer using X-ray imaging. So ensure to inform the mammography technologist that you have breast implants to avoid false results.

Choosing the Right Breast Implant

Now that you have decided to get breast implants, there are other crucial decisions you have to make to ensure the best results after the first procedure. These factors will help you decide the best implant for you down to the surface texture.

• Natural feeling: breast implants containing silicone gel are the closest in feel to breast tissue. Alternatively, you can opt for structured saline breast implants that feel more natural than traditional saline implants, thanks to an inner structure.
• Implant rupture: do you want a saline breast implant that immediately collapses when it ruptures, causing your breast to appear deflated. Or do you want a silicone implant that doesn’t collapse when it leaks, making it challenging to detect a rupture? Consider also that when a saline implant ruptures, your body absorbs and naturally expels the saline solution. Whereas when a silicone implant ruptures, the gel may remain within the silicone shell or escape into the breast implant pocket. You will require surgery to remove the ruptured implant or the implant shell. And during the procedure, your surgeon may insert a new implant.
• Smooth or textured implant: for a soft feeling, smooth implants are the way to go. However, visible rippling under the skin is more likely to occur with smooth than textured implants. And while textured implants have a sandpaper-like surface, they reduce the risk of your implants shifting out of position as well as the risk of capsular contracture.
• Implant shape: teardrop-shaped implants achieve a more natural-looking breast appearance because they have more projection at the bottom than at the top. However, should a shaped implant move out of place, it may cause an unusual breast appearance that requires a revision procedure to move the implant to its original positioning. Round implants have an equal volume at the top and bottom, so even if they rotated out of place, they’d still maintain the same shape.
• Implant size: breast implant sizes range from about 150cc to 800cc or more. You may require a different-sized breast implant for each breast to prevent breast asymmetry and revision surgery. Your cosmetic surgeon will factor in your existing breast size and personal goals then recommend the ideal breast implant size for you for satisfactory results.

And remember, of all the choices you have to make surrounding breast augmentation surgery, choosing a board-certified plastic surgeon is the most important.

Preparation for Breast Augmentation with Breast Implants

Before your surgery, your plastic surgeon may ask you to:

• Get a baseline mammogram.
• Get a blood test.
• Take certain medications, adjust your current medications, or stop taking drugs that prevent blood from clotting.
• Stop smoking if a smoker or quit recreational drugs, such as cocaine.

If an outpatient surgery, arrange for someone to drive you to and from the hospital or ambulatory surgical center. Additionally, plan for someone to stay with you for at least the first night after surgery.

Procedure Steps

During breast augmentation surgery, you’re usually under local anesthesia, general anesthesia, or another type of anesthesia.

To insert the breast implants, your surgeon will make incisions in inconspicuous areas, namely:

• Along the outer edge of your areola (periareolar incision)
• Along your inframammary fold, i.e., the crease under your breast (inframammary incision)
• In your armpit (axillary incision)
• In your navel (transumbilical breast augmentation (TUBA)), but According to the American Society of Plastic Surgeons (ASPS), this approach results in a higher complication rate.

Once your surgeon makes the incision that you both agreed is appropriate for your desired outcome, he/she will insert and place the implant either:

• Behind your pectoral muscle (submuscular placement) or,
• In front of your pectoral muscle but behind your breast tissue (subglandular placement)

The incision technique used and where the implant depends on your body type, the type of implant, your desired outcome, and your plastic surgeon’s recommendations.

After inserting and placing your implants, your surgeon will use layered sutures to close incisions in the breast tissue and stitches, surgical tape, or skin adhesive to close the skin.

Breast Augmentation Recovery

After surgery, you may experience swelling and soreness during the first few weeks. And acute pain will usually subside after 1-5 days. Before leaving the hospital, your medical team will give you postoperative instructions and tell you when to go for a follow-up appointment.

Your plastic surgeon may prescribe medication, such as painkillers and antibiotics to prevent surgical site infection.

He/she will also likely recommend you wear a support bra or compression band for a specified period after surgery. A support garment helps minimize swelling and helps position your implants optimally.

Your surgeon will also let you know when you can go back to work, usually within a week or so. Typically, one should avoid strenuous activities for 2-3 weeks following surgery or until you have permission to increase your activity level.

If the sutures used during surgery do not absorb or if you had drainage tubes placed to drain excess fluid, a follow-up visit is necessary to have them removed.

As your breasts heal, ensure to watch for any signs of infection, including fever or redness in your breast. Contact your surgeon immediately if you notice these symptoms or experience chest pain and shortness of breath.

Breast Augmentation Results

You will notice you have larger breasts right away. However, the final results will be evident after the swelling subsides and your skin stretches, which will take a few weeks. Your incisions will fade with time, which could be several months or several years.

Following all your post-operative instructions and going for routine follow-up appointments can help you get optimal results. Just remember to keep your expectations realistic.

However, breast implants are not lifetime devices, so breast implant removal or replacement surgery is likely in the future.

Cost of Breast Augmentation with Breast Implants

According to 2019 statistics by the American Society of Plastic Surgeons (ASPS), the average cost of breast augmentation is $3,947.

The quoted figure excludes operating room (OR) cost, anesthesia cost, and other related costs. Silicone breast implants tend to cost more than saline breast implants.

To know the final cost of your surgery, consult your plastic surgeon. If for cosmetic reasons, your health provider will not cover the cost of the procedure.

However, most cosmetic surgeons offer several patient financing options, allowing you to get breast augmentation surgery and pay later. These financing plans include:

• Healthcare credit cards, for example, CareCredit and Alphaeon Credit Card.
• A medical loan from a medical lender that your surgeon works with.

Risks and Complications of Breast Augmentation

Like every surgical procedure, breast augmentation poses some risks. These include:

• Capsular contracture, i.e., a pain-causing and shape-distorting capsule of scar tissue that forms around the breast implant
• Persistent breast pain
• Infection
• Seroma, i.e., fluid accumulation
• Changes in nipple and overall breast sensation
• Implant rupture and or leakage
• Implant repositioning
• Likelihood of revision surgery

Breast Implants and Cancer

Do breast implants cause cancer? Short answer, yes. The Food and Drug Administration (FDA) initially identified a possible link between breast implants and the development of anaplastic large cell lymphoma (ALCL) in 2011.

The World Health Organization (WHO) has since named this form of cancer breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).

BIA-ALCL is a rare type of non-Hodgkin’s lymphoma (cancer of the immune system) that arises in people with breast implants.

The FDA believes it is more common in patients with textured implants than in those with smooth implants. However, a person’s risk of developing BIA-ALCL is notably low.

BIA-ALCL develops in the fluid or scar tissue near the implant and not in your breast tissue, so it’s not breast cancer. Nonetheless, BIA-ALCL is a serious cancer that can lead to death, so prompt treatment is crucial.

Surgical removal of the implant and surrounding tissue can successfully treat this cancer. But in some cases, chemotherapy and radiation therapy are also needed.

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