What Happens During Breast Augmentation Surgery
Before diving into implant types, it helps to understand the broader procedure. Breast augmentation surgery is one of the most commonly performed cosmetic procedures in the United States. A surgeon makes a small incision – typically under the breast, around the areola, or in the armpit – and places an implant either beneath the breast tissue or beneath the chest muscle.
The placement, incision location, and implant type all work together to produce the final result. Recovery generally takes one to two weeks before returning to light activity, with full healing taking several months. The implant you choose will affect not only your appearance but also the feel, longevity, and maintenance of your results over time.
Breaking Down the Types of Breast Implants
Understanding the different types of breast implants is essential before making any decisions. Here’s a closer look at the main categories:
Silicone Implants
Silicone implants are the most popular choice among patients in the United States, and for good reason. They are pre-filled with a silicone gel that closely mimics the natural feel of breast tissue, making them a preferred option for women who want results that look and feel as natural as possible.
These implants come in a range of profiles – low, moderate, and high – allowing surgeons to customize the projection and shape for each individual patient. They are FDA-approved for cosmetic augmentation in patients 22 years of age and older and are available in both round and anatomical (teardrop) shapes.
One consideration with silicone implants is that a rupture may be harder to detect than with saline, since the gel tends to stay within the implant shell or surrounding tissue. This is why the FDA recommends periodic MRI screenings to monitor implant integrity.
Saline Implants
Saline implants offer distinct advantages. These implants are inserted empty and filled with a sterile saltwater solution once they are in position. This means:
Smaller incisions are typically required during insertion
The fill volume can be adjusted during surgery for minor asymmetry corrections
A rupture is immediately apparent, as the body safely absorbs the saline
Saline implants are FDA-approved for patients 18 and older, making them accessible to a slightly younger demographic than silicone options. They do tend to feel firmer, and in women with less natural breast tissue, rippling may occasionally be visible or palpable beneath the skin.
Silicone Gel: Cohesive and Gummy Bear Varieties
Not all silicone is the same. The consistency of the silicone gel within an implant can vary significantly, which affects how the implant behaves over time.
Standard silicone gel is a soft material that moves naturally with the body. Highly cohesive silicone gel – the type used in what are commonly called gummy bear implants – is much firmer and holds its shape more rigidly.
Gummy Bear Breast Implants
Gummy bear breast implants get their nickname from the chewy candy they resemble in consistency. These highly cohesive silicone gel implants are form-stable, meaning they maintain their shape even if the outer shell is compromised. They are typically teardrop-shaped, with more fullness at the bottom and a gradual slope toward the top – closely mimicking the natural contour of the breast.
Key characteristics include:
Superior shape retention over time
A firmer feel compared to standard silicone
Lower risk of gel migration in the event of shell rupture
A slightly larger incision required due to their firmer consistency
Potential for rotation, which may require revision surgery if the implant shifts
For women seeking a very defined, stable shape – particularly those undergoing reconstruction or those with minimal natural breast tissue – gummy bear implants can be a compelling choice.
Why Do Many Patients Prefer Saline-Filled Breast Implants?
Shape and Surface Considerations
Beyond fill material, implants also differ in shape and surface texture, both of which matter for long-term outcomes.
Round Breast Implants
Round breast implants are the most commonly used implants in the world. They create fullness across the entire breast, with particular emphasis on the upper pole – the area above the nipple. Because they are symmetrical, there is no concern about rotation affecting the aesthetic outcome.
Round implants come in a wide range of sizes and projections and work well for patients who want a more prominent appearance. They tend to be more affordable than anatomical alternatives and have a longer track record of clinical data supporting their use.
Textured Breast Implants
Textured breast implants have a roughened outer surface, unlike the smooth shell of most round implants. The texture was originally developed to help the implant adhere to surrounding tissue and reduce movement within the pocket.
However, textured implants have faced increased scrutiny in recent years. Some textured implants – particularly those with a macrotextured surface – have been associated with a rare condition called Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). As a result, certain textured implant products have been voluntarily recalled, and many surgeons now use them selectively or have moved away from them altogether.
If you’re considering any implant with texture, a thorough conversation with your surgeon about current safety data is critical.
Working With a Board-Certified Plastic Surgeon
No article can replace a face-to-face consultation with a qualified medical professional. Working with a board-certified plastic surgeon is not just a recommendation; it’s the most important step in your decision-making process.
A board-certified surgeon has completed rigorous training and certification requirements through the American Board of Plastic Surgery, demonstrating competency in cosmetic and reconstructive procedures. During a consultation, they will:
Evaluate your current anatomy, skin quality, and tissue characteristics
Discuss your aesthetic goals and lifestyle factors
Show you before-and-after photos of patients with similar body types
Walk you through the specific implant options best suited to your case
Explain the risks, recovery timeline, and long-term maintenance involved
Choosing a surgeon based solely on price or convenience is a risk not worth taking. Look for board certification, before-and-after portfolios, transparent communication, and a practice that encourages questions rather than discouraging them.
Final Thoughts on Plastic Surgery
Whether you are considering silicone breast implants or structured saline breast implants, the right choice ultimately comes down to your individual anatomy and goals. Breast augmentation patients pursuing purely cosmetic results have different priorities than those undergoing breast reconstruction following breast cancer treatment – the latter often requires a more layered surgical approach and may incorporate a breast lift or even fat transfer breast augmentation to restore natural contours. Traditional silicone gel implants and form-stable implants each bring distinct advantages, and your desired breast size should always be balanced against what your body can support safely and comfortably over the long term.
No conversation about breast implant surgery is complete without addressing risk. During implant insertion, a surgeon creates a breast implant pocket in which the implant is seated, either above or below the muscle. Over time, the body may respond by forming scar tissue around the implant, a process that in some cases leads to capsular contracture, one of the more widely discussed complications of breast surgery. Smooth implants and silicone-filled implants each carry their own risk profiles, and growing awareness around breast implant illness has prompted serious ongoing research into breast implant safety. The outer silicone shell of modern implants has improved considerably, but every patient deserves a comprehensive risk conversation before committing to any breast implant procedure.
Advances in aesthetic plastic surgery mean that this surgical procedure is more refined and more customizable than ever before. From decisions about the breast implant pocket technique to implant type and profile, every detail is designed with patient outcomes in mind. Breast augmentation patients today are better supported than at any previous point in history. Whether your path leads to silicone, saline, a breast lift, or another approach entirely, the most important step you can take is working with a surgeon who places your long-term health and satisfaction at the center of every decision.
About the Author
darryl J, blinski md
With over 47 years of experience, Dr. Blinski is recognized as one of South Florida’s leading plastic surgeons.
