Breast Implants: A Size and Shape for Everyone

If you choose to have reconstruction with breast implants after mastectomy, your plastic surgeon will choose the implants that best fit the dimensions of your chest, while providing the volume and shape you prefer.

Reconstruction with breast implants is the most common method of recreating breasts after mastectomy. A variety of FDA-approved breast implants are available, with different sizes, shapes, projection, and fillings. It's important to discuss the advantages and disadvantages of these different features with your plastic surgeon before your reconstructive procedure.

Shape

Round implants create more cleavage and fullness above the nipple. Contoured implants are shaped more like a natural breast; they're longer and more slender at the top with more fullness at the bottom. Compared to round breast implants, contoured breast implants are firmer and better maintain their shape and position.

Size and Projection

Ranging from small (100 cc) to large (800cc) and in between, breast implants are available in many different sizes. However, choosing the ideal size is a bit more complex than selecting a bra because breast implant volume is measured in cubic centimeters (cc) rather than cup size. The dimension of your chest most influences which implants will provide the fullness and projection of your reconstructed breasts.

Before your surgery, your plastic surgeon will take careful measurements--from nipple to nipple and the base width (from the inner cleavage to the outer edge of each breast )--to determine which implants will be the best fit. Implants that are too narrow or too wide can cause cosmetic issues which may then require additional surgery to remove or replace them. Breast implants that are too small won't give you the volume you want, while implants that are too large may upset the aesthetic proportions of your body.

The projection of a breast implant is an additional consideration to discuss with your plastic surgeon before your reconstructive procedure. Generally, a narrow chest requires a higher profile implant to look natural and achieve the desired breast size. High-profile implants provide more projection; low-profile implants have less projection. If you have a large body frame, low- or moderate-profile implants, which are wider at the base, may be a better fit than high-profile implants. Low-profile, moderate-profile and high-profile breast implants provide varying degrees of projection.

Interior and Exterior

All breast implants used in the United States have an outer shell of medical-grade silicone filled with either sterile saline (salt water) or silicone gel.

Saline implants tend to be firm, like a water balloon. Implants filled with cohesive silicone gel have a thick, semi-solid interior with a consistency like Jell-O. They create a breast that is relatively soft and feels similar to natural breast tissue. Highly cohesive silicone gel implants, often called "gummy bears," are said to be "form stable." Like gummy bear candies, they maintain their shape even if the shell is torn or cut.

Saline breast implants are empty when placed in the chest, and then filled to the desired size by the plastic surgeon. They lack the softness and bounce of silicone gel, which more closely mimics the feel of natural breast tissue. Silicone implants are pre-filled by the manufacturer.

Most breast implants used in the U.S. have a smooth exterior. Roughly textured implants are not used as frequently, due to a slightly increased risk of breast implant-associated anaplastic large cell lymphoma, a rare cancer of the immune system.

Breast implants are either round (top) or contoured (bottom).

© 2023 The Complete Guide to Breast Reconstruction, Johns Hopkins University Press