Breast Implants: Common Questions and Answers


Am Fam Physician. 2021 Nov ;104(5):500-508.

  Patient information: See related handout on breast implants, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Breast implants are used for a wide range of cosmetic and reconstructive purposes. In addition to breast augmentation, implants can be used for postmastectomy breast reconstruction, correction of congenital breast anomalies, breast or chest wall deformities, and male-to-female top surgery. Breast implants may confer significant benefits to patients, but several factors are important to consider preoperatively, including the impact on mammography, future lactation, and potential long-term implant complications (e.g., infection, capsular contracture, rupture, and the need for revision, replacement, or removal). A fundamental understanding of implant monitoring is also paramount to implant use. Patients with silicone breast implants should undergo routine screening for implant rupture with magnetic resonance imaging or ultrasonography completed five to six years postoperatively and then every two to three years thereafter. With the exception of complications, there are no formal recommendations regarding the timing of breast implant removal or exchange. Women with unilateral breast swelling should be evaluated with ultrasonography for an effusion that might indicate breast implant–associated anaplastic large cell lymphoma. There are no specific breast cancer screening recommendations for patients with breast implants, but special mammographic views are indicated to enhance accuracy. Although these discussions are a routine component of consultation and postoperative follow-up for plastic surgeons performing these procedures, family physicians should have a working knowledge of implant indications, characteristics, and complications to better counsel their patients, to ensure appropriate screening, and to coordinate care after surgery.

Breast implants are used for cosmetic and reconstructive purposes. Implant placement for primary breast augmentation is the most common cosmetic surgical procedure in the United States, with more than 313,000 procedures performed in 2018.1 Breast implants also play an important role in reconstructive procedures for breast hypoplasia,2 congenital breast anomalies,3 male-to-female top surgery,4 and postmastectomy breast reconstruction. Rates of breast reconstruction after mastectomy have increased since the passage of the Women's Health and Cancer Rights Act in 1998, which mandates insurance coverage for all stages of postmastectomy reconstruction.5 It also includes coverage of symmetry procedures for the contralateral breast in the case of a unilateral mastectomy.5 Implant-based breast reconstruction is more common than tissue-based (autologous) reconstruction, which commonly uses abdominal tissue for breast reconstruction, for patients who have undergone mastectomy.6 Operative techniques for breast implant placement can have important implications when assessing and examining patients. Notably, implants can be placed above the pectoralis major muscle, where they are more easily palpable, or below the pectoralis major muscle, where features such as implant rupture may be more difficult to discern on examination. Postmastectomy reconstruction improves patient-reported outcomes in psychosocial well-being, sexual well-being, and overall chest satisfaction.7


Breast Implants

In September 2020, the U.S. Food and Drug Administration released new guidance about labeling of breast implants to improve risk communication:

A boxed warning denotes risks such as breast implant–associated anaplastic large cell lymphoma and potential need for additional operations

A patient decision checklist should be provided to document discussion of alternatives to breast implants, risks of breast implant surgery, breast implant–associated anaplastic large cell lymphoma, systemic symptoms, and considerations for a successful breast implant candidate

Chemical materials contained in implants should be described

Silicone rupture screening guidelines

All patients should be given an implant device card

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Clinical recommendationEvidence ratingComments

Screen patients with silicone breast implants for implant rupture with magnetic resonance imaging or ultrasonography five to six years postoperatively and then every two to three years thereafter.20


Expert opinion and consensus guideline from the U.S. Food and Drug Administration in the absence of clinical trials

Suspect breast implant–associated ALCL in patients with textured silicone breast implants and late onset (eight to 10 years) seroma.27


Review of literature on cases of breast implant–associated ALCL

Patients with breast implants should receive additional radiologic displacement views during routine mammographic screening.38


Case series demonstrating improved image quality and breast tissue visualization using displacement views

Educate patients that breast implants are associated with a reduced

The Authors

show all author info

SARINA SCHRAGER, MD, MS, is a professor in the Department of Family Medicine and Community Health at the University of Wisconsin School of Medicine and Public Health, Madison....

SARAH M. LYON, MD, is a resident in the Division of Plastic Surgery at the University of Wisconsin School of Medicine and Public Health.

SAMUEL O. POORE, MD, PhD, is an associate professor in the Division of Plastic Surgery at the University of Wisconsin School of Medicine and Public Health.

Address correspondence to Sarina Schrager, MD, MS, University of Wisconsin, 1100 Delaplaine Ct., Madison, WI 53715 (email: Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

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