Breast augmentation is a surgical procedure where an implant is placed inside each breast to increase size, change shape, or restore volume. The surgery typically takes one to two hours under general anesthesia, and most people return to everyday activities within seven to ten days. Here’s what actually happens at each stage.
Choosing an Implant Type
The first major decision is what goes inside your body. Both saline and silicone implants have an outer shell made of silicone, but they differ in filling and feel.
Saline implants are filled with sterile salt water. They’re approved for people 18 and older. One practical advantage: if a saline implant ruptures, the salt water is safely absorbed by your body, and the deflation is immediately obvious.
Silicone implants are filled with a thick gel that most people find closer in texture to natural breast tissue. They’re approved for augmentation starting at age 22. The tradeoff is that a silicone rupture can be harder to detect because the gel tends to stay in place rather than visibly deflating. This is sometimes called a “silent rupture,” and screening is recommended periodically to check for it.
Where the Incision Goes
The surgeon needs an opening to slide the implant in, and there are three common locations. Each leaves a scar in a different spot, and all three are considered safe.
- Inframammary: A cut along the crease underneath the breast. This is the most common approach because it gives the surgeon direct access and the scar sits in a natural fold where it’s less visible.
- Periareolar: A cut along the lower edge of the areola, where the darker skin meets the lighter skin. The color transition helps camouflage the scar, but this incision is more likely to interfere with milk ducts and nerve function.
- Transaxillary: A cut in the armpit. This keeps any scarring off the breast entirely, though it requires the surgeon to work at a distance from the implant site.
Where the Implant Sits
Once the incision is made, the surgeon creates a pocket for the implant. That pocket can be in one of two locations, and the choice affects how the result looks, feels, and holds up over time.
Subglandular placement puts the implant between the breast tissue and the chest muscle. Recovery is generally less painful because the muscle isn’t disturbed. However, a ten-year comparative study found higher rates of visible rippling and a complication called capsular contracture (more on that below) in subglandular implants, particularly in people with less natural breast tissue to cover the implant.
Subpectoral (under the muscle) placement tucks the implant beneath the chest muscle. This provides an extra layer of tissue over the top of the implant, which reduces visible rippling along the upper breast. The downsides: recovery is more uncomfortable because the muscle needs to heal, and the muscle can sometimes distort the implant’s shape during flexing. The same study noted a 94% rate of gradual upward implant migration over seven years in subpectoral placements.
Your body type matters here. People with more existing breast tissue can get good coverage with subglandular placement. People with very little natural tissue often benefit from the extra concealment that under-the-muscle placement provides.
What Happens During Surgery
You’ll be under general anesthesia or deep sedation for the procedure, so you won’t feel or remember anything. The surgeon makes the incision, creates the pocket in the chosen location, and inserts the implant. If you’re getting saline implants, they’re often inserted empty and filled to the desired volume once they’re in position. Silicone implants come pre-filled.
Once both implants are positioned and the surgeon is satisfied with symmetry, the incisions are closed in layers. Internal sutures hold the deeper breast tissue together, and the skin is sealed with additional sutures, surgical tape, or skin adhesive.
Recovery Week by Week
The first 48 hours are the most uncomfortable. You’ll feel tightness and pressure across your chest, and your surgeon will likely have you wearing a supportive surgical bra. Pain medication keeps this manageable for most people.
By the end of the first week, swelling and bruising noticeably decrease. Many people return to desk jobs or light daily routines at this point, with one important restriction: no lifting anything heavier than a gallon of milk. If you have young children, plan for help during this phase.
Most people feel close to normal within seven to ten days, though the breasts will still be settling into their final position. Strenuous exercise, heavy lifting, and sports are off limits for at least six weeks to give the internal tissue time to heal properly.
Capsular Contracture
Your body naturally forms a thin layer of scar tissue around any implanted object. This is normal and expected. But in some cases, that scar tissue tightens and squeezes the implant, making the breast feel firm, look distorted, or become painful. This is called capsular contracture, and it’s graded on a scale from I (soft, normal feeling) to IV (hard, visibly distorted, and painful).
Prevalence estimates range from 5% to 19% for cosmetic augmentation. It can happen months or years after surgery. Mild cases may not need treatment, but severe contracture often requires a second surgery to remove or replace the implant and the surrounding scar tissue.
A Rare but Serious Risk
Textured implants (implants with a rough surface designed to stay in place) have been linked to a rare type of cancer called BIA-ALCL, a lymphoma that develops in the scar tissue surrounding the implant. It’s not breast cancer. It typically shows up as unexplained swelling or fluid collection around the implant, often years after surgery.
The overall cumulative risk is very low, estimated between 0.003% and 0.29% over 20 to 26 years for textured implants. Risk varies significantly by manufacturer and implant texture type. Smooth-surface implants have not been strongly associated with this condition. One heavily textured product line was found to carry roughly a 1 in 600 risk, while other textured designs had risk levels closer to 1 in 50,000. The riskiest product has since been recalled in many countries.
How Long Implants Last
Implants are not lifetime devices. According to the American Society of Plastic Surgeons, today’s implants are designed to last more than a decade, with the chance of rupture increasing by about one percent each year. Many implants remain in good condition for 20 years or more, but most people will eventually need a replacement or removal surgery at some point, typically between 10 and 20 years after the original procedure.
Reasons for replacement go beyond rupture. Some people choose revision surgery because of changes in breast shape after aging, weight fluctuations, or pregnancy. Others develop capsular contracture or simply want a different size.
Effects on Breastfeeding
Breast augmentation can affect your ability to produce milk, though many people breastfeed successfully after surgery. The key factors are incision location and implant placement. Incisions around the areola are more likely to disrupt the milk ducts and nerves that control lactation. Implants placed under the muscle tend to interfere less with milk production than those placed above it.
Over time, severed ducts can partially reconnect or form new pathways, and damaged nerves may regain some function. How much milk you ultimately produce depends on how many ducts and nerves recover. If breastfeeding is important to you, discussing incision and placement choices with your surgeon beforehand can help preserve that option.