Breast implants are placed through a small incision, guided into a pocket the surgeon creates either behind the breast tissue or beneath the chest muscle. The entire procedure typically takes one to two hours under general anesthesia. While the basic concept is straightforward, several decisions shape exactly how your surgery will go, from where the incision is made to how deep the implant sits.
Where the Incision Is Made
The surgeon needs an opening to work through, and there are four possible locations. Each has trade-offs related to scarring, access, and the type of implant being used.
The inframammary incision is the most common approach. It sits in the natural crease where the underside of the breast meets the chest wall. This location gives the surgeon direct access to the implant pocket and hides well once healed, since the scar falls in a fold that’s already there. Most surgeons prefer it because it offers the most control during placement.
The periareolar incision runs along the border where the darker areola meets the surrounding skin. That natural color transition helps camouflage the scar. The incision can circle the full edge of the areola or follow just the lower half. It works well for both saline and silicone implants, though it does cut through breast tissue, which is a consideration some patients discuss with their surgeon.
The transaxillary incision is made in the armpit, keeping the breast itself scar-free. The surgeon works through this opening to create the pocket remotely, sometimes using an endoscope (a small camera) for visibility. It’s a good option for patients who want no visible marks on the breast, though it can limit the surgeon’s precision compared to a direct approach.
The transumbilical incision goes through the belly button. A tunnel is created from the navel up to the breast, and a deflated saline implant is threaded through, then filled once in position. This approach is associated with a higher complication rate and only works with saline implants, so it’s rarely used today.
Creating the Implant Pocket
Once the incision is made, the surgeon creates a pocket inside the breast to hold the implant. Where that pocket sits is one of the most consequential decisions in the procedure, because it affects how the result looks, how mammograms read, and how the implant feels over time.
Subglandular placement positions the implant above the chest muscle and beneath the breast’s natural glandular tissue. This tends to work well for patients who already have a moderate amount of breast tissue, since that tissue drapes over the implant and helps it look natural. It’s also a good fit for people with well-developed pectoral muscles, because placing an implant under an active muscle can sometimes cause visible distortion when flexing. Recovery from subglandular placement is generally less painful, since the muscle isn’t being stretched.
Submuscular placement tucks the implant beneath the pectoral muscle. The extra layer of muscle over the implant creates a more gradual slope and makes the edges of the implant harder to see or feel, especially in patients with thinner frames and less natural breast tissue. This placement also improves the accuracy of mammograms, since the muscle pushes the implant back and gives imaging equipment a clearer view of the breast tissue in front of it. The trade-off is a more intense initial recovery, because the muscle needs time to adjust to being stretched over the implant.
How the Implant Goes In
Saline and silicone implants enter the body differently. Saline implants are inserted as empty silicone shells, then filled with sterile saltwater once they’re positioned in the pocket. Because they go in deflated, they can fit through a smaller incision.
Silicone implants come pre-filled with a cohesive gel, so they need a slightly larger opening. Getting a soft, full implant through a small incision without excessive force is a challenge, and this is where a tool called the Keller Funnel comes in. It looks like a cone-shaped pastry bag made from sterile, flexible material. The interior becomes extremely slippery when soaked in saline solution. The surgeon loads the implant into the wide end, then gently squeezes it through the narrow end and directly into the pocket.
The Keller Funnel serves two purposes. First, it lets the implant slide through a smaller incision than would otherwise be needed for a pre-filled silicone implant. Second, and perhaps more importantly, it minimizes or eliminates direct hand contact with the implant surface. When an implant touches skin during insertion, it can pick up bacteria, and bacterial contamination is one of the factors linked to capsular contracture, a complication where scar tissue tightens around the implant. The funnel’s no-touch technique helps reduce that risk.
Closing the Incision
Once the implant is seated in position, the surgeon closes the opening in layers. Deep sutures hold the breast tissue together internally, while the skin surface is closed with a combination of additional sutures, skin adhesive, or surgical tape. This layered closure supports healing from the inside out and helps minimize the final appearance of the scar. Over the following months, incision lines gradually fade, though how much varies from person to person.
What Recovery Looks Like
Most patients go home the same day. The first two weeks are focused on rest, with activity limited to light walking around the house to keep blood flowing and reduce the risk of clots. You’ll want to avoid lifting anything heavier than five pounds during this period, including children and pets.
Around weeks three and four, gentle lower-body exercises become safe: bodyweight squats, lunges, and light yoga that doesn’t stretch the chest. Upper body work and anything involving bouncing or impact, like running or jumping, are still off limits.
By weeks five and six, you can add light cardio such as stationary cycling, brisk walking, or the elliptical. The chest still needs protection at this stage, so upper body weights and chest-focused exercises should wait. Light upper body exercises like bicep curls and shoulder raises with minimal weight typically start around weeks seven and eight.
Most patients return to their full workout routine, including running, weightlifting, and chest exercises, after about eight weeks. Anything over ten pounds shouldn’t be lifted until at least that point. When you do return to high-impact activity, a high-support sports bra makes a noticeable difference in comfort and helps protect the results as everything continues to settle. The implants can take several months to “drop and fluff,” meaning they gradually shift into a more natural position as the surrounding tissue relaxes.
Risks Worth Understanding
Capsular contracture is the complication patients hear about most. Every implant triggers the body to form a thin capsule of scar tissue around it, which is a normal response to any foreign object. In some cases, that capsule tightens and squeezes the implant, making it feel firm, look distorted, or become uncomfortable. Mild cases may need no treatment. Severe cases sometimes require surgery to remove or replace the implant. The no-touch insertion techniques described above are one of the ways surgeons try to lower this risk.
Implant rupture is another possibility over the life of the implant. Saline ruptures are immediately obvious because the saltwater leaks out and the breast visibly deflates. The body absorbs the saline harmlessly. Silicone ruptures are harder to detect because the thick gel tends to stay in place, which is why routine imaging is recommended for silicone implant patients. Neither type of implant is designed to last a lifetime; many patients eventually need a replacement surgery, often somewhere around 10 to 20 years after the original procedure.