In many countries today health insurers will reimburse the insertion of breast implants only for clinical indications including congenital abnormalities, sex-reassignment surgery and breast reconstruction, usually following a mastectomy. And non-cosmetic clinical indications for the use of breast implants include breast reconstruction, sex reassignment surgery, and for abnormalities, usually congenital, that affect the shape and size of the breast. Breast implants have been used since as early as 1895 to augment the size or shape of women's breasts and the earliest known implant was attempted by Czerny, using a woman's own fatty tissue from a benign fatty tumor on her back.

Saline-filled breast implants were first manufactured and distributed in France in 1964 and were introduced by Arion with the goal of surgically placing them using smaller incisions than they were using. Dr. Thomas Cronin and Dr. Frank Gerow, two Houston, Texas, plastic surgeons, developed the first silicone breast prosthesis with the Dow Corning Corporation in back in 1961.

There have been many types of breast implants developed other than the saline filled and silicone gel filled, including polypropylene string implants and soy oil, but these are not commonly used, if at all. And leakage of oil into the body cavity during a rupture would not be good. Silicone gel implants have a silicone shell and are filled with a viscous silicone gel. In the mid 1980s, advances in manufacturing principles brought about the elastomer-coated shells to decrease the bleeding of gel and are filled with a thicker, more cohesive gel. These implants are sold under very restricted conditions in the U.S. and Canada and are used in other countries.

Because saline implants are empty when they are surgically inserted, the scar is smaller than it is for silicone gel breast implants which are already filled with silicone before they are placed. One manufacturer did produce a model of pre-filled saline implants but it's been reported to have had high failure rates following breast plastic surgery. For women with very little breast tissue, or for post-mastectomy reconstruction, plastic surgeons believe that silicone gel implants are superior but in patients with more breast tissue, the saline implants can look similar to silicone gel implants. The end result of course with insertion of either type of implant is to get a look of natural breast enhancement.

One study reported that only 30% of ruptures in patients with no symptoms are accurately detected by the most experienced plastic surgeons, compared to 86% detected by MRI. Since the early 1990s, a number of independent reviewers have examined the studies concerning links between silicone gel breast implants and systemic diseases and the consensus of these reviews is that there is no clear evidence of a causal link between the implantation of silicone breast implants in breast plastic surgery and systemic disease. However it's always important to know who is funding these studies and that should clearly be stated.

When silicone implants rupture they rarely deflate but the silicone gel from the implant can leak out into the intracapsular space around the implant area.

In breast plastic surgery the risk and treatment of extracapsular silicone gel is still controversial; plastic surgeons agree that it's difficult to remove, but there is still disagreement about the lasting health effects. Extracapsular silicone gel 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. If it migrates to other parts of the body it's not been proven yet. There is a general international consensus in the medical field that silicone gel 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 unknown mechanisms may prove difficult. But this has been questioned by many women experiencing a variety of health issues.

Researchers must study and compare a very large group of women without breast implants who are of similar age, health, and social status and who are followed for a long time, such as 10 to 20 years, before a relationship between the women with breast implants and any known diseases can be made.

An intracapsular rupture can progress to outside the capsule, which is called an extracapsular rupture, and it's generally agreed that both conditions indicate the need for removal of the implant. The local complications that can occur with placement of breast implants include post-operative bleeding, fluid collections, 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 a disruption of the natural plane between the breasts.

The surgical procedure for breast augmentation takes approximately one to two hours, but the lasting effects of breast plastic surgery, both good and bad, will be around for many years. Make sure you choose a plastic surgeon that is board certified if you decide to go ahead. As with any decision, make sure to weigh the benefits and risks carefully before proceeding with any breast enlargement. And after weighing the risks and benefits you may want to consider a form of natural breast enhancement.