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 shape and size of the breast. Of the breast plastic surgery procedures performed in 2006 in the United States, 329,000 were for breast augmentations. Insertion of breast implants is also known as breast augmentation, breast enlargement, breast enhancement, mammoplasty enlargement or augmentation mammoplasty.

In the 1970s plastic surgeons wanted softer and more lifelike implants so breast implants were redesigned with thinner gel and thinner shells; these 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 common. 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 in the early 1990s. One manufacturer did produce a model of pre-filled saline implants but has been reported to have had high failure rates following surgery.

In the mid 1980s, advances in manufacturing principles brought about elastomer-coated shells to decrease gel bleed, and were filled with thicker, more cohesive gel; these implants are sold under restricted conditions in the U.S. and Canada, but are widely used in other countries. Saline implant shells are made of silicone elastomer and the implants are filled with saline solution after the implant is placed in the body. Dr. Thomas Cronin and Dr. Frank Gerow, who were two Houston, Texas, plastic surgeons, developed the first silicone breast prosthesis with the Dow Corning Corporation back in 1961.

Saline-filled breast implants were first manufactured in France in 1964 and were introduced by Arion with the goal of being surgically placed using smaller incisions than they were then using. The first woman was implanted with silicone implants in 1962.

Since the early 1990s, a number of independent reviewers have examined studies concerning links between silicone gel breast implants and systemic diseases; 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; it's always wondered who is funding these studies and that should clearly be stated. 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 may prove difficult; this has been questioned by many women experiencing various health issues.

Extracapsular silicone 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 reported.

One study reported 30% of ruptures in asymptomatic patients are accurately detected by experienced plastic surgeons, compared to 86% detected by MRI. An intracapsular rupture can progress to outside of the capsule, called an extracapsular rupture, and it is generally agreed that both conditions indicate the need for removal of the implant. Manufacturers and doctors are required to inform women that implants are not permanent devices and that most recipients will probably need additional surgery to replace or remove their implants.

When breast implants are removed that have been implanted for a long period of time, a mastopexy is often performed to tighten up the loose skin: this is additional surgery usually done at the same time and at an additional expense. Studies of saline-filled breast implants 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.

The age and design of the implant are important factors in rupture, but estimating rupture rates of contemporary devices has been difficult for a variety of reasons, mainly because implant designs have changed somewhat over time. Capsules of tightly-woven collagen fibers form as an immune response around a foreign body like breast implants, which tends to wall it off; capsular contracture happens when the capsule tightens and squeezes the implant.

Some doctors in specialties other than plastic surgery, like dermatologists, perform breast plastic surgery like breast augmentation; choose a plastic surgeon instead. If you decide to proceed, make sure you choose the best breast plastic surgeon based on your research; ask health professionals you know for referrals. Just a reminder that breast augmentation is usually considered an elective cosmetic breast plastic surgery.