A breast implant is a prosthesis used to enlarge the size of a womans breasts for cosmetic reasons.

breast implant

Patients seeking breast augmentation have been reported as being usually younger, healthier, from higher socio-economic status, and more often married with children than the population at large. Post-operative surveys on mental health and quality of life issues have reported improvement on a number of dimensions including: physical health, physical appearance, social life, self confidence, self esteem, and sexual function. Longer term follow-up suggests these improvements may be transitory, with the exception of body esteem related to sexual attractiveness. Most patients report being satisfied long-term with their implants even when they have required re-operation for complications or aesthetic reasons.


Size

How big your breasts will be after surgery depends on:
  • How big your chest is now,
  • How much breast tissue you have naturally,
  • What size implant you choose.

    Everyone has a different idea of what a "C cup" is and there is no standard. Do not say, "Doctor, make me a C cup!"
    Also, the volume in ccs is not very useful; just because your friend went from an A cup to a D cup with 750 cc implants, does not mean that you will have the same result with the same size implant.
    Placing implants in a bra to determine the size best is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places and the implants are outside your breast and not under it.
    Computer morphing programs that determine the best implant size can be helpful in some cases, but does not work well with existing implants, sagging or asymmetric breasts.

    Rather show him photos of women who are near your height, weight, bust circumference, breast shape, etc. Also bring a very tight T-shirt or sports bra and try the various implant sizes and profiles in the surgeons office. You will know the right size when you see it!

    Once you have determined which size is best for you, the implant choice should be made based on the base diameter of your chest, and the look that you are trying to achieve, i.e. select the width of the implant so that it matches your chest width. This will avoid a large space between the breasts and give the most natural shape.


    Shape

  • Round

    Are the most natural looking if placed under the muscle. If a woman lies down, round implants settle back evenly, like normal breasts. If a woman stands up, the saline filler goes to the bottom of the implants because of gravity and the implants assume a natural teardrop shape. Photo of round, smooth, silicone implants
  • Anatomical (teardrop/contoured/shaped)

    Are manufactured to be pre-shaped; they have a top and a bottom. They can appear a little elongated in some women. They have a textured surface to avoid the implants from flipping upside down. If a woman lies down, a tear-drop implant will maintain the same shape, which can appear unnatural in some women. Anatomical implants require a textured surface to prevent the implant from flipping over. They do not move like real breasts because of the textured adherence to your tissues. Photo of anatomical, silicone implants

    Profile

    Is the distance the implant projects off the chest wall. Once the surgeon decided what size is suitable for you, he has to choose a profile that achieves that volume with the best match to your breasts base diameter. He also has to consider the look you desire and the laxity of your chest skin.

    breast implant profiles
  • Moderate

    is better suited for wider breasts.
  • High

    is better suited for narrow breasts with more tissue compliance.

    Surface

  • Smooth

    surface implants are the most common. Since there is little consensus on whether textured implants will actually reduce the rate of contracture significantly enough to warrant other potential disadvantages discussed above, many doctors prefer to use smooth, round breast implants. Photo of smooth, round, subpectoral, 300cc implants
  • Textured

    surface implants are supposed to prevent capsular contracture, i.e. scar tissue around a foreign object when it becomes painful or unacceptably firm. Practically the result are inconclusive. Even worse, a textured surface may cause the implant to appear rippled, they have thicker shells and may be firmer in appearance and palpability. Anatomical implants require a textured surface to prevent the implant from flipping over. They do not move like real breasts because of the textured adherence to your tissues. Photo of textured, saline implants

    Fillers

  • Saline

    These shells are made of silicone elastomer and the implants are filled with salt water after the implant is placed in the body. Since the implants are empty when they are surgically inserted, the scar is smaller than is necessary for silicone gel breast implants.

    Good to excellent results may be obtained, but as compared to silicone gel implants, saline implants are more likely to cause cosmetic problems such as rippling, wrinkling, and be noticeable to the eye or the touch. In patients with more breast tissue in whom submuscular implant placement is used, saline implants can look very similar to silicone gel.

    Saline-filled implants were most common implant used in the United States during the 1990s due to restrictions that existed on silicone implants, but were rarely used in other countries.

    A single manufacturer (Poly Implant Prosthesis, France) produced a model of pre-filled saline implants which has been reported to have high failure rates in vivo.

  • Silicone gel

    These shells have a silicone shell filled with a viscous silicone gel.

    Silicone gel implants are better for women with very little breast tissue or for post-mastectomy breast reconstruction. The silicone breasts look and feel more natural.

    The 1st generation of silicone implants (1960s) were made of a silicone rubber envelope (sac), filled with a thick, viscous silicone gel with a Dacron patch on the posterior shell. They were firm and had an anatomic "teardrop" shape.

    The 2nd generation (1970s) were softer and more lifelike, with thinner, less cohesive gel and thinner shells. These implants had a greater tendency to rupture and leak, and complications such as capsular contracture were quite common. It was predominantly implants of this generation that were involved in the class action-lawsuits against Dow-Corning and other manufacturers in the early 1990s.

    Another development in the 1970s was a polyurethane foam coating on the implant shell which was effective in diminishing capsular contracture by causing an inflammatory reaction that discouraged formation of fibrous tissue around the capsule. These implants were later briefly discontinued due to concern of potential carcinogenic breakdown products from the polyurethane. The FDA later concluded that the risk of cancer was very small. Polyurethane implants are still used in Europe and South America.

    Another development in the 1970s was the "double lumen" design. The double lumen was an attempt to provide the cosmetic benefits of gel in the inside lumen, while the outside lumen contained saline and its volume could be adjusted after placement. The failure rate of these implants is higher due to their more complex design. The contemporary versions of these devices ("Becker Implants") are used primarily for breast reconstruction.

    The 3rd and 4th generation (1980s) were elastomer-coated shells to decrease gel bleed, and are filled with thicker, more cohesive gel. These implants are sold under restricted conditions in the U.S. and Canada, and are widely used in other countries. The increased cohesion of the gel filler reduces potential leakage of the gel compared to earlier devices. A variety of both round and tapered anatomic shapes are available. Anatomic shaped implants are uniformly textured to reduce rotation, while round devices are available in smooth or textured surfaces.

    The 5th generation (1990s) were "gummy bear" or solid, high-cohesive, form-stable implants. Their evaluation is in preliminary stages in the United States but these implants have been widely used since the mid 1990s in other countries. The semi-solid gel in these type of implants largely eliminates the possibility of silicone leakage. Studies of these devices have shown significant potential improvements in safety and efficacy over the older implants with low rates of capsular contracture and rupture.

    Saline Silicone
    Age Available at 18 Available at 22
    Consistency Harder than breast tissue Similar to breast tissue
    Cost Less expensive More expensive
    Incision size Smaller incision Larger incision
    Look and feel More natural Less natural
    Rippling Less likely More likely
    Rupture Easy to detect Harder to detect
    Size per volume Look smaller Look bigger


    Incisions

  • Below the breast in the infra-mammary fold (IMF).

    This incision is the most common approach and affords maximum access for precise dissection and placement of an implant. It is often the preferred technique for silicone gel implants due to the longer incisions required. This method can leave slightly more visible scars in smaller breasts which dont drape over the IMF. In addition, the scar may heal thicker.
  • Along the areolar border.

    This incision provides an optimal approach when adjustments to the IMF position or mastopexy (breast lift) procedures are planned. The incision is generally placed around the inferior half, or the medial half of the areolas circumference. Silicone gel implants can be difficult to place via this incision due to the length of incision required (~ 5cm) for access. As the scars from this method occur on the edge of the areola, they are often less visible than scars from inframammary incisions in women with lighter areolar pigment. There is a higher incidence of capsular contracture with this technique.
  • In the armpit and the dissection tunnels medially (transaxillary).

    This approach allows implants to be placed with no visible scars on the breast and is more likely to consistently achieve symmetry of the inferior implant position. Revisions of transaxillary-placed implants may require inframammary or periareolar incisions. Transaxillary procedures can be performed with or without an endoscope (tiny lighted camera).
  • In the navel and dissection tunnels superiorly (transumbilical).

    It is a less common technique. It enables implants to be placed with no visible scars on the breast, but makes appropriate dissection and implant placement more difficult. Transumbilical procedures may be performed bluntly or with an endoscope to assist dissection. This technique is not appropriate for placing silicone gel implants due to potential damage of the implant shell during blunt insertion.
  • Tunneled up from the abdomen into bluntly dissected pockets (transabdominoplasty)

    It is done while a patient is simultaneously undergoing an abdominoplasty procedure.

    Implant pocket placement

  • Subglandular

    is between the breast tissue and the pectoralis muscle. This position closely resembles the plane of normal breast tissue and is felt by many to achieve the most aesthetic results. If you have adequate breast tissue to cover the implant, this placement can give you a very natural look.

    The subglandular position in patients with thin soft-tissue coverage is most likely to show ripples or wrinkles of the underlying implant. Capsular contracture rates are also slightly higher with this approach, and placement of implants in this pocket might be inappropriate in women who are at risk for capsule formation (smokers, multiple breast surgeries). It is more likely to lead to sagging as you age.

  • Subfascial

    is underneath the fascia of the pectoralis muscle. If you have little natural breast tissue or desire an implant larger than your natural breast tissue can cover, this placement can give you a more natural look.

    It is believed that the (sometimes thick) fascial sheet of tissue may help with coverage and sustaining positioning of the implant. Implants that undergo capsular contraction are unlikely to displace upward or toward the underarm. Most often, breast implants are placed under the muscle in order to potentially reduce the incidence of capsular contracture.

  • Subpectoral

    is underneath the pectoralis major muscle after releasing the inferior muscular attachments (dual plane). As a result, the implant is partially beneath the pectoralis in the upper pole, while the lower half of the implant is in the subglandular plane. If you have little natural breast tissue or desire an implant larger than your natural breast tissue can cover, this placement can give you a more natural look. It is less likely to sagg over the long term, because the implant is better supported.

    This is the most common technique in North America and achieves maximal upper implant coverage while allowing expansion of the lower pole. Movement of the implants in the subpectoral plane can be excessive to some patients.

    If you have a lot of sag or droop, you may require a breast lift (mastopexy) too or the implant will align with your chest wall instead of your breast tissue.

  • Submuscular

    is below the pectoralis without release of the inferior origin of the muscle. Total muscular coverage may be achieved by releasing the lateral chest wall muscles (seratus and/or pectoralis minor) and sewn to the pectoralis major. This technique is most commonly used for maximal coverage of implants used in breast reconstruction. If you hace little breast tissue, this placement can help to avoid the “fake” look of implants. It is less likely to sagg over the long term, because the implant is better supported.

    Some surgeons do not recommend the under muscle approach because:

  • it is more painful
  • it bleeds more and has a higher risk of post-op bleeding
  • there is a potential space behind the muscle that extends into the neck, making implant migration more likely
  • muscle activity can move the implant (No recommended for Women who lift a lot of weight, like body builders)
  • muscle activity during exercise distorts breast contours even in the best outcomes (and forever);
  • the breast is a modified skin organ and is naturally located on top of the muscle

    If you have a lot of sag or droop, you may require a breast lift (mastopexy) too or the implant will align with your chest wall instead of your breast tissue.


    Nipple position

    Breast enlargement will elevate the nipples slightly but it will not relocate them. Nor will it change the shape of your (sagging) breasts. For this you need to do a mastopexy (breast lift)

    Cost

    American Society of Plastic Surgeons - 2011, surgeons fees only.
    Implants: silicone gel $3694
    Implants: saline $3308
    Implants: removal $2435

    Czech Republic (2011) from CZK 75 000.

    The surgical procedure for breast enlargement takes 1 to 2 hours.


    Recovery

    Post operative pain is very much. Most patients have to use pain killers for several days. You may have aches and pains for up to a year.

    Patients are able to return to work or school in approximately 1 week. Scars from a breast augmentation surgery will last at least 6 weeks and usually begin to fade several months after surgery.

    It will take time and practice to get used to your new breasts;

  • Implants are heavy. You really notice it braless and at night.
  • Many of your clothes wont fit; shirts and blouses wont close. Buy a bigger size and they are too big in the belly.
  • You will have to buy and discard several bras before you find a comfortable bra. Trying on is not enough. Sit through a political speech in it and you will know if it is a keeper.
  • You will bump them into everything. (OUCH!)
  • You will have to learn to move differently, relearn sport and fitness maneuvering.
  • You will not be able to sleep face down like you used to.
  • You will have to get used to all the new attention they draw and the hands who want to feel them.
  • The best scratch of the day will be when you retire the bra for the evening. (Ahhhhhh!)

    For most patients, the pain, suffering and some gross bruising were all worth it. And with real cleavage, you will never need to load anything in your car by yourself again!


    Complications

    10% of woman are unable to breast feed. The nipple may be more or less sensitive than normal (7%). Nerves are vital to breastfeeding since they trigger the brain to release the hormones that affect milk production. Once lactation starts, implants may also cause exaggerated breast engorgement with more intense than usual pain, fever and chills. Incisions under the fold of the breast (inframammary) and through the armpit (transaxillary) shouldnt cause any trouble. However, the popular periareolar method has greater risk of problems.

    Implants age over time and may need to be replaced. When silicone implants break, they rarely deflate and the silicone from the implant can leak out into the space around the implant. It is suggested that MRI scans be done every 3 years to check for silent ruptures.

    Asymmetry
    Bottoming out (double bubble)
    Capsular contracture
    Mondors cord
    Rippling
    Ruptured implant repair
    Symmastia (disruption of the natural plane between breasts)

    Other complications include scarring (6%), post-operative bleeding (hematoma), fluid collections (seroma), surgical site infection, breast pain (5%), wound dehiscence (with potential implant exposure), breast tissue necrosis (1%), thinning of the breast tissue and unreliable mammograms.

    Both saline and silicone implants are very durable and daily activities will likely not cause any increased risk to the integrity of the implant. Blunt force, altitude and pressure have no effect on implants. It is safe to play BDSM games, travel by air within pressurized cabins and scuba dive without concern. Penetrating them with sharp objects will result in rupture. Repeated trauma from the folding io (?) the implant over time may cause rupture.


    Implants for transsexuals and shemales

    This is different from doing implants for natural females!

    This should be considered only when hormone therapy has enlarged your breasts as much as possible (12-18 months after initiation of hormone therapy).

    Because males have larger chests and tighter skin, the profiles are more likely to be moderate or with larger implants, moderate plus.

    Because males have more pectoralis muscle bulk and taut skin, 33% to 50% will benefit from tissue expander placement to stretch the lower pole muscles and skin. Otherwise their breasts will look too small, firm, convex-up, concave-down with wide cleavage. Assessment of muscle and skin tightness must be determined before recommending this 2 stage approach. If appropriate, it will often minimize the need for multiple corrective operations. It takes 2 to 3 months to expand the tissue.

    Seek a surgeon who has performed many transsexual surgeries and who has the office- and nursing staff with the associated capabilities to do this kind of implants.

    The best looking / feeling breast augmentations are seen in males who have enough breast tissue to cover the implants they choose. The more breast tissue between the skin and the implant, the more the ripples of the implant would be covered and the more attractive the result.

    The under muscle approach is not recommended because the muscle in males is much more developed than in the genetic female, so going under the muscle means working through a much more robust (read: strong; bloody) muscle. New generation, cohesive, gel implants are so soft and have so few problems with wrinkling and rippling that they are very well tolerated on top of the muscle, even in very slender patients

    Photos of implants for transsexuals and shemales

    How to find the best plastic surgeon.

    Go to a strip club. See which girls have the best breasts. Ask them for a referral.

    Find cosmetic surgeons for breast implants in South_Africa


    More info

    Books: reading list
    Forum: www.ImplantInfo.com
    Forum: www.RealSelf.com
    Video

    Breast forms for crossdressers who want to enhance their figure.


    This page has been updated on the 2018-04-19.