In short. Implant choice comes after the shape question rather than before it. How the device fits into a plan that begins with the envelope and the position.
Key points
- First, is the position right, and does it need an operation to be right?
- Second, how much volume is wanted, and can the envelope carry it?
- Third, if an implant is the way to add it, what follow-up does that involve and is that acceptable?
An implant is the most discussed object in breast surgery and the last decision in a well-ordered plan. What it can achieve depends on the envelope it goes into, so the plan starts there.
The envelope comes first
Three findings about the envelope decide what an implant can achieve. The quality of the skin, because skin that has lost its recoil carries weight lower. The width of the breast at its base, because an implant wider than the base is felt at the edges. And the height of the fold, because that decides where the breast sits.
Whether a lift belongs in the same plan
Where the breast has dropped, the position problem is answered by removing skin, and that decision is made independently of the volume question. Sometimes the two are combined in one operation, and sometimes the lift is done first because the envelope needs to be stable before volume is judged. Where the drop is mild and the skin still has recoil, a lift may not be needed.
Where fat transfer fits
Fat transfer adds volume without a device, in modest amounts, and can soften the edges of an implant or improve a contour irregularity. It cannot replace an implant where a large addition is wanted, and it does not lift. Where someone wants a small change, or wants to avoid a device, it may answer the complaint on its own.
The order of the decisions
First, is the position right, and does it need an operation to be right? Second, how much volume is wanted, and can the envelope carry it? Third, if an implant is the way to add it, what follow-up does that involve and is that acceptable? Taken in that order, the size is an outcome rather than the starting point; taken in the other order, the envelope decides the result.
What comes with the device
An implant brings a follow-up obligation, and imaging is part of the plan. The device is not expected to last a lifetime, and removal or replacement at some point is part of the conversation rather than a failure. Removal is not a return to the starting point either, because the envelope has usually been stretched by the implant.
Planning for the second operation
A first operation planned with the possibility of a second in mind tends to be a better first operation: the scar is placed where it can be reused, the envelope is not over-filled, and the follow-up is arranged rather than promised.
Findings around an implant that need assessment
- A breast that becomes firm, tender or visibly different in shape.
- A swelling, or a collection of fluid, that appears years after implantation.
- A lump you can feel, or skin that has dimpled or thickened over the implant.
What an assessment records before an implant is discussed is set out in Breast Assessment Before Any Aesthetic Plan, and how the position problem is judged in Volume, Shape and Position.
Frequently asked questions
Why can an implant not be chosen first?
Because what an implant can achieve depends on the envelope it goes into. Skin that has lost its recoil carries weight lower, a narrow base limits how much can be placed without the implant being felt at the edges, and a difference in fold height is not corrected by volume at all. Choosing a size first and assessing the envelope afterwards is how a plan ends up being revised.
Does an implant ever avoid the need for a lift?
Sometimes it can, and only where the drop is mild and the skin still has recoil. Where the breast has clearly dropped, an implant adds weight to an envelope that is not holding what it has, and the result is usually a larger breast in a low position. In that situation the lift is the part of the plan that addresses the complaint, and the implant, if it is used at all, is the part that addresses the volume.
How long should I expect an implant to last?
It is not a lifetime device and no implant is expected to last for the rest of your life. Many last for many years without a problem, and some need attention sooner, which is why follow-up, imaging and a willingness to consider further surgery are part of the decision rather than an unlikely possibility. Anyone who is not prepared to consider a second operation is a poor candidate for a first one.
Risks & Limitations
- No breast operation makes the two sides identical, and no result can be promised.
- Scars from breast surgery do not disappear. They soften and fade over a year or more.
- Adding volume does not lift a breast, and a lift does not add volume.
- An implant is not a lifetime device. Removal or replacement at some point is part of the plan, and removal does not restore the shape the breast had before it was placed.
- Fat transfer is partly reabsorbed. A further session is sometimes needed to hold the same volume.
- Nipple and areola sensation may change after an operation, and it does not always return to what it was.
When to Seek Care
- A new lump, or a lump that has changed in size, shape or feel.
- Skin that has dimpled, puckered or thickened, or a nipple that has newly turned inwards.
- A discharge from the nipple, and any discharge that is blood-stained.
- Spreading redness with fever, or a wound that opens after breast surgery.
- A breast implant that becomes firm, tender or different in shape, or a swelling that appears years after it was placed.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — procedure and safety guidance
- National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
- Cochrane Library — systematic reviews
- Chinese Medical Association Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.