Breast augmentation is a surgical procedure that increases breast size or restores volume using either implants or fat transferred from another part of your body. It is one of the most commonly performed cosmetic surgeries, and the choices involved go well beyond simply picking a size. The type of implant, where it’s placed, how the surgeon accesses the chest, and what recovery looks like all vary significantly depending on your anatomy and goals.
Implant Types: Saline vs. Silicone
Both saline and silicone implants have an outer shell made of silicone. The difference is what’s inside. Saline implants are filled with sterile salt water, while silicone implants contain a silicone gel that most people find looks and feels closer to natural breast tissue.
The FDA sets different age requirements for each. Saline implants are available to anyone 18 and older for cosmetic augmentation, while silicone implants require you to be at least 22. Both types are available at any age when used for breast reconstruction after mastectomy.
Fat Transfer as an Alternative
If you want a modest size increase without implants, fat transfer breast augmentation is an option. A surgeon uses liposuction to remove fat from areas like your belly, hips, back, or thighs, purifies the cells, and injects them into your breasts. The tradeoff is that fat transfer only increases breast size by about one to two cup sizes and does not add firmness. It also requires you to have enough body fat to harvest, since some fat cells die during the process and your surgeon needs to remove more than they’ll ultimately use. People with very low body fat, those who smoke, or those with significant weight fluctuations are generally not good candidates.
Where the Incision Goes
For implant-based augmentation, the surgeon needs an entry point. Three incision locations are most common, and each comes with distinct advantages.
- Inframammary (under the breast): Placed in the crease where your breast meets the chest wall. Many surgeons prefer this approach because it allows the most precise positioning of the implant. It does not affect nipple sensation or breastfeeding ability, and the same incision can be reused if you need a future procedure. The downside is that the scar can be visible when you’re lying down.
- Periareolar (around the nipple): A small incision along the border of the areola, where it tends to blend into the natural color change. Scars heal well and are nearly invisible with clothing on. However, because the incision passes through milk ducts and nearby nerves, it can reduce nipple sensation and may complicate breastfeeding. It’s also not suitable if you have very small areolae.
- Transaxillary (in the armpit): Leaves no scar on the breast itself. This approach works well for some patients but offers the surgeon less direct access and control over implant positioning.
Over the Muscle vs. Under the Muscle
Once the implant is inside, it sits in one of two positions: above or below the chest muscle (the pectoralis). Each placement has long-term consequences that are worth understanding.
Placing the implant under the muscle (subpectoral) does a better job of concealing rippling along the upper part of the breast, which is especially helpful for people with thinner breast tissue. The drawback is that the muscle can cause visible distortion or shifting of the implant during exercise or flexing. One long-term study found a 94% rate of upward implant migration at seven-year follow-up in subpectoral placements, even when the initial positioning was appropriate.
Placing the implant above the muscle (subglandular) avoids muscle-related distortion but tends to show more rippling and implant edges, particularly in people with less natural breast tissue. The risk of capsular contracture, a condition where scar tissue tightens around the implant and hardens the breast, exists with both placements. Rates for cosmetic augmentation generally fall between 5% and 19%.
What Recovery Looks Like
The first week after surgery is the most restrictive. You’ll feel groggy from anesthesia initially, followed by soreness, swelling, and a sensation of tightness or pressure across the chest. No heavy lifting or strenuous activity is allowed. Rest is the priority.
By week two, pain starts to ease noticeably. Bruising forms but begins to fade, and many people can return to desk-type work if they avoid physical exertion. Your surgeon will typically remove sutures at a follow-up appointment during this period.
Weeks three and four bring a significant shift. Most swelling subsides and you’ll start feeling more like yourself. Gentle walks are fine, but high-impact activity and heavy lifting are still off the table until at least the end of week four.
By weeks five and six, most people return to all normal activities, including more vigorous exercise, though caution with high-impact sports is still wise. The implants begin to settle into their final position during this phase, and you’ll see the first signs of your long-term results. Full settling can take several months.
How Long Implants Last
Breast implants are not permanent. Modern implants are designed to last more than a decade, and many remain in good condition for 20 years or longer. The chance of rupture increases by roughly one percent each year. Most people choose to have their implants removed or replaced somewhere between 10 and 20 years after the original surgery, whether due to rupture, changes in breast shape over time, or simply wanting a different size.
Safety Risks to Know About
The most common complication is capsular contracture. Your body naturally forms a thin layer of scar tissue around any implant, but in some cases that capsule thickens and tightens, making the breast feel firm or look distorted. When this happens, surgical correction is typically needed.
A rarer but serious concern is breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a type of immune system cancer that develops in the tissue surrounding the implant. As of mid-2024, the FDA had received 1,380 case reports worldwide, with 64 reported deaths. The risk is highest with textured implants and those with a polyurethane shell. BIA-ALCL is not breast cancer. It typically presents as persistent swelling or fluid collection around the implant months or years after surgery, and when caught early, it is highly treatable.
Who Is a Good Candidate
You should be in good overall health with no active infections, untreated cancers, or serious illnesses. Most surgeons require that you don’t smoke, since smoking impairs wound healing and increases complication rates. Significant alcohol consumption is also a concern. For silicone implants, you need to be at least 22 for cosmetic purposes, while saline implants are available starting at 18. Beyond medical criteria, having realistic expectations about the outcome matters. Your existing breast tissue, chest shape, and skin elasticity all influence what results are achievable.