Breast implants are medical devices surgically placed under the breast tissue or chest muscle to increase breast size (augmentation) or rebuild breast shape after mastectomy (reconstruction). Every breast implant has an outer shell made of silicone rubber, but they differ in what’s inside, how they’re shaped, and where they’re placed in the body. Most implants last 10 to 20 years before they need to be replaced or removed.
Saline vs. Silicone Implants
The two main types of breast implants are defined by their filler material. Both use the same type of silicone rubber shell on the outside, but the similarity ends there.
Saline implants are filled with sterile salt water, the same concentration found naturally in your body. They’re typically inserted empty and then filled to the desired volume once they’re in position. This means the incision can be smaller. Some saline implants have adjustable volumes with multiple chambers, while others are filled once to a fixed size. If a saline implant ruptures, the salt water is harmlessly absorbed by your body, so a deflation is immediately obvious: the breast visibly loses volume.
Silicone gel implants come pre-filled with a fixed amount of silicone gel and are available in varying levels of thickness, from a traditional gel to a firmer, highly cohesive gel (sometimes called “gummy bear” implants because they hold their shape even if cut). Most people find silicone implants feel closer to natural breast tissue. The tradeoff is that a rupture can be harder to detect. The gel may stay contained within the scar tissue that forms around the implant, producing what’s called a “silent rupture” with no obvious change in appearance.
Shapes and Surface Textures
Beyond the filler, implants vary in shape and surface finish. Round implants are the most common and look the same no matter how they settle in the chest. Anatomical (teardrop) implants taper upward to mimic the natural slope of a breast, with more volume at the bottom. These shaped implants are only available with a textured surface, which helps them grip surrounding tissue and stay in the correct orientation.
Textured shells were designed to reduce the risk of the implant shifting out of position and to lower rates of capsular contracture, a condition where the scar tissue around the implant tightens and hardens. However, textured implants carry a distinct risk: bacteria adhere more easily to the rougher surface, which may increase the chance of infection. Textured surfaces are also linked to a rare cancer called BIA-ALCL (more on that below). Smooth-shelled implants move more freely inside the breast pocket and are the more popular choice in cosmetic augmentation today.
Where Implants Sit in the Body
Surgeons place implants in one of two positions relative to the pectoral (chest) muscle, and the choice affects recovery, appearance, and long-term behavior.
Above the muscle (subglandular): The implant sits behind the breast tissue but on top of the chest muscle. Because the muscle isn’t cut or lifted, recovery is typically faster, with less swelling and pain in the first few weeks. The implant moves naturally with the breast, and flexing your chest won’t distort its shape. This placement tends to create a rounder, fuller look in the upper breast. The downside is that in women with thinner breast tissue, the implant edges can be visible or palpable.
Below the muscle (submuscular): The implant goes behind both the breast tissue and the pectoral muscle. The extra layer of muscle coverage helps hide the implant’s edges, which makes this a better option for thinner patients or those with less natural breast tissue. It also creates a more gradual slope, which many people find looks more natural. Recovery takes longer because the muscle needs to heal. One quirk of this placement: when you flex your chest, the implant can visibly shift or distort.
Age Requirements and FDA Rules
The FDA sets different age minimums depending on the implant type. For cosmetic augmentation, saline implants are approved for patients 18 and older, while silicone gel implants require a minimum age of 22. For breast reconstruction after mastectomy, both types can be used regardless of age. The FDA considers any implant use in minors to be off-label.
Since 2020, all breast implants sold in the United States carry a boxed warning, the most prominent type of safety alert the FDA issues. The warning communicates several key points: implants are not lifetime devices, the likelihood of complications increases over time, implant contents can leak, and there are associations with BIA-ALCL and a collection of symptoms some patients call breast implant illness. Patients must also be informed about the risk of additional surgeries, capsular contracture, interference with mammograms, and the need for ongoing monitoring.
How Long Implants Last
Breast implants are not permanent. Today’s implants are designed to last more than a decade, and many remain in good condition for 20 years or longer. The chance of rupture increases by roughly one percent each year. Most women have their implants removed or replaced somewhere between 10 and 20 years after their initial surgery, whether because of a complication, a change in preference, or simply because the implant has reached the end of its functional life.
For silicone implants specifically, the FDA recommends your first screening for silent rupture at 5 to 6 years after surgery, then every 2 to 3 years after that. Either an ultrasound or MRI is acceptable for routine screening in patients with no symptoms. If you notice pain, changes in shape, or swelling, an MRI is the preferred imaging method.
Capsular Contracture
Your body naturally forms a thin layer of scar tissue around any implanted device. This is normal and expected. Capsular contracture happens when that scar tissue tightens and compresses the implant, making the breast feel firm, look distorted, or become painful. It’s one of the most common reasons people have implants replaced. Mild cases may cause only slight firmness, while severe cases can change the breast’s shape significantly and require surgery to correct.
BIA-ALCL: A Rare but Serious Risk
Breast implant-associated anaplastic large cell lymphoma is a rare cancer of the immune system, not of breast tissue itself. It occurs almost exclusively in patients with textured implants, at a rate of roughly 1 in 559 patients with textured devices. The median time to diagnosis is about 10 years after implant placement. The most common warning signs are a sudden buildup of fluid around the implant (called a seroma), a noticeable mass near the implant, or chest wall pain. When caught early, it’s highly treatable, usually by removing the implant and the surrounding scar tissue capsule.
What Recovery Looks Like
Recovery depends heavily on implant placement. With above-the-muscle placement, many women return to light activities within a few days and experience relatively mild discomfort. Below-the-muscle placement involves more swelling, tightness, and a longer healing window because the chest muscle needs time to adapt to being stretched over the implant. Regardless of placement, most surgeons restrict heavy lifting and upper-body exercise for several weeks.
Swelling can take weeks to fully resolve, and the implants often sit higher on the chest initially before gradually settling into a more natural position over the following months. Final results typically aren’t apparent until three to six months after surgery.