Breast implants remain a common option for breast reconstruction after mastectomy and for cosmetic augmentation. Current practice uses saline or cohesive silicone gel implants, sometimes after tissue expansion. Risks include infection, capsular contracture, rupture, and a rare lymphoma (BIA-ALCL) associated mainly with textured implants. Implants are not lifetime devices; regular follow-up and individualized imaging schedules are recommended. Alternatives such as autologous reconstruction exist, and shared decision-making with a board-certified plastic surgeon is essential.
What breast implants do and who chooses them
Breast implants restore or change breast size for two main reasons: reconstruction after cancer surgery and cosmetic augmentation. Women who have had a mastectomy often choose implants to rebuild breast shape. Others choose implants to increase size or correct asymmetry.Types of implants and how they're placed
Two common fill types are saline (sterile salt water) and silicone gel. Modern silicone implants use a cohesive gel that holds its shape. Surgeons place implants either under the breast tissue or beneath the chest muscle, depending on anatomy and the goals of reconstruction.For many post-mastectomy reconstructions, surgeons use a two-stage approach. They first insert a tissue expander - a balloon-like device placed under the chest muscle. The surgeon adds saline to the expander through a port over weeks or months to stretch the skin and muscle. After adequate expansion, they replace the expander with a permanent saline or silicone implant.
Some women have immediate reconstruction (implant placed at the time of mastectomy). Others wait until after cancer treatment. Autologous flap reconstruction (using a patient's own tissue) is an alternative to implants and may suit some patients better.
Risks and long-term expectations
All implants carry risks: infection, bleeding, implant rupture or deflation (saline), rippling, asymmetry, and scarring. A common complication is capsular contracture - hardening of scar tissue around the implant that can cause firmness or distortion.Regulatory agencies and medical societies have identified a rare lymphoma linked mainly to textured-surface implants, called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Certain macrotextured implants were removed from the market in recent years. Your surgeon will discuss surface types and risk.
Implants are not lifetime devices. Many people need replacement or removal years after the original surgery because of rupture, cosmetic change, or personal preference.
Follow-up and monitoring
Regular follow-up with your surgeon matters. For silicone implants, manufacturers and regulators recommend routine clinical exams and imaging when indicated to check for silent rupture or other issues. Ask your care team what imaging schedule and signs to watch for after reconstruction or augmentation.Recovery and outcomes
Recovery time varies by procedure: simple augmentation usually has a shorter recovery than reconstruction after mastectomy. Physical therapy and scar care can improve comfort and range of motion. Many women report improved body image and quality of life after reconstruction, and patient forums and resources (for example, breastcancer.org) offer photos and peer experiences to help set expectations.Making the decision
Discuss goals, health history, cancer treatments, and alternative options (including flap reconstruction) with a board-certified plastic surgeon. Informed consent should cover risks, likely outcomes, and timelines for future monitoring and possible reoperation.- Confirm current FDA/manufacturer recommended imaging schedule for silicone implants (timing and modality) and update patient guidance accordingly.