Breast implants come in several types, and the differences go beyond just saline versus silicone. The fill material, shape, surface texture, projection profile, and placement location all vary, and each combination produces a different look and feel. Understanding these categories helps you have a more productive conversation with a surgeon about what will work best for your body and goals.
Fill Material: Saline, Silicone, and Structured
The most fundamental choice is what’s inside the implant. There are three main options available today.
Saline implants are filled with sterile salt water. They’re FDA-approved for augmentation starting at age 18. Because saline is thinner than silicone gel, these implants can sometimes feel less natural, particularly in people with minimal breast tissue covering them. One practical advantage: if a saline implant ruptures, the salt water is harmlessly absorbed by your body, and the deflation is immediately obvious.
Silicone gel implants are filled with a cohesive silicone gel and are widely considered to look and feel more like natural breast tissue. The FDA approves them for augmentation starting at age 22, though they’re available at any age for reconstruction after mastectomy. Silicone ruptures are harder to detect because the gel tends to stay in place rather than deflating visibly. The FDA recommends periodic imaging to check for so-called “silent ruptures.”
Structured saline implants (sold under the brand name Ideal Implant) are a hybrid design. They use saline as a filler but contain an internal scaffolding of nested shells with small perforations. About two-thirds of the saline sits in an inner chamber, with the remaining third in an outer chamber. These internal baffles control how the saline moves, preventing the upper portion from collapsing when you’re upright and giving the implant a tissue-like feel closer to silicone gel. You still get the safety benefit of saline: a rupture is obvious and the fluid is harmless.
Highly Cohesive “Gummy Bear” Implants
Gummy bear implants are a subcategory of silicone implants made with a thicker, denser gel than standard silicone. The nickname comes from their consistency: if you were to cut one in half, the gel holds its shape rather than flowing, much like the candy. This means that even if the outer shell breaks, the gel doesn’t leak into surrounding tissue. They feel firmer than traditional silicone implants, and because they maintain a stable form, they’re often paired with an anatomical (teardrop) shape. That firmness is a tradeoff. Some people prefer the softer, more pliable feel of standard silicone gel.
Shape: Round vs. Teardrop
Implants come in two basic shapes, and each produces a distinctly different silhouette.
Round implants are symmetrical in every direction, providing uniform fullness. They tend to add more volume to the upper part of the breast, which creates a fuller, more lifted look and more defined cleavage. Because they’re the same shape no matter how they’re oriented, there’s zero risk of a visible problem if the implant shifts or rotates inside the pocket. Round implants are also generally softer and move slightly with your body, which many people find natural-looking in motion even if the shape itself is less anatomical on paper.
Teardrop (anatomical) implants are fuller at the bottom and taper toward the top, mimicking the natural slope of breast tissue. They’re a popular choice for people with very little existing breast tissue, a thin frame, or a narrow chest wall, where a round implant might look obviously artificial. The tradeoff is that teardrop implants require a textured outer surface to grip surrounding tissue and stay oriented correctly. If one rotates, the breast can look distorted, and corrective surgery may be needed.
Surface Texture: Smooth vs. Textured
The outer shell of an implant is either smooth or textured, and this choice carries real health implications.
Smooth implants have a polished surface and can move freely within the tissue pocket. This slight movement is considered natural by many surgeons. Textured implants have a roughened surface designed to adhere to surrounding tissue, which helps prevent rotation (critical for teardrop shapes) and may reduce the risk of capsular contracture, a condition where scar tissue tightens painfully around the implant.
However, textured implants are linked to a rare cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). As of early 2022, 1,130 women worldwide had been diagnosed with BIA-ALCL, and at least 59 had died from it. The risk is categorical: smooth implants have no documented cases, while macrotextured implants carry a real, if still uncommon, risk. One specific macrotextured product (Allergan’s Biocell) accounted for roughly 91% of worldwide cases despite representing only about 5% of implants sold in the U.S. before it was recalled. Implants with lighter texturing (“microtextured”) appear to carry less risk than heavily textured ones, but the exact numbers remain uncertain.
Implant Profile: How Far It Projects
Profile describes how much the implant sticks out from your chest wall. Two implants can hold the same volume of fill but look very different depending on their profile, because the base width and forward projection are inversely related: a narrower base pushes the same volume further forward.
- Low profile: Wide base, minimal projection. Best suited for people with broader chests who want a subtle enhancement.
- Moderate profile: A middle ground that tends to produce the most natural-looking results. Often recommended for smaller or average-width chests.
- High profile: Narrow base, maximum forward projection. Creates a very full, rounded look. Often chosen by petite people with narrow chest walls who want noticeable volume without an implant that extends too far toward the armpit.
- Ultra-high profile: The narrowest base and most extreme projection available. Less commonly used and typically reserved for very specific body proportions.
Your chest width, existing breast tissue, and desired look all factor into which profile makes sense. A surgeon will typically measure your chest wall and ribcage to narrow down the options.
Placement: Over or Under the Muscle
Where the implant sits relative to your pectoral muscle affects both the final appearance and your recovery.
Subglandular (over the muscle) placement positions the implant between the breast tissue and the chest muscle. Recovery is generally faster and less painful because the pectoral muscle isn’t disturbed. Swelling tends to be milder. When there’s enough natural breast tissue to cover the implant, results can look and move very naturally. The downsides: implant edges or surface rippling are more likely to be visible through the skin, mammograms can be slightly harder to read, and the rate of capsular contracture is higher. In one 10-year study, capsular contracture occurred in 26.3% of subglandular augmentation patients.
Submuscular (under the muscle) placement tucks the implant beneath the pectoral muscle, which provides an extra layer of tissue coverage. This typically produces a more natural contour, especially in lean patients, and improves mammogram accuracy. The capsular contracture rate drops meaningfully: 15.7% over 10 years in the same study. The tradeoffs include a longer, more uncomfortable recovery, the possibility that chest muscle contractions can temporarily distort the implant’s shape, and a tendency for the implants to sit slightly further apart, creating wider cleavage.
Incision Location
The surgeon accesses the chest through one of three standard incision sites. The inframammary incision is made in the crease beneath the breast and is the most common approach, offering direct access and a scar that’s hidden in the natural fold. The periareolar incision circles the lower edge of the areola, where the color transition helps camouflage the scar. The transaxillary incision is placed in the armpit, leaving no scar on the breast itself but giving the surgeon less direct control over implant positioning. Each approach has tradeoffs in scar visibility and surgical precision, and not every incision site works with every implant type.
How Long Implants Last
Breast implants are not lifetime devices. In a 10-year study of silicone gel implants, about 82% of augmentation patients still had their original implants in place at the end of the study period. The implant-level rupture rate was 7.7% over that decade. Capsular contracture, where the scar tissue around the implant hardens and may cause pain or distortion, affected roughly 19% of augmentation patients over 10 years.
These numbers mean that while most implants last well beyond a decade, a meaningful percentage of people will need a revision or replacement at some point. Routine monitoring, whether through physical exams or imaging, helps catch problems like silent ruptures before they cause symptoms. Many surgeons advise planning for at least one replacement over your lifetime if you get implants in your 20s or 30s.
FDA Labeling and Safety Requirements
Since October 2021, the FDA has required that all breast implants be sold with a boxed warning (the most serious type of safety label) and that patients receive a standardized checklist of risks before surgery. These rules were designed to ensure that anyone considering implants gets clear, upfront information about complications like BIA-ALCL, capsular contracture, and the possibility of additional surgeries. Your surgeon is required to walk through this information with you and confirm that you’ve reviewed it before proceeding.