Should I Get Silicone Breast Implants? A Surgeon’s Walkthrough

Silicone implants are still the most popular choice for breast augmentation. Silicone implants are FDA-approved for patients 22 and older. Dr. Gary Vela handles breast augmentation at Snatched Plastic Surgery.

What silicone implants are today?

Today’s silicone implants are very different from the 1980s versions. Current devices are the fifth generation: cohesive gel that is cross-linked into a form-stable fill, so it retains its shape even if the shell is cut - the “gummy bear” type. More crosslinking means a firmer, more form-stable implant. They come round or shaped, in profiles from low to ultra-high, and more than 90% of implants used in the U.S. today are smooth-surfaced [1].

How sizing works

Bra-cup sizing doesn’t account for your frame - sizing starts with your measurements. Your surgeon measures your chest width and existing breast tissue, then lets you try on implant sizers and preview the result with 3D imaging, so you’re choosing based on what fits your frame. A larger implant isn’t always better: implants that are too large for your tissue increase the risk of complications and a second surgery later.

Where the incision goes

Most often, the incision is in the fold under the breast - which gives the surgeon the best access, and it heals into a thin line hidden in the crease. The edge of the areola is another option. The transaxillary route (through the armpit) avoids a breast scar, though the implant may sit off-center with that approach. Implants are usually placed under the chest muscle, which gives a softer, more natural edge and lowers the risk of hardening around the implant.

Recovery timeline

The first 3 to 5 days are typically the most uncomfortable - prescribed pain medication helps manage it [2]. Within a week, you can typically resume light daily activities, and driving is usually permitted once your surgeon clears you [2]. Patients usually return to desk work at 2–3 weeks [2]. You’ll wear a compression garment for about 6 weeks, and heavy lifting and strenuous workouts can generally resume at week 6, once your surgeon clears you [2]. Then the implants settle into place (“drop and fluff”) over 3–4 months, with subtle changes continuing up to a year [3].

The risks, explained clearly

The most common implant problem is capsular contracture - scar tissue tightening around the implant. A systematic review places the rate at 3.6% overall, though individual studies range from 2.8% to 20.4% [4]. BIA-ALCL is a rare lymphoma associated with textured implants - not breast cancer. The FDA estimates lifetime risk at 1 in 3,817 to 1 in 30,000 for textured devices [1]. Allergan’s BIOCELL textured implants were recalled in 2019 [5], and the FDA does not recommend removing implants in women without symptoms [1]. Some women report fatigue, brain fog, and joint pain they attribute to implants, though the medical cause is still debated. A 2025 analysis found 81.9% of women reported improvement in their symptoms after implant removal [6]. Implants are not lifetime devices: the American Society of Plastic Surgeons says 10–15 years is typical before replacement [7], and the FDA recommends periodic imaging to check silicone implants for silent rupture - ask your surgeon about the schedule.

Frequently asked questions

How do I pick the right size?

Your surgeon’s measurements determine the choice - chest width, tissue, and 3D imaging previews, not bra cups. Bring reference photos, but rely on the measurements: implants too big for your frame raise the risk of complications and revision surgery [6].

What is capsular contracture?

Scar tissue forms around every implant; contracture is when it tightens and hardens the breast. It’s the most common implant complication, at 3.6% overall in a systematic review - individual studies ranged from 2.8% to 20.4% [4]. Placing implants under the muscle lowers the risk.

What is BIA-ALCL?

A rare lymphoma associated with textured implants - not breast cancer. The FDA estimates lifetime risk at 1 in 3,817 to 1 in 30,000 for textured devices [1]. Allergan’s BIOCELL textured implants were recalled in 2019 [5]. Today, more than 90% of U.S. implants are smooth-surfaced [1].

What about breast implant illness?

Some women report fatigue, brain fog, and joint pain they attribute to implants, though the medical cause is still debated. A 2025 analysis found 81.9% of women reported improvement in their symptoms after implant removal [6].

How long do implants last?

They are not lifetime devices. The American Society of Plastic Surgeons says 10–15 years is typical [7], since complication risk increases over time. The FDA recommends periodic imaging to check silicone implants for silent rupture - ask your surgeon about the schedule.

Can I breastfeed with implants?

Many women can. Implants placed under the muscle usually leave the milk ducts and nerves undisturbed, so breastfeeding is often unaffected. Placement through the areola carries a slightly higher chance of interfering with milk flow. If future breastfeeding matters to you, raise it at the consultation - incision and placement choices can be planned around it. Nipple sensation changes are usually temporary, and most women who want to nurse after augmentation are able to.

Sources

[1] Practical Dermatology - Dr. William P. Adams Jr. on BIA-ALCL risk by implant texture: https://practicaldermatology.com/topics/skin-cancer-photoprotection/an-update-on-breast-implant-associated-anaplastic-large-cell-lymphoma/22995/

[2] Healthline - Breast augmentation recovery: https://www.healthline.com/health/breast-augmentation-recovery

[3] American Society of Plastic Surgeons - Breast Augmentation: https://www.plasticsurgery.org/cosmetic-procedures/breast-augmentation

[4] Prosthesis (MDPI) - Systematic review: capsular contracture rates after augmentation: https://mdpi-res.com/d_attachment/prosthesis/prosthesis-07-00038/article_deploy/prosthesis-07-00038.pdf?version=1743501604

[5] Oncology Nursing News - FDA action on Allergan BIOCELL textured implants (2019 recall): https://oncnursingnews.com/view/fda-takes-action-against-breast-implant-associated-cancer

[6] Aesthetic Plastic Surgery (Springer) - 2025 meta-analysis: symptom improvement after explantation: https://link.springer.com/article/10.1007/s00266-025-05142-x

[7] American Society of Plastic Surgeons - When to replace breast implants: https://www.plasticsurgery.org/news/articles/is-it-time-to-replace-your-breast-implants

Thinking about implants? Snatched Plastic Surgery is at 730 NW 107th Ave #115 in Miami. Book a consultation with Dr. Gary Vela and talk through size, profile, and placement for your frame.

Explore your procedure options or book a consultation with our team.