Breast implant types and sizes: how to choose

What types of breast implant are there?

Implants differ in four ways: what fills them, their shape, their surface and their size. Placement and incision are decided at the same time, and every choice is agreed with your surgeon after an examination.

Silicone or saline: what is the difference?

Silicone gel implants feel closer to natural breast tissue and wrinkle less, and they are the type most commonly used in the UK. A silicone leak is often silent, so even without symptoms the FDA recommends a first ultrasound or MRI 5–6 years after surgery, then one every 2–3 years.

Saline implants are filled with sterile salt water. If one leaks, it deflates visibly and the body absorbs the fluid, but folding and deflation are more likely over time. Structured saline designs have an internal structure intended to feel more natural. In the United States, the FDA approves saline implants for cosmetic augmentation from 18 and silicone gel from 22. Op. Dr. Bilgehan İlker generally prefers silicone.

Form-stable silicone, sometimes called 'gummy bear', uses a denser, firmer gel that keeps its shape even if the shell breaks; placing it needs a slightly longer incision.

Round or teardrop: which shape suits you?

Round implants give more fullness in the upper part of the breast, and high-profile models project further forward. If a round implant turns in its pocket, it keeps its shape. Op. Dr. Bilgehan İlker notes that round implants can be placed through any of the usual approaches.

Anatomical (teardrop) implants are fuller at the bottom and slope towards the top, but they do not suit every approach. If one rotates, the breast can look distorted, and correcting it needs surgery. Dr. İlker uses round implants when you want upper fullness and anatomical ones for a natural slope.

Smooth or textured: does the surface matter?

Yes, for movement and for one rare risk. Smooth implants feel softest but can move and ripple. Tissue grips a textured surface, so textured implants move less, and in one 10-year study they showed less capsular contracture (9.0% against 17.5%).

The trade-off is BIA-ALCL, a lymphoma of the immune system, not breast cancer, linked mainly to textured implants: estimates range from 1 in 3,817 to 1 in 30,000 people with them. Ask which surface is proposed for you, and why. Regulators do not recommend removing textured implants that cause no symptoms.

Ask Dr. İlker a question

How is the right implant size chosen?

Implant size is given as a volume in cubic centimetres (cc), together with a profile that describes how far the implant projects. The number alone says little about how it will look on you. What decides the size is your frame and chest measurement, how much of your own tissue will cover the implant, and the change you want.

Op. Dr. Bilgehan İlker explains that an implant changes the letter in your bra size (the cup), not the number (the band), which follows your chest measurement. Size, implant type, placement and incision are agreed only after an in-person examination.

Size and placement are decided together. The implant can sit in front of the chest muscle, behind it, or in a dual plane combining both, which has been described particularly for breasts with some glandular sagging or a narrow lower half. The choice depends on your tissue cover, the implant size and your goals.

Why do new implants look larger and higher at first?

Because of swelling. In the first week the breasts look larger and higher than planned, which can make a well-chosen size seem too big. Over several weeks the implants settle, and within a few months the breasts look and feel more natural, so judge the size only then. Some surgeons recommend wearing a sports bra day and night for up to 3 months.

Can your own fat be used instead of an implant?

For a modest increase, yes. Fat transfer breast augmentation moves fat taken by liposuction into the breasts, adding about one cup size at most. Part of the fat is absorbed in the first months: in studies, an average of 53–62% remained at 12 months. You need enough fat to spare, and fat can also be used alongside an implant.

What happens to implants over the years?

Whatever type you choose, implants are not lifetime devices. For many people, replacement or removal comes up at around 10–15 years, although in one 10-year study 81.8% of patients still had their original implants. Breasts also keep changing with age, weight, pregnancy and menopause.

Keep a written record of your implants' manufacturer, model, size and surface, and examine your breasts regularly. You will need those details for scans and for any later implant revision.

What should you ask before choosing an implant?

• Which implant, by filling, shape, surface and size, do you recommend for me, and why?
• Is my tissue cover enough for that size, and would it sit over the muscle, under it or in a dual plane?
• Have my breasts dropped enough to need a breast lift as well? An implant adds volume, not lift.
• How could this choice affect breastfeeding and future mammograms?
• Will I get my implant details in writing?