Breast implants have been used since about 1895 to augment the size or shape of women's breasts. The earliest known implant was attempted by Dr. Czerny, using a woman's own fatty tissue from a lipoma on her back. In some countries, for cosmetic breast plastic surgery, health insurers will reimburse insertion of breast implants only for clinical indications, meaning, congenital abnormalities, sex-reassignment surgery or breast reconstruction - usually following a mastectomy. And non-clinical indications, which are the most common reason women get breast implants, are considered cosmetic and are not covered by health insurers.

The first woman implanted with silicone implants was back in 1962. For women with very little breast tissue, or who are having post-mastectomy reconstruction, plastic surgeons believe that silicone gel implants are the superior device; but in patients with more breast tissue, saline implants can look very similar to silicone gel implants. One manufacturer produced a model of pre-filled saline implants, but it has been reported to have had high failure rates following implantation.

Because saline implants are empty when they're surgically inserted, the scar is smaller than for the silicone gel breast implants which are already filled with silicone before they are placed. There are two primary types of breast implants: saline-filled and silicone-gel-filled. Saline implant shells are composed of silicone elastomer and the implants are filled with saline solution after the implant is placed inside the body.

The current saline implant devices are manufactured now with thicker, room temperature vulcanized (RTV) shells. It was predominantly silicone implants that were designed in the 1970s that were involved in the class-action lawsuits against Dow-Corning and many other manufacturers back in the early 1990s.

It's important to remember that breast implants don't last a lifetime and at some time or other would need to be removed and replaced or removed permanently. A contracture is a complication that can be very painful and distort the appearance of the implanted breast; contractures are common. Be aware that thousands of women claim they have become ill from their breast implants. These complaints include neurological and rheumatological issues.

Studies of saline-filled breast implants that were approved by the FDA in May 2000 showed rupture and deflation rates of 3-5% at three years and 7-10% at five years for breast augmentation patients. When the silicone implants rupture they rarely deflate, and the silicone from the implant can leak out or leach into the intracapsular space around the implant. Local complications that can occur with 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, disruption of the natural plane between the breasts and others.

An intracapsular rupture can progress to outside the capsule, called an extracapsular rupture, and it's usually agreed that both conditions indicate the need for removal of the implant. Some studies have indicated that subjective and objective symptoms of women with breast implants may improve partially or entirely when their implants are removed.

The risk and the treatment of extracapsular silicone gel are still controversial. Plastic surgeons agree that it's difficult to remove. But they disagree about the lasting health effects. Researchers must study and compare a large group of women without breast implants who are of similar age, health, and social status and who are followed for a long time, meaning 10 to 20 years, before a relationship between women with breast implants and any diseases they have can be made.

After breast plastic surgery, depending on the level of activity required, patients are usually able to return to work or school within a week. Make sure the plastic surgeon you choose, if you decide to do so, is a board certified plastic surgeon. Some doctors in specialties other than plastic surgery, like dermatologists for example, perform breast plastic surgery like breast augmentation.