Breast Implant Options for Reconstruction After Mastectomy

Saline, silicone, and investigational types can be considered

In This Article

If you plan to have a mastectomy and pursue reconstruction using breast implants, as opposed to having tissue flap surgery (TRAM, DIEP, latissimus dorsi), you'll have three main options to choose from. The U.S. Food and Drug Administration (FDA) has approved saline, silicone, and highly cohesive silicone gel ("gummy bear") breast implants for this use. While these implants have similarities, you'll need to weigh the differences to decide which is right for you.

breast implant placement
 Verywell / Emily Roberts

Common Features

Breast implants are silicone sacs that are filled with either sterile salt water (saline) or silicone gel. They are surgically placed between layers of muscle to create a reconstructed breast mound. Implants are sized to match your remaining breast or to create symmetry (and your desired look) if both breasts have been removed.

Some implants have a smooth silicone shell while others have a textured one. Smooth-shelled implants may rotate over time, while textured shells are less likely to do so.

No breast implant is guaranteed to last a lifetime, and implants come with risks, from rupture to cancer of the immune system. When an implant leaks, shifts, or doesn't look right, you will have to have it surgically replaced or removed.

After getting implants, you won't have the same sensation as you did in your natural breasts, and your breasts will probably move differently.

All reconstruction surgeries involve similar risks, regardless of implant type. These include:

  • Scar tissue
  • Pain
  • Infection
  • Adverse reaction to anesthesia

Modern anesthesia is considered very safe and extreme reactions are rare. They tend to be more common in people undergoing lengthy surgeries or older people. These reactions may include:

  • Temporary confusion
  • Heart attack
  • Pneumonia
  • Stroke

Your doctor can address your questions and concerns about the risks.

Different Shapes and Sizes

Breast implants, like natural breasts, come in different shapes and sizes. Some implants are round and some are tear-drop shaped. Implants also come in a variety of profiles, or cup sizes.

Your plastic surgeon can help you decide which size, type and style of breast implant will work best for ​your breast reconstruction and for your desired figure. Most plastic surgeons can show you "before and after" photos of patients who have had implant reconstruction, so you will know what to expect.

Types of Breast Implants
Consideration   Saline   Silicone Gummy Bear
Natural Appearance Least More Most
Natural Feel Least More Most
Expense Least More Most
Risks Least Most Moderate
Rupture Detection Visually Evident May be evident or silent; requires routine MRI Not visually evident; requires routine MRI
Rupture Correction Easiest Harder Harder
Other Considerations     Larger scar

Saline Implants

Saline is sterile and similar to fluids already present in your body, so they're considered safer than silicone implants in case of a leak. It's also easier to detect a leak in saline implants. However, they can have a rippling appearance when you move, which makes them look less natural than silicone. Saline implants may feel less like natural breast tissue, as well.

The three kinds of saline breast implants are:

  • A single sac that's filled with a pre-determined amount of saline during surgery: This kind of implant cannot be expanded after the surgery.
  • A pre-filled single sac containing saline: Likewise, this kind of implant cannot be expanded after the surgery.
  • A single sac that is filled with saline during surgery: This kind of implant has a valve that allows more saline to be added after surgery.

Risks of saline implants include:

  • Rupture and leaking, through which the breast implant will deflate
  • Hardening of the area around the implant (capsular contracture)
  • Need for removal or replacement, requiring additional surgery

Silicone Implants

The three kinds of silicone breast implants are:

  • A pre-filled single sac containing silicone: This is not expandable after surgery.
  • A two-layered sac (one inner sac pre-filled with silicone and one outer sac that is filled with saline during surgery): These are also unable to be expanded after surgery.
  • A two-layered sac (one inner sac pre-filled with silicone and one outer sac that is filled with saline during surgery): These can be expanded after surgery by adding more saline through a valve.

While silicone implants may move and feel more like your natural breasts, they come with added risk due to the fact that your body doesn't naturally contain silicone.

Risks of silicone implants include:

  • Rupture with a leak, which allows the silicone gel to spread outside the shell
  • Silent rupture, or slow leak, detectable only with magnetic resonance imaging (MRI) (Note: Screening is recommended three years after surgery and every two years after that.)
  • Need for removal or replacement, requiring additional surgery

When silicone leaks into your system, it can cause myriad problems. These include:

  • Swelling and irritation or pain in the breast
  • A distorted appearance of the affected breast
  • Lumps
  • Hardening

Additionally, some women report a set of systemic symptoms following silicone leaks or ruptures, such as:

  • Fatigue
  • Memory loss
  • Cognitive difficulties ("brain fog")
  • Joint pain

According to the U.S. Food and Drug Administration (FDA), medical science hasn't determined whether these symptoms, often referred to as "breast implant illness," are due to silicone in the body, but studies are ongoing. Some research has suggested that silicone implants are not linked to connective tissue disease, breast cancer, or reproductive problems.

Gummy Bear Implants

The newest type of implant is often referred to as a gummy bear implant. It contains a highly cohesive silicone gel that's less likely to get wrinkled and dimple. In fact, it will even retain its shape if the outer silicone shell is broken.

All gummy bear implants are teardrop-shape. If you want large implants without the unnaturally round look some implants give the upper breast, this may be the right type for you.

Also, gummy bear implants are less likely to rupture or leak than older implant types, and capsular contracture is less common. However, the surgeon may need to make a larger incision than what is needed for saline or standard silicone implants.

Risks of gummy bear implants include:

  • Leaks that, while less common, may be harder to detect; this requires periodic MRIs to check their integrity, which other implant types do not
  • An odd appearance if they do rotate, due to their shape

A Word From Verywell

If you don't need to have radiation or chemotherapy after your mastectomy, you can get implants right away. However, if you do need one or both of these treatments, the doctor will put in a temporary implant called a tissue expander. An expander stretches the skin and muscle to make room for a permanent implant, which may go in a couple of months later. Speak to your doctor about all of the above options so you feel confident about whatever decision you make.

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Article Sources

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