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Breast implants are a hugely popular option for augmentation with a high satisfaction rate. And it takes a lot to get from the hundreds of options available to the perfect pair for you. From construction and transportation to placement and beyond, this is the life cycle of the modern implant.
Featured Experts:
- Dr. Kelly Killeen, double board-certified plastic surgeon and contracted Natrelle partner
- Bradley Bengtson, MD, is a board-certified plastic surgeon in Grand Rapids, MI
- Raman C. Mahabir, MD, is a board-certified plastic surgeon in Tuscon, AZ
- Philippe A. Capraro, MD, is a board-certified plastic surgeon in Denver
- Robert Singer, MD, is a board-certified plastic surgeon in San Diego
- David Shafer, MD, is a board-certified plastic surgeon in New York and contracted Natrelle partner
- Sandhya Pruthi, MD, is a professor at the Mayo Clinic College and past director of the Breast Diagnostic Clinic at Mayo Clinic
The Importance of Implant Choice
“Implant choice is more than just choosing a cup size,” explains Beverly Hills plastic surgeon and Natrelle partner Kelly Killeen, MD. “The key to a beautiful result is an implant choice that fits your anatomy.”
Grand Rapids, MI plastic surgeon Bradley Bengtson, MD agrees. “I would probably argue that it’s the most important aspect,” he says. “Because ultimately at the end of the day, if you experience something that’s different than what you were picturing, the procedure can be a technical success but it can be a failure as far as not meeting patient outcome.”
By offering patients a selection of implant choices within a range appropriate for their frame, practitioners can help meet patient expectations while ensuring a proper, natural fit.
Tuscon, AZ board-certified plastic surgeon Dr. Raman C. Mahabir emphasizes the importance of proper measurement to determine your anatomical fit. “Your plastic surgeon will take the full measurements of your chest and breasts to get what’s called the footprint or the base diameter of your breasts,” he explains. “Everyone is different, so you have to respect the width of your chest.”
What are implants made of?
When measurements like chest wall width and the weight of the implants are taken into account, you still have your choice of look and feel. All four breast implant manufacturers approved by the FDA for use in the U.S. have a variety of widths, projections and gel firmness.
“There are two main types of implants,” says Denver plastic surgeon Philippe A. Capraro, MD. “Those are saline implants, which are filled with salt water, and silicone implants, which are made these days with a thick, cohesive gel.”
“Typically today we are using a lot of gel implants,” Dr. Bengtson says. “We are several generations into implants now. The shells are very strong, the gels are very thick. The gel is so thick that you can cut the implant in half and all the gel stays inside the implant shell.”
“Natrelle provides both silicone and saline implants,” says New York plastic surgeon and Natrelle partner David Shafer, MD. “Their silicone implants come in varying levels of gel cohesivity, often referred to as ‘gumminess,’ allowing patients to select the feel and shape that best suits their aesthetic goals.”
How are breast implants chosen?
“To help patients make the most informed decision, I encourage patients to use advanced tools like the Natrelle 3D Visualizer App, powered by Crisalix, which allows them to see potential outcomes based on different implant options,” says Dr. Shafer. “This interactive technology helps [a] patient visualize their post-surgery appearance via 3D simulation, making it easier to understand how different implant sizes, profiles and gel cohesivity levels will appear on their natural anatomy.”
Dr. Capraro explains that when an implant is chosen, he places an order with the brand manufacturer for a few different options. “When I order implants, I also order options that are slightly smaller and slightly larger, in differences of maybe an ounce at most—this is just in case we discover an issue with sizing,” he explains. “I also get three of each size of implant, just in case an implant is dropped or its sterility is otherwise compromised.”
And, in case you didn’t know, implants are typically hand-made devices. For example, the Natrelle hand-crafted implants take 12 days to manufacture.
How are breast implants stored and transported?
“Breast implants are delivered in sterile, sealed packaging that adheres to stringent regulatory standards to ensure patient safety,” says Dr. Shafer. “Each implant is accompanied by detailed product information, including reference and serial numbers, which are essential for tracking and warranty purposes.”
Under a few layers of medical-grade packaging, the implants are sealed in a sterile plastic container for transport. Then, the impacts are sent directly to the facility where the procedure will be performed.
Implant Placement
To place a breast implant, your surgeon needs to create a surgical pocket for it to rest in. “I like to use the inframammory incision, where the breast meets the chest wall,” Dr. Capraro says. “Typically, an incision is made under the muscle, and once the pocket is created, I use a tester (not the actual implant) to determine how it looks.”
Dr. Bengtson’s technique emphasizes a bloodless approach, utilizing a precise one-inch incision at the base of the breast to create a surgical pocket for the implant. “It’s crucial that the pocket perfectly matches the width of the implant and is created with no bleeding,” he explains. “This meticulous approach results in reduced swelling, bruising and pain during recovery.”
“Once we’re ready to place the actual implant, I sterilize the pocket, change my gloves and sterilize my new gloves,” Dr. Capraro explains. “We take steps to protect the nipples and the incision, and then I use a Keller funnel to place the implant like you would use a pipet. That way, we are never directly touching the sterile implant.”
“With saline implants, the device is typically inserted empty and then filled with saline during the surgery,” Dr. Shafer notes. “For silicone and cohesive gel implants, the implant is pre-filled, making the incision slightly smaller.”
How are implants monitored?
“Keep in mind, a breast implant is not meant to last a lifetime,” explains Mayo Clinic College Professor and women’s health expert Sandhya Pruthi, MD. “You should continue to have yearly clinical breast exams.” Additionally, imaging studies like MRIs or ultrasounds are essential tools that can determine implant integrity.
“If you have a saline implant, I tell patients that they don’t need to exchange them until it breaks,” Dr. Capraro says. “And you will know when it breaks because the saline is absorbed by the body and the breast will deflate.”
“Other surgeons will suggest replacing saline implants around the ten-year mark,” adds San Diego, CA plastic surgeon Robert Singer, MD. “Partially because the patient may be in optimal health for the surgery, disruption increases with time, and no one can predict what the patient’s health will be in the future when a removal and replacement may be required.”
And regardless of implant type, saline or silicone, regular monitoring is a must.
“Regular follow-ups are important to monitor for any signs of complications,” says Dr. Shafer. “Patients can receive imaging (like MRI or ultrasound) to check for silent rupture or other issues at the five and 10 year marks. After 10 years, even if there are no issues, patients should still be monitored regularly for changes in the implant or surrounding tissue. In the NATRELLE clinical study, 94 percent of primary breast augmentation patients were satisfied with their implants 10 years after surgery.”
As Dr. Shafer suggests, not all implants will rupture.
“I have patients with implants in for over 40 years and they are still intact,” notes Dr. Singer. “We simply can’t predict the full lifecycle of an implant—there’s not a clock that ticks down until rupture. Some will and others will not.”
