Breast implants

Originally Published: April 12, 1996 - Last Updated / Reviewed On: September 30, 2011
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Dear Alice,

I always had small breasts until I became overweight. I am now going on a medically supervised diet. I know that I am ready to really lose the weight and keep it off. The only trouble is that I am only a size "B" cup now. When I lose the weight, I am sure to be an "A," or even an "AA." So, I have been considering the possibility of breast implants. Can you tell me some of the repercussions of breast implants? Can you breast-feed later? What happens during pregnancy? What are the health risks? Well, any information you have about the topic would be helpful. Thanks!

—Flatty but not a Fatty!

Dear Flatty but not a Fatty!,

It is great that you are asking these questions and doing your research as you consider the possibility of getting this surgery. A good first step in the process is making sure you have clarity about your reasons for wanting to increase your breast size. What factors beyond the weight loss are influencing your decision? What are the benefits, as you see them, of having larger breasts? Are there any potential non-health related drawbacks for you? What would be your ideal size? And what was your process in deciding that this size would be better for you? Women are bombarded by messages about how women's breasts should look. Family, friends, lovers, ads, movies, and many other influences shape people's views on this. It may be a useful exercise to think back about your own influences as you work through your decision.

In terms of the procedure itself, a likely first step would be a consultation with a surgeon during which a prospective patient would discuss general health, medical history, lifestyle, hopes, and expectations for the outcome. Here also, a surgeon would explain various options such as outpatient vs. overnight stay, sedation vs. general anesthesia, type of implant, location of implant, and type of incision.

Incisions are made in areas that minimize visible scarring. There are three primary incision options. The first is just underneath the areola, another is just underneath the breast itself, and the third is near the underarm. The type of incision agreed upon by patient and surgeon may vary depending on the desired outcome, the body type of the patient, and the specialization of the surgeon.

After the incision is made, the implant is inserted into a pocket in one of two possible locations: Underneath the pectoral muscle, or over the pectoral muscle, just behind the mammary glands. Where it goes may depend on type of placement, degree of enlargement, and body type.

There are two different kinds of implants approved by the FDA: Saline and silicone. Implant type and size is generally based on skin elasticity, desired size increase, breast anatomy, and body type. Saline implants are filled with sterile salt water so if the implant leaks, the saline would be absorbed and expelled by the body. Silicone implants are filled with gel that feels much like actual breast tissue. If the implant leaks, the gel may remain within the implant shell or may escape into the breast implant pocket. Manufacturers occasionally introduce new types of implants, so there may be additional options available.

Health risks can include:

  • Hematoma or significant bleeding soon after the procedure.
  • Capsular contracture, or firm scars that form around the implant.
  • Breast feeding complications and effects on children. Some women with implants breastfeed successfully while others cannot. Implants tend to decreases lactation, in some people by as much as 64%. Additionally, it is not yet clear whether silicone implants result in the presence of silicone in breast milk and if so, it is not known what effect, if any, this might have on an infant who breastfeeds.
  • Difficulties detecting breast cancer. When reading a mammogram, it may be difficult for a physician to distinguish scar tissue around an implant from tumors. Also, because mammograms require compression of the breast, they can sometimes cause ruptures.
  • Infection.
  • Implant leakage or breakage.
  • Improper healing or a wrinkling of tissue around the implant or incision site.
  • Decreases in nipple sensation (temporary or permanent).
  • Persistent pain.
  • The need for revisions.

A surgeon will have a better sense of which concerns will be most relevant for you. Talking with others who have had the surgery can also be immensely helpful, not only in helping to identify a quality surgeon, but also in providing a sense of what to expect. It's also important to consider the cost of getting breast implants and the possibility that implants may need to be replaced after a certain number of years. 

If you need more information or want to read the latest on breast implant research in progress, call the Consumer Inquiries Information Line of the Food and Drug Administration (FDA) Office of Consumer Affairs at (301) 827-4420 [10 A.M. - 4 P.M. (EST), Monday - Friday].

Good Luck!