Breast implants give you more control over your size, shape, and profile. Implant plastic surgery can improve appearance after aging and childbearing, and restore a more youthful appearance. Note: Sagging breasts require a breast lift, which can be performed with or without implants.

In breast augmentation with implants (augmentation mammoplasty), the implants are inserted behind breast tissue or above the breast muscle. Implants range in volume from 120 mls to 850 mls. You can view examples in our breast augmentation before-and-after photos. In addition to the volume range, implants vary in shape, profile, outer thickness, and outer surface layer.

Some women feel that silicone implants are smoother and softer than saline-filled implants. These implants feel like a semisolid gel. Because of their smooth surface, silicone implants are often preferable for women who have little breast tissue, particularly for women undergoing breast reconstruction.

Breast implant surgery can enhance the size and shape of your breasts. Because of improvements in surgical methods and breast-implant technology, this procedure has become more refined, providing better post-surgical results than years ago. This procedure may be combined with a breast lift to provide a fully satisfactory outcome.

Breast implants come in many sizes and shapes. The type of breast implant that you choose for surgery should be based on your desired change in profile and cleavage. Factors include positioning, surface texture, shape, personal anatomy and other considerations.
Breast implants come in many varieties, including

• Implant Surface - smooth or textured
• Implant Shape - round or shaped
• Implant Profile - how far the implant protrudes
• Implant Size or Volume - size typically ranges from 120 to 850 cc
• Implant Filler - saline or silicone

Implant Material - "anatomy" of the implant

The type of breast implant you choose is based on your profile and increased-size goals, as well as other individual and anatomical factors. For example, you may want to restore your breasts to a pre-pregnancy or pre-breastfeeding appearance (which may mean that you will also need a breast lift to treat the sagging appearance), or increase the size of genetically smaller breasts.

The surface of the implant is important for a number of reasons. Implants with textured surfaces were designed to reduce the chance of capsular contraction.

However, textured implants are more likely to be visible through the skin, depending on the implant placement.

The shape, profile, and volume of the implant should be selected based on your breast-line goals. These factors are also affected by the implant placement. For example, a contoured breast shape may appear more rounded if the implant is placed in the full sub-muscular or partial sub-muscular position. Shell thickness may also be an important consideration depending on placement.

Making a choice may seem overwhelming when you first investigate all the factors involved. Here is a good way to start putting the pieces together:

• Implant Anatomy fills you in on choices of material.
• Saline vs. Silicone helps you understand these two main types of implant filler.
• Implant Placement explains why certain locations for the implant work better for certain situations.
• Implant Incision describes scarring differences and other incision concerns.
• Two articles, Side Effects and Complications, help you understand various risks.

There are many types of breast implants to choose from., the main components of breast implants include

• the shell (the outside layer, sometimes called the envelope or lumen)
• the filler (inserted into the shell)
• the patch (covers the hole where the filler is inserted into the shell)

Typically the shell is made of a single layer ("single lumen"), but some implants have a double layer — a shell within a shell ("double lumen").

Both silicone and saline implants have an outer shell made of silicone-rubber material. But when someone refers to a "silicone breast implant," they mean the filler of the implant, not the shell. The two types of implants used in the United States are

saline filled, silicone-rubber shell
silicone gel-filled, silicone-rubber shell

Currently, the use of silicone gel-filled implants is limited to patients requiring reconstructive or revision breast surgery.

Generally, the silicone-rubber shell is made of

• Cured long strands of silicones
• Approximately 20 percent finely powdered silica tightly bound to the silicone polymers
• Small amounts of other materials

Saline implants are filled with a sterile saline solution — the same type of salt water used in general surgery and for other internal purposes.

There are several types of saline-filled breast implants. These types vary depending on whether saline is prefilled before breast surgery or is filled during surgery, and whether the volume of the implant is adjustable.

Common saline implants:

Single lumen ("lumen" is the outside shell) — prefilled at the factory to a fixed volume. There are no valves for filling during surgery or for adjusting after surgery.

Single lumen — filled with a fixed volume of saline during surgery through a valve. After surgery there are no adjustments to the implant volume.

Single lumen — filled during surgery. After surgery, the volume of the implant can be adjusted by adding or extracting saline through a valve in the implant.

The filler in silicone gel-filled breast implants is composed of silicone oil, cured large silicone, a small amount of uncured silicones, and other materials. Silicone is a very safe compound and has been widely used in a number of medical applications for many decades.

There are several types of silicone-filled breast implants:

Single lumen — prefilled by the manufacturer to a specific volume of silicone gel.

Double lumen — the inner lumen is prefilled by the manufacturer to a specific volume of silicone gel. The outer lumen is filled during the breast augmentation procedure with a fixed volume of silicone gel using a valve in the implant.

Double lumen — the outer lumen is prefilled at the manufacturer with a fixed volume of silicone gel, while the inner lumen is filled during the procedure through a valve in the implant. This third type allows for adjustments to the filler volume after surgery.

The fourth type of silicone implant may appear to have no shell — looks and feels like a semi-solid rubber gel.

Saline breast implants have been considered advantageous because if ruptured, the saline can be easily dissolved by the body. A disadvantage is that saline implants are more likely to show ripples through the skin. This article explores the differences, pros, and cons of saline and silicone implants.

Lawsuits against the manufacturers of silicone breast implants in the early 1990s caused a closer inspection of the safety of silicone implants. The Food and Drug Administration (FDA) removed silicone-filled breast implants from the market in 1992. This left only saline-filled implants available to the public. From 1992 to 2005 investigators involved in clinical studies — who were evaluating the use of silicone implants for reconstructive and revision surgery — were the only ones allowed to use silicone breast implants. According to the American Society for Aesthetic Plastic Surgery, surveys in 2005 showed that 83.4 percent of respondents used saline and 16.6 percent used the silicone implant. In November 2006 the FDA lifted restrictions, and approved the use of silicone breast implants for women who are at least 22 years old.

An advantage of saline breast implants is that, if ruptured, the saline (salt solution) is dissolved by the body. A disadvantage is that saline implants are more likely to show ripples in the implant or the implant itself may appear less natural in small-breasted or reconstructive patients. This is especially important for very thin women who have little breast tissue to cover the implant, or for women who have a breast injury or need breast reconstruction. The small ripples in the implant may be more likely to show through the skin in these women.

Breast implants are placed in the breast in one of three different ways:

• Subglandular implant placement
• Partial submuscular implant placement
• Complete submuscular implant placement

These placements vary from shallow (subglandular) to deep (complete submuscular). The optimum implant location depends on the size of the breast implants, your anatomy, and other factors related to your goals and expectations.

Implants are inserted behind the breast tissue, or above the breast muscle, through carefully placed incisions. Since breast augmentation is performed for cosmetic reasons, you and your surgeon will select an incision location that will be as inconspicuous as possible. Incision location is also based on individual anatomy, your desired outcome, and the size and shape of the breast implants. There are four main types of incisions used during breast augmentation:

Inframammary Incision
The inframammary incision (crease or fold incision) is placed near the crease where
the breast and chest come together.

Peri-areolar Incision
The peri-areolar incision (nipple incision) is placed along the outline of the areola, or the brown or pink pigmented region surrounding the nipple.

Transaxillary Incision
The transaxillary incision (transax or armpit incision) is placed in the natural folds of the skin of the armpit.

TUBA Incision
The TUBA incision (belly button, navel, or transumbilical incision) is made within the navel.

As with any surgery, breast augmentation surgery has some associated risks. Though infrequent, complications can result in further treatment or a longer recovery. Risks associated with breast implant surgery could include obstructed mammography, breast feeding issues, infection, and possible implant leakage. This article presents several types of side effects that you should know about.

The type of breast implant you choose is based on your profile and increased-size goals, as well as other individual and anatomical factors. For example, you may want to restore your breasts to a pre-pregnancy or pre-breastfeeding appearance (which may mean that you will also need a breast lift to treat the sagging appearance), or increase the size of genetically smaller breasts.

Many breast implant patients successfully breastfeed; however, breast implants may interfere with breast feeding. Tell your plastic surgeon about plans to breastfeed because it may impact the surgical technique.

There is a risk that breast implants may impede breast cancer detection. During mammography, X-ray, or ultrasound the implants could hide suspicious tumours or lesions. Treatment providers must take special care of breast-implant patients during breast exams. Additional views are required, which take additional time for imaging. When you make a mammography appointment, tell the receptionist about the implants so they can schedule the extra time.

The radiologist needs to use special imaging: "Eklund displacement views." Eklund views maximize what is seen of the breast tissue to better detect tumours or lesions. Eklund views are done in addition to the standard views.

Just before the actual mammograms begin, tell the radiology technician about the breast implants. This helps ensure that the technician includes Eklund displacement views in the examination.

Mammography also compresses the breasts, which increases the chance of a rupture.

After breast surgery, some implant patients experience loss of sensation in the nipple and breast area. Loss of sensation results from damage to nerve endings in the breast and nipple. The loss of sensation is often temporary, but it can be permanent. The surgical technique can play a role in this complication. Your surgeon can determine the most appropriate implant and surgical technique to minimize loss of sensation.

There have been studies of possible harmful effects of breast implant materials leaking or leaching into the surrounding breast tissue. The studies concluded that there is insufficient evidence of harmful effects for implant materials that are approved by the FDA. These FDA-approved materials are also widely used in other types of medical implants, including pacemakers, intraocular lenses, artificial joints, and other medical devices.

No implant will last forever. Implants can break or rupture, causing deflation. Many ruptures result from the natural aging of the implant, excessive compression to the breast, or trauma to the breast. The most noticeable effect is that the size and shape of the breast change. Depending on the size of the rupture, changes in breast appearance can occur over a few days or over a very long period of time.

Mammography sometimes compresses the breast implant enough to cause rupture. According to the FDA and medical literature, there were reports of 58 breast implant ruptures during mammography from 1992 to 2002. Technicians must take special care to ensure that excessive pressure is not placed on the breasts.

Typically, surgery is needed to remove a deflated breast implant. Most women decide to have the implants replaced. For those women who do not have their implants replaced, dimpling or puckering of the breast may appear following removal.

The type of breast surgery also influences cost. There are a number of different methods for the breast implant procedure.    Some implant techniques are easier and less time consuming. The type of anaesthesia used will impact the cost as well. General anaesthesia (you are asleep) is more costly than a local anaesthetic (you are sedated but remain awake).