What is breast implant surgery?
Breast implants, either filled with saline or silicone gel, are designed to augment your breast size and enhance their contour. These implants can also play a critical role in reconstructing breasts following a mastectomy or lumpectomy.
Pioneered by plastic surgeons, Thomas Cronin and Frank Gerow, the first silicone breast implants emerged in 1961. A year later, in 1962, a woman named Timmie Jean Lindsey became the first to experience a breast augmentation using the Cronin-Gerow implant. Since these initial developments, breast implant surgery has ascended as one of the most sought-after surgical procedures across the globe.
Despite their popularity, breast implants have faced their fair share of contention due to associated health risks. Although numerous extensive studies have yet to definitively link breast implants to systemic disease, a connection between implants and BIA-ALCL has been acknowledged by the TGA. In a 2019 statement, the TGA confirmed an association between predominantly textured breast implants and a rare type of lymphoma, breast implant-associated anaplastic large cell lymphoma, known as BIA-ALCL.
While research into the safety of breast implants continues, recently we have seen significant advancements in breast implant technology. These improvements have led to more natural-looking options that carry less risk.
The current market offers a wide variety of implants, with hundreds of different sizes, shapes, and designs available. These choices directly influence the final appearance and feel of your enhanced breasts.
What are the pros & cons of getting breast implants?
- Silicone gel and saline-filled implants are both capable of increasing breast size, enhancing their position, amplifying fullness, and promoting symmetry.
- These implants can rectify tuberous breasts or act as a solution for breast reconstruction post-mastectomy.
- The placement, size, and form of the implant can be tailored to match your body structure and individual preferences, leading to very natural-looking outcomes.
- 95% of breast implant surgery patients deem the procedure worth the money, which is considerably higher than that of fat transfer breast augmentation patients.
- A majority of patients reported a surge in their self-confidence post-surgery.
- Possible complications include implant rupture and leakage, and there can also be cosmetic concerns such as asymmetry, capsular contracture, rippling, or 'bottoming out' (a condition where the implant slides down the chest wall and shows below the natural breast crease or drags the breast tissues down), which may necessitate revision surgery.
- Breast implants are not designed to last forever. Regular monitoring and follow-up appointments are necessary, and at some point, it is likely that the implants will need to be replaced.
- Some patients who deemed their procedure as not worth the money, expressed regret over their choice of size, shape, or implant type. Others were dissatisfied with the scarring or asymmetrical outcomes of their breast implant surgery.
A seasoned, board-certified plastic surgeon can provide guidance on whether you are a suitable prospect for breast implants, or if an alternate enlargement method might be better. When selecting a surgeon, take a thorough look at their before & after photos of breast implant surgeries and reviews from their customers.
Different types of breast implants and how to choose one
During your preliminary consultation, your surgeon will assist you in selecting the implant size and shape that best aligns with your desired results. They will also provide you with an account of the pros & cons associated with different kinds of implants, such as silicone vs. saline and smooth vs. textured implants.
Silicone vs Saline Implants
Silicone implants, comprising of a silicone implant case and interior, are the most common breast implant used for augmentation.
- Tightly compact silicone breast implants are filled with a dense silicone gel.
- 'Gummy bear' implants are firmer and more rigid, maintaining their shape effectively over a longer period. They can be either round with a smooth exterior or teardrop-shaped with a textured surface to prevent rotation or misplacement.
Saline breast implants consist of a silicone outer filled with sterile saltwater.
- These implants can either be filled before or after placement, allowing for smaller incisions and scars.
- Saline implants tend to be less costly than their silicone counterparts.
- All saline breast implants have a smooth exterior.
When asked about which type of breast implant feels the most natural, surgeons commonly agree that silicone best replicates the weight and feel of natural breast tissue.
Textured vs Smooth Implants
According to the leading implant manufacturers 90% of silicone breast implants used have a smooth shell, with only 10% being textured.
- Smooth implants have an outside silicone cover, allowing them to move freely among the breast tissue, or the pocket scar tissue that naturally develops around the implant.
- Textured implants feature an uneven surface, akin to soft rubber sandpaper, which adheres to the tissue, thereby reducing movement. Some implants are very textured, while others only have light texturing.
Textured implants were believed to be less likely to result in capsular contracture - a condition where an unusually hard capsule of tissue constricts around the implant, leading to malformation and breast pain. However, new research presents conflicting evidence, and many plastic surgeons no longer hold the view that textured implants consistently lower the risk of capsular contracture.
The popularity of textured implants has declined since 2019 when the TGA highlighted the increased risk associated with textured implants and anaplastic large cell lymphoma (BIA-ALCL), a rare immune system cancer. Nonetheless, some surgeons continue to endorse lightly textured implants, which have demonstrated lower ALCL rates compared to highly textured implants.
Implant Shape, Size, and Projection
More and more plastic surgeons now offer 3D visualisation during breast implant consultations, allowing you to envisage the results of various sizes, shapes, and projections on your body.
- Round implants provide more 'upper fullness' at the top of the breast for improved cleavage.
- Tear drop-shaped implants mimic the natural shape of the breast, narrow at the top and broader at the bottom. These types of implants have textured surfaces to maintain their position. They are also pricier than round alternatives.
- Breast implants are available in a wide range of sizes, measured in cubic centimetres (ccs). An implant 125cc to 200cc can raise breast volume by approximately one cup size.
- Your body proportions and ideal outcome will decide your implant size.
- Surgeons generally recommend against choosing overly large implants, as they can lead to neck and back pain. Over time, larger, heavier implants can also stretch the breast tissues.
- The projection or profile of an implant, low, medium or high, describes the degree of protrusion from the chest.
- The size and width of your chest will determine your implant’s projection.
How much do breast implants cost?
Average Cost: $9,750
Range: $5,300 - $15,050
The total cost of your breast implant surgery is influenced by various aspects, including the kind of implants you select, the proficiency of your surgeon, the location of the operating theatre, and the type of anesthesia used.
When a breast implant operation is undertaken as an optional aesthetic procedure, it typically falls outside the scope of Medicare and private health insurance coverage.
To alleviate the financial burden, many providers allow instalment arrangements or approve financing alternatives like Afterpay, making the procedure more accessible.
How do you prepare before breast implant surgery?
Before undergoing your breast implant surgery, it is critical to share your complete medical history with your plastic surgeon. They might need medical examinations to confirm your fitness for the operation.
Your surgeon's role also includes helping you select implants, deciding whether to position them underneath or above the chest muscles and providing guidance on the location of the incision.
You should receive comprehensive pre-surgery instructions from your surgeon, including:
- Abstaining from smoking for a minimum of 2 weeks prior to the operation
- Avoiding blood-thinning supplements that could affect bleeding - for a few days before the surgery
- Arranging for a reliable person to transport you home and provide assistance for the initial few days post-surgery
To ensure a smoother recovery, some patients suggest:
- Procuring all prescribed medications in advance
- Having at your disposal ice packs, button-down shirts, and pre-prepared meals
- Organizing childcare and pet care for at least the first week of your recovery period.
What happens during breast implant surgery?
Conducted under either general or local anesthesia with IV sedation (also known as twilight anesthesia), this outpatient surgical procedure lasts approximately 60 minutes.
Once you are comfortably anesthetized, your surgeon employs one of several incision methods.
- Short incisions, approximately 1-2 inches long, are created beneath each breast, just slightly above the breast crease
- This is the preferred technique due to the crystal-clear visibility it provides to the surgeon as they position the breast implant.
- It is believed to have the least bacterial load naturally, thus decreasing complication risk.
- The resulting scars are conveniently tucked away under the breast crease.
- Incisions are made where your natural skin tone meets the darker pigmentation at the bottom of the areolar.
- There is a higher risk for complications such as capsular contracture as this approach involves opening bacteria-dense milk ducts.
- The size of the silicone implant that can be utilized with this technique is restricted.
- Incisions are made inside the armpit, eliminating any scarring on the breast.
- This technique is endoscopic, meaning your surgeon constructs a pocket and inserts the implant with the aid of a miniature camera.
- This method could potentially result in more bleeding and trauma due to the limited visibility.
- Similar to the periareolar technique, there are bacterial considerations and size limitations for implants.
Transumbilical or TUBA Breast Implant Method:
- This technique, rarely employed due to its lack of precision and control, involves a single incision in the belly button and is only suitable for saline implants.
- As an endoscopic procedure, it involves moving the saline implants through a subdermal tunnel to the breast location, where they are subsequently filled.
- Its primary advantage is the minimal scarring left behind.
Following the incision, your surgeon carves a pocket in the breast tissue to accommodate the implants. A touchless technique, often facilitated by a Keller funnel, is typically used to limit bacterial contamination and possible complications.
The surgeon can place the implant either over the muscle (subglandular), under the muscle and fascia (submuscular, also known as dual plane), or under the fascia (subfascial). Each of these methods has specific benefits and drawbacks:
Subglandular (Above Muscle) Implant Placement:
- Advantages include a less invasive procedure and faster recovery.
- It can also help circumvent the necessity for a breast lift in patients with mild sagging.
- On the downside, the implant tends to be more visible, particularly in lean individuals, potentially leading to a less natural look.
- It may also complicate mammographic imaging interpretation
- Lastly, it can increase the risk of capsular contracture.
Submuscular (Below Muscle & Fascia) Dual Plane Placement:
- Comparatively, this method usually results in a softer, more natural appearance.
- Mammogram image interpretation is more straightforward.
- It is linked with fewer incidences of capsular contracture.
- This is a more invasive approach with an extended recovery period and increased postoperative pain.
- It may also result in an animation deformity, a condition where breast shape changes when the pectoralis muscles tense.
Subfascial (Under the Fascia) Placement:
- A 2020 review in the Aesthetic Surgery Journal associated this placement with no animation deformity and an “extremely low rate of capsular contracture.”
- It is a more invasive procedure than subglandular placement.
- Despite being introduced in 2001, it is still quite rare, and your surgeon might not offer this option.
Following implant placement, your surgeon sutures layers of internal stitches to support your breast tissue.
Your doctor may also administer long-acting analgesics like Bupivacaine into the muscle to alleviate postoperative discomfort and bypass the need for narcotics. Surgical drains may be inserted to facilitate fluid removal during healing.
Once the effects of anesthesia have subsided, you'll be able to return home. Your breasts will be covered in medical dressings and comfortably supported by a specially designed bra.
How long does it take to recover from breast implant surgery?
The duration of recovery post-surgery can span anywhere from a single day to a full week, contingent on the specific details of your procedure and the surgeon's technique.
Some surgeons promote the concept of 'rapid recovery breast augmentation', a seemingly marketing-oriented term that is actually rooted in science and comprises a sequence of steps. The primary goal of this approach is to decrease bleeding and tissue damage during the implantation, which in turn lessens post-operative inflammation, discomfort, and potential infection risks.
Here are a few key points to remember:
- In the initial days following the procedure, you may experience swelling and tenderness in your breasts, for which your surgeon may prescribe pain relievers, muscle relaxants, or sleep-inducing medications.
- Surgical drains installed during the operation require removal 1 to 2 weeks post-surgery.
- Depending on your individual healing progress, you will be advised to refrain from vigorous activities, including lifting anything over 5kgs, for a period ranging from 2 up to 12 weeks.
- On the day after the surgery, doctors typically recommend patients shower and start range-of-motion exercises involving their arms and shoulders.
- You will be required to wear a specially designed supportive bra for a minimum of 6 weeks while being mindful of your incisions to prevent detachment or infection.
Once the incisions have healed adequately, you can utilize a silicone scar gel, to help lessen discolouration and smooth out raised scars.
When do you start seeing breast implant results?
A transformation in size and shape will be immediately noticeable post-surgery. However, for the intended look and feel to fully manifest, it takes time for your tissues to adjust, your muscles to relax, and your breasts to descend and soften.
Initially, breast implants tend to position themselves high on the chest. Over time, they gradually descend and fill out, a process often referred to as "drop and fluff." The majority of this dropping typically occurs within the first 3 months post-surgery. However, achieving your final desired result can take anywhere from 6 months to a year.
How long do breast implant results last?
Traditionally, it was recommended that breast implants be replaced every decade. However, most modern plastic surgeons suggest that unless complications arise or you desire a change in size, shape, or implant technology, there's no urgent need for a routine replacement schedule.
Leading implant manufacturers provide warranties, with many offering a lifetime guarantee for instances involving rupture.
Are breast implants safe? What are the risks and side effects?
Breast implant surgery, like any major operation, carries inherent risks such as adverse reactions to anesthesia, bleeding, infection, and pain.
Certain risks, however, are unique to the breast implant procedure. During your consultation, your board-certified plastic surgeon is expected to discuss a comprehensive list of potential risks and complications, including:
- Capsular contracture
- 'Bottoming out' of the implant
- Visible rippling
- Implant rupture or leakage
- Loss of nipple sensation
- Discomfort in the breast area
- Symmastia (also known as 'uni-boob')
- BIA-ALCL, a rare lymphoma linked to textured implants, typically alongside chronic swelling and discomfort
- Breast implant illness (BII)
Some of these complications may necessitate the surgical removal of the implant, with or without subsequent replacement.
A detailed list of potential complications associated with breast implants can be found on the TGA's website. Additionally, a complete list of risk and complications is provided in the patient information materials before your breast implant surgery.
In recent times, there has been an uptick in patients reporting Breast implant illness (BII), gaining traction from social media support groups where patients attribute various health issues to their implants.
Although BII is not officially recognized as a medical condition and there are no specific tests for it, frequently reported symptoms include fatigue, cognitive impairment, musculoskeletal pain, hair loss, weight fluctuations, and anxiety/depression.
Continual monitoring of implants is crucial for maintaining breast health. To detect silent ruptures of silicone implants, doctors recommend routine screening through ultrasound or MRI.
Moreover, regular mammograms remain essential for breast cancer detection. When booking your appointment, make sure to mention that you have implants. Ensuring that the medical staff have the necessary experience and the facility is adequately equipped to evaluate your breast health accurately without risking implant rupture.
Can breast implants cause cancer?
Yes, there are indeed certain situations where implants can cause cancer. One such risk associated with implants having a textured silicone outer is breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). This rare immune system lymphoma typically occurs in the scar tissue and fluid surrounding the implant.
As of January 2021, the Australian Society of Plastic Surgeons (ASPS) reports 993 confirmed cases of BIA-ALCL Globally.
Given that roughly 30 million women have textured implants, the risk is generally considered low, estimated between 1 in 2,800 to 1 in 35,000 patients, according to ASPS figures. However, some patient advocates suggest that these rates might be underreported.
On their own accord, Allergan voluntarily recalled its macro-textured breast implants in July 2019, given their strong link to BIA-ALCL.
To mitigate your ALCL risk, consider 'microtextured' or smooth implant alternatives with your plastic surgeon.
TGA warns breast implants linked to new types of cancer
In September 2022, the TGA issued a public alert about new types of cancer linked with both smooth and textured breast implants: breast implant-associated squamous cell carcinoma (BIA-SCC) and various forms of lymphomas (excluding BIA-ALCL).
In March 2023, the American Regulator the FDA stated, from the published literature, the FDA has become aware of 19 cases of SCC in the capsule surrounding the breast implant. Reports in the literature have linked the disease's progression to fatalities. Despite occurrences of SCC in the capsule around the breast implant potentially being rare, the cause, incidence, and risk factors remain undetermined.
Most of these SCC cases also presented breast swelling and/or pain. Further reported symptoms include skin discolouration and the presence of lumps.
Can you breastfeed after getting breast implants?
In the event you conceive after your breast implant surgery, the possibility to breastfeed typically remains viable in most situations.
Regardless of whether your implants are positioned subglandularly or beneath the muscle, it should not impede your breastfeeding ability.
However, combining breast implants with nipple surgery may potentially harm the milk ducts, hence it is recommended to postpone such procedures until after breastfeeding.
Pregnancy, along with the accompanying weight fluctuations, can alter breast size and shape. To maintain your surgical results, it is advisable to hold a stable weight and avoid pregnancy until 2 years after your breast surgery.
What are the best alternatives to breast implants?
Breast lifts are procedures designed to reshape breasts that have sagged or become asymmetrical due to age, pregnancy, or weight loss.
In contrast, fat transfer breast augmentation involves extracting fat from areas like your hips, thighs, or abdomen via liposuction, which is then transplanted to your breasts to improve their size and contour.
The advantage of this approach lies in using your own tissue for breast volumization. However, the potential downside is that it cannot provide the same level of enhancement achievable with an implant.
Generally, fat transfer can increase breast size by 1 to 2 cup sizes, also offering body contouring benefits due to the liposuction process used to extract the fat. This method tends to be pricier than implants, as it necessitates an extra liposuction step.
Sources & Studies
Australian Society of Plastic Surgeons 2022, BIA-ALCL, BIA-SCC, and other various cancers, Australian Society of Plastic Surgeons, viewed 28 June 2023, <https://plasticsurgery.org.au/protecting-patient-safety/bia-alcl/>.
Chacko, A & Lloyd, T 2018, ‘Breast implant-associated anaplastic large cell lymphoma: a pictorial review’, Insights into Imaging, vol. 9, no. 5, pp. 683–686, viewed 28 June 2023, <https://insightsimaging.springeropen.com/articles/10.1007/s13244-018-0652-z>.
Gould, DJ, Shauly, O, Ohanissian, L & Stevens, WG 2020, ‘Subfascial Breast Augmentation: A Systematic Review and Meta-Analysis of Capsular Contracture’, Aesthetic Surgery Journal Open Forum, vol. 2, no. 1, viewed 28 June 2023, <https://academic.oup.com/asjopenforum/article/2/1/ojaa006/5724437?login=false>.
Therapeutic Goods Administration 2019a, Allergan macro-textured breast implants and tissue expanders, Therapeutic Goods Administration (TGA), viewed 28 June 2023, <https://www.tga.gov.au/news/product-recalls/allergan-macro-textured-breast-implants-and-tissue-expanders>.
― 2019b, Update on safety and performance concerns of suspended breast implants, Therapeutic Goods Administration (TGA), viewed 28 June 2023, <https://www.tga.gov.au/news/safety-alerts/update-safety-and-performance-concerns-suspended-breast-implants>.
― 2022, Breast implants: Report of squamous cell carcinoma and various lymphomas in scar tissue around breast implants, Therapeutic Goods Administration (TGA), viewed 28 June 2023, <https://www.tga.gov.au/news/safety-alerts/breast-implants-report-squamous-cell-carcinoma-and-various-lymphomas-scar-tissue-around-breast-implants>.
U.S. Food & Drug Administration 2023, ‘UPDATE: Reports of Squamous Cell Carcinoma (SCC) in the Capsule Around Breast Implants - FDA Safety Communication’, FDA, viewed 28 June 2023, <https://www.fda.gov/medical-devices/safety-communications/update-reports-squamous-cell-carcinoma-scc-capsule-around-breast-implants-fda-safety-communication>.