Ten years after the initial breast implant surgery, one in five patients may need a revision surgery.

It is recommended to replace the implants if there is a problem. However, with regular monitoring (self-checks and doctor visits), it is not necessary to automatically replace the implants every 10 years.

Additionally, with the recent rise of a new type of implant known as form-stable or “gummy bear” silicone, this situation is changing. These implants are more durable compared to saline and traditional silicone implants. Therefore, the need for revision surgery might be less frequent with gummy bear implants.

The aforementioned time frames pertain to cosmetic breast augmentation surgery. The situation differs for implants used in breast reconstruction. The revision rate for implants used in reconstruction can vary due to the thinning of breast skin after radiation and mastectomy. Ultimately, a doctor’s opinion is crucial in these cases.

For a while, breast implants were only available in round shapes filled with saline or silicone. Over time, both round and anatomical (teardrop-shaped) implants were developed.

Round implants give the upper part of the breast a fuller appearance and can rotate over time—this rotation is not noticeable. Anatomical implants (so named because they resemble the natural teardrop shape of a breast) have a tapered upper part, emphasizing fullness in the lower part of the breast and aiming to better mimic a natural breast appearance. However, if these implants rotate, the change is more noticeable.

The silicone shell of the implant can be textured or smooth. Smooth implants move more easily, and some women believe they better mimic natural breast tissue. Textured implants remain more stable once placed, making rotation and sagging less likely.

We recommend women considering breast augmentation surgery attend their consultation without a predetermined size, shape, or type of implant in mind. It’s good to have an idea of desired details, but a significant part of the plastic surgeon’s job is to determine how to achieve the patient’s aesthetic goals from their current appearance to the desired look. After the examination, the plastic surgeon will identify the most suitable implant shape, placement plan, and size to address your issues, present different alternatives, explain their advantages and disadvantages, and involve you in the decision-making process to determine the ideal option.

One of the most discussed options for breast augmentation is the choice between silicone and saline (filled with saline solution) implants. All breast implants have a silicone outer shell. Whether textured or smooth, the shell is a versatile polymer. It can be beneficial for patients to have some information before consulting their doctor to understand the outcomes of different implant options. Today, saline implants have almost entirely been replaced by silicone (cohesive gel) filled implants in cosmetic breast surgeries due to issues like rippling, leakage problems, and not feeling like real breast tissue when touched. However, they are still frequently used in reconstructive breast surgery after breast cancer.

The incision is made around the nipple to hide the color/texture change between the areola and the rest of the breast. The rate of loss of sensation in the nipple is higher, and there is an increased risk of bacterial infection in the implant.

The recovery time varies from patient to patient, but noticeable reductions in pain can occur after a few days, and swelling can decrease after a few weeks. During your consultation, your surgeon will provide necessary recommendations and specify a recovery period suited to your current condition.

The recovery process after breast augmentation surgery follows specific stages. Initially, the breasts are tight and swollen, and pain may be felt. Significant improvement occurs in the following six weeks. By the end of the three-month period, most of the swelling subsides, and the breasts become softer and appear more natural. This process is directly related to your anatomy. Generally, you will need to avoid work for one week and exercise for six weeks.

If you smoke, it is recommended that you stop smoking at least two weeks before the surgery. Even a single cigarette before surgery can pose a risk. Most plastic surgeons may refuse to perform the surgery if this rule is not followed. Nicotine can constrict blood vessels, resulting in a risky outcome for blood circulation. It can disrupt blood flow to the nipple, causing necrosis (death of tissue). Carbon monoxide can affect the amount of oxygen reaching the healing tissue.

During the recovery period after breast augmentation surgery, some changes need to be made to your daily routine. One of these changes is your sleeping position. The correct sleeping position will help ensure proper healing, allowing patients to return to their normal lives as quickly as possible.

The best sleeping position during the recovery period after breast augmentation is to sleep on your back. Sleeping on your back is crucial during the early stages of healing after breast augmentation. This position ensures that the surgical incisions heal properly.

In addition to sleeping on your back, it is beneficial to prefer a slightly elevated sleeping position during the first few weeks following surgery. Elevating the upper body helps maintain blood flow and reduce inflammation.

To increase breast size and improve their shape, the natural breast augmentation process combines different steps and procedures. First, fat is removed from areas with unwanted fat, such as the hips, thighs, or back, using an advanced liposuction technique. After being removed, the fat is purified and then injected into the breasts to enhance fullness. The natural breast augmentation process is used not only to add volume to small breasts but also to address asymmetry issues caused by breast cancer or for reconstruction purposes.

Breast augmentation via fat transfer or using implants brings several differences. For instance, natural breast augmentation can significantly increase breast size but does so in a more subtle and natural way.

Generally, this procedure results in an increase of about ½ or 1 cup size. Therefore, for larger enhancement goals, surgeries using one of the various types of implants might be a better option.

Another difference is that natural breast augmentation shapes other areas of the body. Hence, this contributes to the overall improvement of body shape, while implants focus solely on breast enlargement.

• It does not require general anesthesia.
• The incisions are minimal.
• There is less scarring.
• The breasts feel and look more natural.
• There is no risk of capsular contracture or rippling.
• Unlike implants, they do not need to be repositioned or removed.
• It has a faster recovery process with a shorter rest period.

Achieving a natural look involves a bit of science and a bit of art. Experienced surgeons assess the patient’s body structure to change the body’s appearance, considering variables like implant size and shape, the amount of natural breast tissue, and implant placement to ensure the final results look as natural as possible. Every woman has unique characteristics, but the following methods help achieve more natural results:

• Placing the implants under the muscle (sub-muscular);
• Choosing medium profile implants;
• Limiting the size of the breast implant to keep the breasts proportionate to the rest of the patient’s body;
• Focusing on limiting the width of the breast implant;
• Using teardrop-shaped implants when patients have little or no natural breast tissue.

Several techniques are used to create a more enhanced appearance. Some of these techniques include:

• Placing the implant over the chest muscle (sub-glandular);
• Choosing high-profile implants;
• Selecting a large-sized implant that is not proportional to the patient’s body.

Ultimately, the patient must decide what type of results they want. However, your surgeon can help and guide you in the decision-making process by determining the type of implant and surgical techniques that best suit your body and desired results.

In addition to determining the type of implant and the method of placement, the surgeon must decide with the patient where the incisions will be made. Most plastic surgeons have a preference, but each woman’s unique circumstances and physiology can be determining factors.

This method is used in the majority of breast augmentation surgeries that do not include a lift. The incision is made in the fold where the breast meets the chest, usually about 4 cm long. It is the most direct path to reach the breast tissue. Since the scars are under the breast, they are not noticeable. Most asymmetries can be corrected this way, and operations like implant removal or replacement can be performed using the same incision site.

The incision is made in the armpit. It hides the scar formation in the breast area, but these scars can still be visible. It makes the procedure more complex because the incision is far from the breast area, and the revision rate may be higher. Additionally, there is an increased risk of loss of sensation in the nipple area and improper implant placement (malposition), which can lead to numbness in the inner arm or asymmetry between the breasts.

This incision is made around the nipple to conceal the change in color/texture between the areola and the rest of the breast. There is a higher rate of loss of nipple sensation, and it may increase the risk of bacterial infection in the implant.

When performed by an experienced cosmetic surgeon, the success rate of breast augmentation surgery is very high. However, like any surgery, breast augmentation is not without risks. Some possible side effects include thick scarring, infection, bleeding, hematoma, capsular contracture, implant rupture, implant rotation, incorrect position displacement (malposition), adverse reactions to anesthesia, and unsatisfactory results requiring additional surgical operations.

As with any surgery, experiencing some pain during the recovery period after breast augmentation surgery is normal. These pains are generally manageable with the correct methods for dealing with pain. For the first 2-3 days, you should take the medications prescribed by your doctor, especially those to control postoperative discomfort.

Some patients may feel discomfort not only in the breast area but also due to tightness and cramps affecting the shoulders, neck, and back. These symptoms are usually controlled with muscle relaxants. Muscle relaxants should not be used with painkillers or at least should be taken an hour apart to avoid drowsiness and lethargy.

Most patients can return to work 5-7 days after surgery. It is advisable to avoid heavy exercises, especially those involving the upper body, for at least three weeks. Light exercises, such as short walks throughout the day, are recommended to facilitate recovery.

Additionally, it is essential to maintain a balanced diet and stay hydrated after the surgery. Wear comfortable clothing and use bras that support your breasts.

As with any surgery, experiencing some pain during the recovery period after breast augmentation surgery is normal. Initially, the breasts are tight and swollen. You should take the medications prescribed by your doctor for the first 2-3 days. Most patients can return to work 5-7 days after surgery. It is advisable to avoid heavy exercises, especially those involving the upper body, for at least three weeks. Significant improvement occurs in the following six weeks. By the end of the three-month period, most of the swelling subsides, and the breasts become softer and appear more natural.

Most women who undergo breast augmentation are in their 20s and 30s. These women should consider potential risks for their baby if they become pregnant after the surgery. Studies have shown that there are no medical risks to babies breastfed by women with saline or silicone breast implants.

Pregnancy causes many hormonal changes in breast tissue, affecting the size, shape, and appearance of the breasts, which can change due to the implants. Breast augmentation surgery does not have a negative impact on future pregnancy or breastfeeding. Since breast tissue is cut and altered during breast augmentation surgery, nipple sensation and breastfeeding may be affected. Plastic surgeons can use specific techniques during the placement of implants to avoid changes in nipple sensation and breastfeeding. These techniques include:

• Making an inframammary incision (under the breast fold) or an axillary incision instead of a periareolar incision (around the nipple)
• Placing the implant under the muscle (subpectoral) instead of under the breast tissue (subglandular)
• Choosing a smaller implant to avoid large incisions and potential damage to the nerves that provide nipple sensation

Breast implants are not expected to last longer than ten years. Like any surgery involving foreign materials, there are some complications associated with breast implants. The most common reasons for needing to replace implants include rupture, leakage, and capsular contracture. If saline implants leak, the saline is reabsorbed by the body, but if silicone implants leak, the leaked silicone gel needs to be removed surgically. Capsular contracture is an abnormal scar formation around the implant that causes pain and hardening of the breast. This condition often progresses, leading to breast deformity and displacement of the implant. Capsular contracture can occur in one or both breasts at any time after the implant is placed. Similarly, rupture and leakage can occur at any time after surgery. The longer the time since the implants were placed, the higher the risk of leakage or rupture, but there is no definitive indication for removing or replacing implants at the ten-year mark. The removal or replacement of breast implants should only be considered if one of these complications occurs. Additionally, routine check-ups are recommended for all women. These routine check-ups include breast examinations, mammography, ultrasound, and MRI, depending on the patient’s age and risk factors for breast diseases. Routine check-ups are necessary to assess the implants and determine appropriate corrective actions.

To prevent rippling after breast augmentation surgery, it is ideal to decide before the surgery which type of implant you need and whether it will be placed under the muscle. The best way to prevent or at least minimize rippling is to place the implant under the muscle, ensure there is enough breast tissue, and avoid over- or under-filling the saline implants if they are chosen. Sometimes, especially for patients with little breast tissue, using silicone implants and placing them under the pectoralis major muscle may be better. If saline implants are used, it is essential to ensure they are filled to the maximum recommended amount, not over- or under-filled. Additionally, using cohesive gel silicone implants instead of saline implants significantly reduces the risk of rippling.

Fat cells can be transferred from one part of the body to another (see Fat Injection). This requires a liposuction procedure, which adds the risks associated with liposuction to the potential complications of breast surgery. However, this method can achieve an aesthetically pleasing breast appearance, especially in the décolletage area, while removing stubborn fat from unwanted areas and creating a beautiful, slim waistline.

As with all plastic surgery procedures, each type of breast augmentation has its advantages and limitations. The feel of saline implants may not be natural, especially if there is minimal breast tissue. However, saline is easily absorbed in case of rupture. Silicone implants have a much more natural feel, but “silent leakage” is possible. Despite being considered safe, the FDA recommends an MRI three months after the implant is placed and then every two years to ensure no rupture. Augmentations using fat transfer may not create as much volume as the patient desires if the body cannot supply enough blood to the transferred cells. In most cases, about 40-50% of the injected fat is “lost,” and most patients do not achieve more than a one-cup size increase. While this does not pose a serious health issue, it may result in insufficient augmentation. Additionally, since fat tissue is liquid, it does not provide structural support and is often used in conjunction with implants in breast augmentation surgeries.