What Do Breast Implants Feel Real?

Dear xklorx,

The way a breast feels after breast augmentation will vary depending on a number of factors:

1. Silicone vs saline.  Silicone implants tend to feel more realistic than saline (all factors begin equal) because of the properties of silicone gel being more 'flesh-like'. Saline is soft, but has more or a 'water balloon' type softness
2. Type of silicone implant. The high cohesive gel implants ('gummy bear implants') are firmer than the current silicone implants. This may come as a surprise to some patients who think that the gummy bear implants are better in all characteristics compared to the current generation. These firmer implants tend to feel less realistic than the current generation implants.
3. Over or under the muscle.  The more tissue there is covering the implant, the more real the augmented breast tend to feel, therefore under the muscle gives a more natural feel than over the muscle
4. Amount of native breast tissue. Again, the more tissue there is covering the implant, the more natural it will feel. If you have more breast tissue, the breast will feel more realistic than if you start with very little breast tissue. 
5. Size of implant. A large implant means that the total breast volume is composed  mostly of the implant, with a minor contribution from the native breast.  In general. smaller implants tend to look and feel more realistic vs large implants (with all things being equal).
6. Textured or smooth implant. Textured implants tend not to move as much as smooth surfaced implants. A relatively immobile textured implant tends to feel less realistic than a smooth mobile implant.

Sometimes one factor can overcome another. For example, if there is enough breast tissue, the difference between a silicone and saline implant may not be noticeable. In this example the may situation change if a very large implant is chosen, or if the implant is placed over the muscle. The best way to assess these factors is with a consultation with a board certified plastic surgeon.

The overwhelming majority of patients have no concerns about how their breasts feel after their surgery. Although maybe not indistinguishable from natural breasts, most patients will say that they feel 'real enough'.  In the absence of capsular contracture, complaints about the implants being hard or too firm are rare.

Best regards,

Lawrence Tong, MD, FACS, FRCSC

Breast implants should feel real.

Hard feeling breasts result from capsule contracture: implants do not get hard, but if the space for the implant in the breast shrinks down and tightens around the implant, the implant will feel unnaturally firm.

It is important to do all that can be done to prevent capsule contracture.  In my practice, I recommend:

• avoiding any medications or supplements that can thin the blood for 14 days before surgery
• submuscular placement of the implant
• implant manipulation to keep the space open
• avoiding high impact activities and heavy lifting for 6 weeks after augmentation
• taking prophylactic antibiotics when getting your teeth cleaned by the dentist

Smooth-surfaced silicone implants provide the most natural feel.

If you are talking about implants sitting on the table, the saline imlpants feel like a water balloon and the silicone implants feel like cooked oatment. However how they feel in a breast depends on a number of things.

If the implants are working the way they should, the saline implant will generally start out feeling a bit more firm than a silicone implant which may be virtually undectable by feel. Over a period of time, more of the silicone implants will more often become more firm than saline implants (i.e. the contracture rate for significant hardening is higher for silicone gel implants).

However, if the implants do not develop capsular contracture, it is the relative proportion of implant to natural breast and the relative dimensions in the post-op breast that will determine what the implant feels like. For example, if I put a small (by volume and width) saline implant into a relative full breast, the implant will be general "hidden" by the natural breast and the breast will feel relatively natural. If, on the other hand, I put a relatively large implant into a small breast, the breast will beginto take on the charactertistics of the implant. So, it is not the implant itself that is as important as the way it is being used.

Great question.

The answer is, it depends.

There are three things to consider when thinking about how implants feel.

First - Where has the implant been placed. Typically, breast augmentation is done "below the muscle". This means that the implant is usually placed in a subpectoral plane. This provides a significant amount of camoflage for the implant (you feel skin, subcutaneous fat and breast tissue and muscle before you feel the implant). The qualifier here is that it is rare to have an implant that is completely under the muscle and typically the inferior border is not covered. Most people have more breast tissue at this level.

Second - What type of implant was used? Silicone implants mimic breast tissue more readily than saline imlpants do. Properly filled saline implants tend to feel more like water balloons in your hand. The larger the implant, the more you may be able to feel that implant.

Third - What is the nature of the capsule around the implant? Over time, patients can develop capsular contracture. This is typically what causes breasts to feel hard after the implant. This is not a normal result after breast augmentation, but there is an increased chance of occurrence over time. For patients with capsular contracture, the capsule usually needs to be removed surgically to improve the feel of the breasts.

In addition, remember that immediately after breast augmentation surgery, the breasts will feel more firm until the swelling comes down.

I hope this helps!

There is significant variation of the degree of softness and how breasts feel from person to person, even in those who have never had breast surgery. There are multiple factors in how the breasts will feel after an augmentation:

·    1.      The fill material of the implant: Generally the feel of silicone is more natural than that of saline, especially in a person with very little breast tissue.

·     2.    The amount of a person’s own breast tissue: If someone has a fair amount of their own breast tissue, then the feel of saline versus silicone is not as important because the existing breast tissue provides a thicker cover over the implant.

·     3.    The position of the implant. Sub-muscular or sub-glandular: If an implant is under the muscle, there is additional tissue that covers the implant, usually resulting in a softer feel.

·     4.   The configuration of the implant: Higher profile implants may feel firmer. Form stable implants also known as highly cohesive gel implants and commonly called “gummy bear implants”, which may be appropriate in some patients, are claimed to feel more natural, but are actually firmer than the other current types of silicone implants.

·     5.   The implant covering: Smooth surface implants move more naturally than textured implants, so they feel more natural, especially when someone lies down.

·     6.   Implant size. Very large implants usually do not feel or look as natural. Saline implants that are significantly over-filled definitely feel firmer.

·     7.     Capsular contraction: Implants initially feel tighter and firmer and then get softer unless there is a tightening of the internal scar that forms around an implant which can make the breast feel firmer. It occurs in a lower rate with saline implants and in a sub-muscular position.

·     8.    The plastic surgeon: It is not only the type and position of the implant that is important in achieving an outcome. It is also the plastic surgeon. To maximize the probability of having a pleasing result, have a consultation with a plastic surgeon who is certified by the American Board of Plastic Surgery and ideally a member of The American Society for Aesthetic Plastic Surgery and address your concerns    .

Most patients who have undergone a breast augmentation are happy they did it.

Robert Singer, MD  FACS

La Jolla, California

Breast implants are intended to feel real. The achievement of this goal will depend on placement (submuscular placement generally leads to a more natural feel), patient specific factors (body fat percentage and amount of native breast tissue), and type of implant used (silicone generally feels more natural than saline). Breast implants that feel hard or are painful are the result of capsular contracture, a not infrequent complication following breast augmentation surgery. 

Breast implants can feel very natural, or can feel like a "bag of water". This depends on multiple factors. First of all, Silicone implants absolutely feel much more natural than Saline implants. This is a fact. Secondly, the larger a woman's breasts are to begin with, the less palpable the implant will be after surgery. And third, if an implant is placed under the muscle, there is one more layer of tissue covering the implant, essentially making it more hidden and less palpable. Women who want the most natural feel to their breast chose Silicone over Saline, however, this usually requires a larger scar.

The feel of a breast implant varies from person to person. Many factors come into play. Some factors include the amount of breast tissue a person already has to cover the implants, whether or not the implants will be on top of the muscle, entirely under the muscle, or partially under the muscle; whether they are saline implants or silicone implants; the quality and thickness of the skin, etc...

In general, silicone implants will feel more "natural" than saline implants. Silicone implants can feel like a thick marshmallow, whereas saline implants can feel like a bag of water. Some patients will do very well with either type of implant if they have thick skin and a fair amount of breast tissue in either the subglandular or submuscular position. In general, woman who are quite thin, have little breast tissue with loose skin, and have nursed children will do better with a silicone implant, preferably a high profile silicone implant to achieve a more natural feel.

Implants can feel hard for several reasons. Some include a saline implant that is way too over-filled. Another reason can be a capsular contracture.