Most women get breast implants for non-clinical reasons so they're considered cosmetic and are not covered by health insurance. If you're considering any type of breast plastic surgery, it's important to know all the pros and cons related to the type that you want. The non-cosmetic clinical indications for the use of breast implants are for breast reconstruction, sex reassignment surgery, and for abnormalities, usually congenital, that affect the size and shape of the breasts.

Two Houston, Texas plastic surgeons developed the first silicone breast prostheses in 1961 with the Dow-Corning Corporation. But it was the predominantly silicone implants that were designed in the 1970s that were involved in the class-action lawsuits involving Dow-Corning and many other manufacturers in the early 1990s. Back in the 1970s, plastic surgeons weren't happy with the implants they were using. They wanted softer and more lifelike implants. So breast implants were redesigned with thinner gel and thinner shells. These new implants had a greater tendency to rupture and leak, or "bleed" silicone through the implant shell into the body cavity. And complications such as capsular contracture were very common.

There have been quite a few types of breast implants developed over the years other than the commonly used saline-filled and silicone gel-filled implants, including polypropylene string and soy oil. But these are not commonly used, if at all and leakage of soy oil into the body during a rupture would not be good for the patient.

Compared to silicone gel implants, the saline implants are more likely to cause problems such as rippling and wrinkling, and they can be noticeable to the eye or to the touch. The silicone gel implants have a silicone shell. And they are filled with a viscous type of silicone gel.

Saline-filled breast implants were first manufactured in France back in 1964 and were introduced by Arion. They were to be surgically placed using much smaller incisions than they were using at the time. In the mid 1980s, advances in manufacturing principles brought about elastomer-coated shells with the goal of decreasing gel bleed. They are filled with a thicker, more cohesive gel. These implants are sold under some restricted conditions in the United States and Canada, but are widely used in other countries.

Researchers must study and compare a large group of women with and women without breast implants who are of similar age, health, and social status. They must be followed for a long time, usually 10 to 20 years, before a relationship between women with breast implants and any diseases can be made. The age of the implants and design are important factors in rupture, but estimating the rupture rates of modern devices has been difficult for a variety of reasons, mostly because implant designs have changed over the years.

If the silicone implants rupture they rarely deflate and the silicone from the implant can leak out into the intracapsular space around the implant. The silicone that is extracapsular (leaked outside the capsule) has the potential to migrate to other parts of the body, but most clinical complications have appeared to be limited to the breast and axillae as inflammatory nodules (granulomas) and enlarged lymph glands in the armpit area called axillary lymphadenopathy. It's not really known if other body parts are involved or not.

In one study it was reported that only 30% of ruptures in patients with no overt symptoms are accurately detected by experienced plastic surgeons, compared to 86% detected by MRI. There is a general international consensus in the medical field that silicone implants in breast plastic surgery have not been shown to cause systemic illness, excluding the possibility that a small group of patients may become ill through (as yet) unknown mechanisms.

Most, if not all, countries outside of the United States have not endorsed routine MRI screening. They have taken the position that MRI's should be reserved only for cases involving suspected clinical rupture or to confirm mammography or ultrasound studies that suggest rupture. And local complications that can occur with breast implants include post-op bleeding, fluid collection, surgical site infection, breast pain, alterations in nipple sensation, interference with breast feeding, visible wrinkling, asymmetric appearance, wound dehiscence with potential implant exposure, thinning of the breast tissue, and disruption of the natural plane between the breasts.

When an intracapsular rupture progresses to outside of the capsule, called an extracapsular rupture, it's generally agreed that both conditions indicate the need for removal of the implant. The risk and treatment of extracapsular silicone gel is still controversial and plastic surgeons agree that the gel is difficult to remove. There is disagreement about what may be lasting health effects.

The surgical procedure for breast augmentation takes about one or two hours, but the lasting effects of breast plastic surgery, both good and bad, will be around for many years. Make sure to do plenty of research online and offline before you make a decision about any breast plastic surgery you have in mind, including breast augmentation, mastopexy and any other cosmetic breast procedure. Some doctors in specialties other than plastic surgery, such as dermatologists, perform breast plastic surgery like breast augmentation but it's better to choose a board certified plastic surgeon instead if you decide on surgery. There are risks with any surgery. Make sure you know what the risks are.