Breast implants are used to increase the size of the breasts, and also to improve the shape of the breasts following pregnancy.

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Patient with 500cc Silicone Breast Implants

Breast implant surgery is performed under general anaesthetic or sedation and takes around 1 hour.

Details of the Breast Implant Operation

An incision made in order to place the implant is small (around 1.5 inches) and is located either in the inframammary crease (the crease under your breast), around your areola, or in your armpit.

Breast implants are usually positioned behind the muscle, but may also be placed in front.

Implants are made of cohesive silicone gel, sometimes with a coating of polyurethane.

They may have a round or teardrop shape, and the surface of the implant can be smooth or textured.

A new range of lightweight breast implants called B-Lite Implants has been introduced to reduce the weight of breast implants by up to 30%.

Augmentation with Breast Implants

Harley Breast Patient Before & After

Harley Breast - Patient Breast Implants Before and After - Before
Link to Before & After Photos

300 cc round high projection Sebbin implants, submuscular


Breast Implant Volume

Image of caliper measuring Breast Implants sizes

The volume of the breast implant is measured in cc’s or ml’s (which is essentially the same thing) and increases in size in steps; generally from 200 cc/ml to 700 cc/ml.

Breast implants larger than 700 ml, and up to 1,100 ml are manufactured on demand and handled by the manufacturer as custom-made implants.

Breast implant volume is one of a number of important factors which determines how the breast augmentation will look, and what the patient’s final cup size will be.

The same implant size will produce different results for different patients, depending on their body type.

– A tall patient, with wide shoulders and small breasts (A-cup), may require 450 cc implants to achieve a D-cup after receiving breast implants.

– A shorter patient who already has B-cup breasts may only require 300 cc implants to achieve a D-cup.

It is important for the surgeon to understand the look you are going for.

Some women prefer a small increase in breast size for a result which appears perfectly natural and for the most part undetectable.

Others are seeking to achieve the largest size that their chest will safely accommodate without the risk of complications.

Breast Implant Projection

Implants generally come in moderate, high and extra-high projections.

Many patients who come to the clinic have the idea that implant projection means how high the implant points up.  This is not the case.

Implant projection really means how far forward from your body the implant will stick out in front of your chest.

As you can see from the chart below, the Extra-High Profile implant has a projection of 5.7 cm forward, while the Moderate Profile implant only projects forward 3.3 cm.

The projection of the implant and the implant width or diameter, determine the overall volume of the implant, in cc’s or ml’s.

Image of Breast Implants Sizes

Suitable Implants for Your Body Shape

In order to get a beautiful, natural shape, we need to select the right implant projection, according to the patient’s starting shape, and the size and shape she wants.

During your consultation we first measure the width of your breast using a measuring device called a calliper, to figure out how wide the implants can be, while still fitting you perfectly.

If the implants are too wide for your original breasts, they will tend to make your breasts end up looking a little too round, and less natural.

The surgeon next determines how much forward projection you need, to get the total volume that you want (because implant width * projection = total implant volume).

Higher projection implants might be required if a patient with a small frame and narrow chest, wants a significant increase in size, but is too narrow for a wide implant.

Breast Implants Measurements

“A smaller, narrow frame might require a higher projection implant, to get a big increase in volume.”

It is important that we don’t project too far forward (for your shape), or else your result will start to look unnatural.

Implants come in a number of different widths and projection profiles.  Your surgeon will know what is best suited to your body structure, and what you are wanting to achieve.

Unless you specify otherwise, your surgeon will limit the implant size, to ensure your outcome is a beautiful and natural looking result.


Breast Implant Texture

Breast implants can be smooth or textured (rough).

Smooth Surface Breast Implant next to Rough Surface Implant

Textured surfaces are more commonly used on teardrop shaped implants than on round implants.

This is to help keep the teardrop implant in place (a round shaped implant rotating is not a problem, however, a teardrop implant should move.

Round implants tend to stay in place more easily and do not benefit as much from a textured surface.

The other reason why some implants are textured is that they were found to potentially lower the risk of capsular contracture when the implant is being placed in front of the muscle (sub-glandular pocket), rather than behind the muscle.

However, studies showed that when the implant is placed behind the muscle (which is the most common method) there is little if any difference in the risk of capsular contraction over using smooth implants.

Textured implants generally have a higher complication rate.

Your surgeon will recommend the best implant size, shape and texture for your body, and to achieve the look you want.

Breast Implant Placement

Breast implants can be Under or Over the muscle.

Diagram of Breast Implants Placement Options

The Scar – Incision Placement

Incision placement depends on a number of factors including your preference for the location of the incision scar, your body shape, the proposed size of the implants, and the preference of the surgeon for a particular approach.

There are four incision sites used in breast augmentation, with the most common being the inframammary incision (in the crease below the breast).

The different incision sites have their own advantages and disadvantages which your surgeon will discuss with you during your consultation.

Incision Options Breast Implants

Inframammary Incision

The most common incision site is in the breast crease. This method involves an incision on the underside of the breast, tucked in near the fold. The technique is popular because it allows maximum access to create an implant pocket and for the surgeon to manoeuvre during implant placement.

On the negative side, the incision creates a thin scar under the breast which can be longer than the incisions made in other areas and may be visible after surgery when the patient is laying on her back.

Periareolar and Subareola Incision

Around the edge of the areola is a common incision site for patients who are also undergoing a breast lift and will have scarring in this area in any case. As the size of the areolas varies from patient to patient, there may be insufficient space to insert a pre-filled implant. In patients with darker skin, the incision method can also cause raised hypertrophic scarring.

Transaxillary Incision

An incision is made in the armpit area, into which the implant is inserted and guided down towards the breast. This is a popular technique for patients who are concerned about the risks of scarring and would rather have any scar located in the armpit area. This is an excellent incision location for hiding all traces of your breast augmentation, however, there are two major downsides to the approach.

  1. There is a higher chance of asymmetry problems between the left and right implant, as the surgeon has impaired access to the region.
  2. Incisions in this area are associated with a slightly higher chance of infection.  Note: all surgery carried a small risk of infection, which is why you will be prescribed antibiotics.

Transumbilical Incision

The least common incision site, which gives the surgeon the least ability to manoeuvre and place the breast implants, is an incision in the belly button. The implant is then guided into the breast area and inserted into place. This method will not work with silicone breast implants.


Scarring is a process with several distinct stages.

For the first two weeks, the body is concentrating on fighting any bacteria in the area of the scar and sending signals to begin rebuilding blood vessels and repair tissues.  In this early period, the scar weak and the skin can still split open easily.

The scar will generally not be red or pink yet until the second stage, generally in weeks 2 to 6 when more collagen is created in the area.  In this stage, the scar will become more raised and take on a pink or red colour.

In the third stage, generally from week 6 to 12 months from the surgery, the scar is maturing as tissue and collagen are remodelling the scar so that it is stronger and becomes less noticeable.  The collagen in the scar will align into a better structure, requiring overall less scar tissue. The scar will slowly start to fade and flatten out.

Scarring after Breast Implants

Although scars will heal on their own, there is an understandable desire to intervene somehow to speed up recovery or improve the final result. The most effective method known is to apply strips of silicone to the scar. Although not well understood, in theory, silicone helps collagen realign more effectively. Solid silicone sheets need to be on the scar almost all the time in order to have an effect.

Silicone Strip for Scar Reduction after Breast Implants

Your surgeon can recommend other methods of minimising scarring, such as taping the area to provide support and take some of the tension off the incision. Steroids administered by local injection or topically can improve hypertrophic scarring.  Only certain scar types can benefit from steroids. Using some steroids can make the overall appearance worse by thinning the surrounding skin and causing atrophy of the surrounding tissues. Your surgeon will guide you on the best way to treat scarring during your follow-up consultations.

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About the author

Clinic Director Dr Gary Horn

Dr Gary Horn is director of Harley Breast and is responsible for all website content.

Dr Horn is a registered Plastic Surgeon in the UK (GMC 4267803) and Belgium.

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Dr Gary Horn is a highly acclaimed Consultant Plastic and Reconstructive Surgeon with over 25 years of experience in breast augmentation and reshaping using breast implants (over 2,000 surgeries performed) and fat transfer to the breast. Dr Horn is a registered Plastic Surgeon in the UK (GMC 4267803) and Belgium.

SPECIALITIES: General Plastic Surgery, Cosmetic Plastic Surgery

LANGUAGES:  English, French


Dr Horn is qualified to perform a large range of procedures, including:
Breast augmentation with cohesive silicone gel implants, fat transfer to the breasts, Breast Lift, Mastopexy.

French Society of Plastic, Reconstructive and Aesthetic Surgery (SoFCPRE)

European Board of Plastic Surgery
International Society of Aesthetic Plastic Surgery
General Medical Council Membership Dr Gary Horn