Breast augmentation is a surgical procedure that changes the size, shape, or fullness of the breasts using implants or fat transferred from another part of the body. It is one of the most common cosmetic surgeries performed, chosen both for aesthetic reasons and for reconstruction after mastectomy or injury. The procedure typically takes one to two hours under general anesthesia and involves placing an implant behind the breast tissue or chest muscle, or injecting purified fat harvested through liposuction.
Types of Implants
The two main implant types are saline and silicone, and they differ in fill material, feel, and how they behave if something goes wrong. Both have an outer shell made of silicone, but saline implants are inserted empty and then filled with sterile salt water once in position. Silicone implants come pre-filled with a cohesive silicone gel. Most people find that silicone implants look and feel closer to natural breast tissue.
Implants also come in different shapes and textures. Round implants provide more fullness in the upper breast, while teardrop-shaped implants mimic a more natural slope. The surface can be smooth, which allows the implant to move freely within its pocket, or textured, which was originally designed to reduce the risk of the implant rotating or the scar tissue around it tightening.
There are age requirements set by the FDA. Saline implants are available to anyone 18 and older for cosmetic augmentation. Silicone implants require you to be at least 22 for cosmetic purposes, though they’re available at any age when used for breast reconstruction.
Fat Transfer as an Alternative
Fat transfer augmentation skips implants entirely. A surgeon uses liposuction to harvest fat from areas like the abdomen, thighs, or flanks, purifies it, and then injects it into the breasts. The typical volume transplanted ranges from about 120 to 250 mL per breast per session, with an average around 205 mL. For reference, that translates to roughly a half-cup to one-cup-size increase, depending on your frame.
The results are more modest than what implants can achieve. In one study of 105 patients, about 45% saw significant improvement and another 39% saw noticeable improvement, but roughly 16% saw no meaningful change. Those who didn’t improve were generally thinner patients who simply didn’t have enough fat to harvest, with less than 150 mL injected per side. Fat transfer works best for people who want a subtle size increase and have enough donor fat available. Multiple sessions may be needed to reach the desired result.
Where the Implant Goes
Implants can be placed in two main positions: above the chest muscle (subglandular) or partially behind it (subpectoral, sometimes called “under the muscle”). Each has trade-offs that depend on your body type and goals.
Subglandular placement tends to produce a shorter recovery and avoids the muscle-related complications that come with subpectoral placement, such as visible distortion of the breast when you flex your chest. However, implants placed above the muscle are more likely to show visible rippling along the upper breast, especially in people with less natural breast tissue to cover the implant.
Subpectoral placement does a better job concealing the implant’s edges along the upper breast. The trade-off is a higher rate of implant displacement over time. One long-term study found a 94% rate of upward implant migration at seven-year follow-up, even when the implant was well-positioned initially. Muscle contraction can also cause movement or shape changes that some people find bothersome, and these issues tend to be more pronounced in people with strong chest muscles and less breast tissue.
Incisions and Scarring
Surgeons typically use one of three incision locations: along the crease under the breast (inframammary), around the lower edge of the areola (periareolar), or in the armpit (transaxillary). The inframammary incision is the most common because it provides the most direct access and leaves a scar that sits in a natural fold. Periareolar incisions hide well but carry a higher chance of affecting milk ducts and nerve function. Armpit incisions leave no scar on the breast itself but can make precise implant positioning more difficult.
Recovery Timeline
Immediately after surgery, your breasts will be wrapped in gauze and supported by an elastic bandage or surgical bra to control swelling. Acute pain typically lasts one to five days, managed with prescribed pain medication. Soreness and swelling can linger for several weeks. During the first few days, there’s a risk of bleeding into the pocket around the implant, so activity is kept to a minimum.
Most people return to desk work within a week, though physically demanding jobs require more time off. Exercise and heavy lifting are restricted for several weeks, with the exact timeline set by your surgeon based on healing progress and implant placement. It can take three to six months for implants to settle into their final position, a process sometimes called “dropping and fluffing,” where the implant moves lower and the surrounding tissue softens.
How Long Implants Last
Breast implants are not permanent. Today’s implants are designed to last more than a decade, and many remain in good shape for 20 years or longer. But the chance of rupture increases by about one percent each year. The most common reason for replacement surgery is implant rupture, followed by cosmetic concerns and capsular contracture (the tightening of scar tissue around the implant that can make the breast feel firm or change its shape).
When a saline implant ruptures, you’ll know quickly. The salt water leaks out, the implant deflates, and the breast visibly changes shape. Your body safely absorbs the saline. A silicone rupture is harder to detect because the thick gel tends to stay trapped within the surrounding scar tissue. These “silent ruptures” may cause no symptoms at all. The FDA recommends an MRI five to six years after getting silicone implants, and then every two to three years going forward, to screen for undetected ruptures.
Risks and Complications
Capsular contracture is one of the most talked-about complications. Every implant develops a thin layer of scar tissue around it, which is normal. But in some cases, that tissue thickens and tightens, squeezing the implant. The result ranges from mild firmness to visible distortion and discomfort. It can happen with any implant type or placement and sometimes requires surgery to correct.
A rarer concern is breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a type of cancer that develops in the scar tissue surrounding the implant rather than in the breast tissue itself. The FDA first issued a safety communication about it in 2011, estimating the risk at roughly 1 in 500,000 women per year. It has been linked primarily to textured-surface implants. When caught early, BIA-ALCL is typically treatable with implant removal and surgical excision of the surrounding capsule.
Some patients also report a cluster of symptoms they call “breast implant illness,” including chronic fatigue, joint and muscle pain, and difficulty concentrating. These symptoms don’t fit neatly into a single diagnosis, and the FDA acknowledges that some patients report improvement after having their implants removed.
Effects on Breastfeeding and Sensation
Breast augmentation can affect your ability to breastfeed, though it doesn’t make it impossible for most people. Implants placed below the muscle tend to interfere less with milk production than those placed above it. Incisions made around the areola are more likely to disrupt milk ducts and the nerves that signal milk production, compared to incisions under the breast crease.
Over time, severed ducts can reconnect or form new pathways, and damaged nerves may regain function. How much milk you ultimately produce depends on how many ducts remain connected and how well the relevant nerves recover. If breastfeeding is important to you, discussing incision placement and implant position with your surgeon beforehand can help minimize the impact.
Cost and Insurance
When performed for cosmetic reasons, breast augmentation is almost never covered by insurance. The total cost includes the surgeon’s fee, anesthesia, operating room or facility charges, medical tests, post-surgery garments, and prescriptions. These components add up, and the surgeon’s fee alone is only part of the picture. When augmentation is part of breast reconstruction after mastectomy, insurance coverage is typically required by federal law.
It’s also worth factoring in long-term costs. Implants will likely need to be replaced at some point, and silicone implants require periodic imaging to check for silent ruptures. If you choose to have implants removed without replacement, the FDA notes you may experience cosmetic changes to your natural breasts, including dimpling, wrinkling, or tissue loss that reflects the stretched state of the skin and tissue after years with an implant in place.