Breast Cancer ·

10 — Breast Implants: Types, Materials, Shapes, Placement & Manufacturers

BREAST CANCER SERIES

10 — Breast Implants: Types, Materials, Shapes, Placement & Manufacturers

Breast reconstruction after mastectomy is not a single procedure or a single type of implant. Modern breast implants are engineered medical devices whose characteristics—fill material, gel cohesivity, shell, surface, shape, projection, volume and anatomical placement—can substantially influence the reconstructed breast's appearance, feel, movement and long-term complication profile.

For women undergoing reconstruction after breast cancer, implant selection is therefore a reconstructive decision rather than simply a cosmetic one. The condition of the mastectomy skin, amount of remaining soft tissue, chest-wall anatomy, previous or planned radiation therapy, cancer surgery, body habitus and the patient's reconstruction goals all influence which approach is appropriate. (U.S. Food and Drug Administration)

1. What Is a Breast Implant?

A breast implant is a medical prosthesis consisting primarily of a silicone elastomer shell surrounding a filling material. The two principal implant categories are:

Saline-filled implants — silicone shell containing sterile saline solution.
Silicone gel-filled implants — silicone shell containing silicone gel.

The shell itself is therefore silicone in both major categories; the principal difference is what occupies the internal volume. Implant dimensions, shell thickness, surface characteristics, shape and gel properties vary among devices and manufacturers. (U.S. Food and Drug Administration)

The term “gummy bear implant” is commonly used for highly cohesive silicone gel implants. It is not a third fundamental category of implant material; it describes the physical behaviour of a cohesive silicone gel that tends to maintain its form when cut or compressed.

2. Saline vs. Silicone Gel

Characteristic	Saline	Silicone gel
Outer shell	Silicone elastomer	Silicone elastomer
Filling	Sterile saline	Cohesive silicone gel
Rupture behaviour	Usually visible deflation	May be clinically silent
Feel	Can be firmer, particularly with less tissue coverage	Generally more tissue-like
Insertion	Some devices can be inserted empty and filled during surgery	Implant is pre-filled
Monitoring	Clinical assessment plus imaging when indicated	MRI or ultrasound may be used to screen for silent rupture
Reconstruction	Used in selected cases	Widely used in implant reconstruction

With a saline implant, rupture normally results in loss of volume because the saline is absorbed by the body and the implant deflates. Silicone gel rupture can remain clinically silent because the gel may remain within the surrounding fibrous capsule. (U.S. Food and Drug Administration)

For silicone implants, the FDA identifies MRI as the most effective method for detecting silent rupture, with ultrasound also accepted as a screening alternative in asymptomatic patients. (U.S. Food and Drug Administration)

3. Implant Shape

Round implants

Round implants have approximately circular dimensions when viewed from above and provide relatively uniform projection. They are available in multiple diameters, volumes and projection profiles.

Anatomical or teardrop implants

Anatomical implants are designed with a tapered upper portion and greater lower-pole projection. Their geometry attempts to reproduce the natural distribution of breast volume.

However, anatomical implants introduce an additional consideration: rotation. A rotated anatomical implant can alter breast shape, which is one reason implant surface and pocket design are important considerations.

Shape is only one component of the final reconstruction. The surgeon must consider the patient's existing chest-wall dimensions and the thickness and quality of the tissues covering the implant.

4. Implant Profile and Projection

Two implants can have the same volume but produce very different breast dimensions.

Profile describes how far the implant projects anteriorly from the chest. Common terminology includes:

low profile
moderate profile
moderate-plus profile
high profile
extra-high profile

Manufacturers use different terminology, so profiles should not be compared solely by their names. Diameter, base width, projection and volume are more useful physical parameters.

For reconstruction, implant selection must fit the patient's chest rather than simply target a particular cup size.

5. Surface: Smooth vs. Textured

The outer shell can be smooth or textured.

Smooth implants

Smooth shells permit movement of the implant within its pocket and are currently important in modern reconstruction and augmentation.

Textured implants

Texturing was developed partly to influence implant-tissue interaction and reduce implant movement or rotation in particular designs.

However, surface texture has an important safety implication. BIA-ALCL—breast implant-associated anaplastic large cell lymphoma—occurs more frequently in association with textured implants than smooth implants. BIA-ALCL is a rare T-cell lymphoma of the immune system, not breast carcinoma. (U.S. Food and Drug Administration)

In 2019, Allergan's BIOCELL textured breast implants and tissue expanders were voluntarily recalled following FDA action concerning BIA-ALCL risk. (U.S. Food and Drug Administration)

This does not mean that every person with a textured implant will develop lymphoma. It means surface characteristics are an important part of informed implant selection and long-term surveillance.

6. Implant Placement: Where Does the Implant Go?

The implant can occupy different anatomical planes.

Prepectoral

The implant is positioned above the pectoralis major muscle, beneath the mastectomy skin envelope.

This approach avoids dissecting or elevating the pectoralis muscle and can eliminate muscle-related animation deformity. However, the remaining mastectomy skin must have sufficient thickness and vascularity to cover the implant. Thin tissue can make implant edges, rippling or wrinkling more visible. (American Society of Plastic Surgeons)

Subpectoral

The implant is placed partly or substantially beneath the pectoralis major muscle.

The muscle provides additional soft-tissue coverage, which can be useful when there is limited tissue over the implant. However, muscle elevation can produce postoperative tightness, pain and animation deformity—the visible movement of the reconstructed breast when the pectoral muscle contracts. (American Society of Plastic Surgeons)

Dual-plane reconstruction

A dual-plane technique combines different tissue planes so that the implant receives muscle coverage in one region while occupying a different plane elsewhere. The exact technique varies considerably between surgeons and reconstructive circumstances.

The anatomical principle is simple:

Skin → breast tissue/mastectomy flap → pectoralis major muscle → ribs

The implant may be positioned between these layers according to the reconstructive technique.

7. Tissue Expanders: The Staged Reconstruction

A breast implant does not always go in immediately.

In a common two-stage reconstruction, the surgeon initially places a tissue expander. This is a temporary silicone-based device that gradually creates or stretches the soft-tissue envelope needed to accommodate the definitive implant.

The expander is progressively filled over weeks or months. Once sufficient expansion has occurred, a second operation removes the expander and places the permanent implant. (U.S. Food and Drug Administration)

A simplified sequence is:

Mastectomy → tissue expander → gradual expansion → exchange surgery → permanent implant → nipple/areola reconstruction if desired

Some appropriately selected patients can undergo direct-to-implant reconstruction, avoiding the expansion stage. Whether this is possible depends heavily on mastectomy technique, tissue perfusion, available soft-tissue coverage and the patient's anatomy.

8. Breast Implants Used in Canada

Health Canada regulates breast implants as medical devices. Every breast implant sold in Canada must have a Health Canada medical device licence. (Canada)

Health Canada's current overview identifies three manufacturers selling breast implants in Canada:

Allergan Inc.

Associated with the Natrelle family of breast implants. Health Canada states that Allergan's macro-textured implants were suspended in 2019 and were no longer sold in Canada from July 2019. (Canada)

Mentor / Johnson & Johnson

Associated with MemoryGel silicone gel implants and saline products. Health Canada identifies smooth and micro-textured silicone-shell implants among its Canadian products. (Canada)

Tiger Aesthetics Medical, LLC

Health Canada identifies Tiger Aesthetics Medical as a manufacturer of smooth silicone-shell implants filled with silicone gel. Tiger Aesthetics is also associated with the current Sientra implant portfolio. (Canada)

Important: manufacturer availability and licensed models differ by country. A product appearing in the United States, Europe or another market should not automatically be assumed to be licensed for use in Canada.

9. What Happens Around an Implant?

Once implanted, the body recognizes the device as a foreign material and forms a fibrous capsule around it.

This is a normal biological response:

Implant → inflammatory response → fibroblast activity → collagen deposition → fibrous capsule

Normally the capsule remains relatively soft. In capsular contracture, the capsule becomes abnormally thickened and contracts around the implant. This can produce firmness, distortion, pain or displacement. It is one of the major reasons patients may eventually require revision surgery. (U.S. Food and Drug Administration)

From a tissue-engineering perspective, the implant therefore does not exist in isolation. Its long-term behaviour reflects an interaction between:

implant biomaterial + surface + mechanical forces + immune response + surrounding tissue + surgical pocket.

10. Important Long-Term Risks

Breast implants are not lifetime devices. The probability of complications and additional surgery increases with time, although no individual implant's lifespan can be predicted. (U.S. Food and Drug Administration)

Important complications include:

capsular contracture
rupture or deflation
infection
hematoma or seroma
implant malposition
asymmetry
breast or nipple sensory changes
pain
rippling or wrinkling
skin or soft-tissue thinning
additional surgery or implant removal
BIA-ALCL
rare reports of other malignancies arising in the capsule surrounding implants

The FDA has also reported cases of squamous cell carcinoma and various lymphomas in the capsule surrounding breast implants, considered rare but important findings requiring continued surveillance. (U.S. Food and Drug Administration)

11. Breast Cancer and Reconstruction Are Different From Cosmetic Augmentation

The reconstructive breast has a different biological starting point from an augmented breast.

After mastectomy, much of the native breast tissue has been removed. The reconstructed breast therefore depends on the skin envelope, chest wall, pectoral muscle, implant or tissue flap, and sometimes fat grafting to recreate volume and contour.

Radiation therapy can also influence the reconstructive environment by affecting skin and soft-tissue quality and increasing the complexity of reconstruction. Consequently, the timing of radiation, mastectomy and reconstruction must be coordinated between the oncology and reconstructive teams.

Implant reconstruction is only one option. Autologous reconstruction, using the patient's own tissue—commonly from the abdomen, back or thighs—can provide an alternative when an implant is unsuitable or unwanted. (American Society of Plastic Surgeons)

12. Keeping a Permanent Record of the Implant

Patients should retain their breast implant product registration/device card. It identifies information such as the manufacturer, model and serial number and can become extremely important if a product advisory, recall or safety issue arises. Health Canada specifically recommends requesting this information from the surgeon. (Canada)

Canada also introduced a voluntary breast-implant safety/recall registry in May 2026, allowing Canadians to receive direct alerts concerning recalls and safety issues. (Canada)

Conclusion

Modern breast implants are sophisticated biomaterials rather than simply silicone “bags.” Their fill material, gel cohesivity, shell, surface, geometry, profile and anatomical placement determine how the device behaves mechanically and biologically within reconstructed tissue.

For breast-cancer reconstruction, the central question is therefore not “Which implant is best?” There is no universally best implant. The scientifically appropriate choice is the device and reconstructive plane that provide an adequate soft-tissue envelope, appropriate dimensions and acceptable long-term risk for the individual patient.

The evolution of reconstruction increasingly reflects a tissue-engineering principle: the implant, surrounding extracellular matrix, scar capsule, vascularized skin and muscle form an integrated biological-mechanical system. Understanding that interaction is essential to improving reconstruction beyond simply replacing lost breast volume.

References

U.S. Food and Drug Administration (FDA). Types of Breast Implants. (U.S. Food and Drug Administration)
U.S. Food and Drug Administration (FDA). Risks and Complications of Breast Implants. (U.S. Food and Drug Administration)
U.S. Food and Drug Administration (FDA). What to Know About Breast Implants. (U.S. Food and Drug Administration)
U.S. Food and Drug Administration (FDA). Questions and Answers About Breast Implant-Associated Anaplastic Large Cell Lymphoma. (U.S. Food and Drug Administration)
Health Canada. Breast Implants: Overview. (Canada)
Health Canada. Breast Implants: Health Canada's Role. (Canada)
Health Canada. Breast Implants: Common Risks. (Canada)
American Society of Plastic Surgeons. Breast Reconstruction Options. (American Society of Plastic Surgeons)
American Society of Plastic Surgeons. Prepectoral vs. Subpectoral Reconstruction. (American Society of Plastic Surgeons)