Breast augmentation with implants is one of the most popular cosmetic procedures performed in the United States and Internationally. One report claims that breast-related plastic surgical procedures currently ranks as number one, with a 4% increase in the number of procedures done between 2017 and 2018. In the United States, an estimated 313,735 breast augmentation procedures were done in 2018.
A common question among women interested in breast augmentation surgery is whether their augmented breasts will still feel real. We take a closer look at factors that may affect how these implants feel compared to real breasts.
Expecting a simple answer? Unfortunately, there are many factors that influence the feel of a breast. Let's start with the first issue: what does a 'natural' breast feel like?
You may think, "Of course, I know what breasts feels like!" Well, just as breasts come in different shapes and sizes, they also have different "feels". Firm versus squishy. This is largely determined by the types of tissue in the breast, and the consistency of those tissues. Glandular breast tissue is more dense and rubbery feeling. It's the Firm component. Glandular tissue helps give and maintain a breast's round shape and projection (how far the breast sticks out forward). Breasts can also have a far amount of fat, which is softer and does not maintain its shape well. Fat is the Squishy component. The overall feel of the breast will depend on how much of each (glandular versus fatty) tissue you have.
The quality of the breast skin can affect overall feel, but to a much lesser extent than what's under the skin.
To add to the complexity, this balance can change month to month, and over the years. Breast tissue is hormonally sensitive and therefore can change with one's menstrual cycle. This is different between patients, and likely has some genetic component. Some ethnic populations may also have more or less breast tissue change with their cycles. Pregnancies obviously change this balance for most women. Finally, breasts will change over the span of one's life time. Again this is because the breast is sensitive to hormone levels which fluctuate with age. Genetics also play a part here. Typically with age, the glandular tissue (firmness) gets replaced by more of a fatty tissue (squishy). Think of the classic Grandmother Birthday Card, that pokes fun at deflated 'pancake' breasts that hang down to the knees. The overall volume (amount of tissue) in the breast may be the same, but the fat does not maintain its shape or firmness, thus giving the flattened and droopy appearance. #grandma-has-feelings-too.
We've established that a natural breast feel is variable between different people and even in the same person depending on timing. However, what often matters in plastic surgery, is what the patient desires or expects their breast to feel like after surgery. Some like 'em like pillows, and some like 'em like rocks.
To provide a better overview of whether breast implants will feel real and the particular experience a woman may expect, we will take a look at some of the most important factors that need to be taken into account below.
Obviously one of the big perennial questions is saline versus silicone. This has to do with the specific type of implant filling. It's good to think of implants on the firm to squishy spectrum. This depends on how compressive the material is.
Saline implants have a reputation for feeling too firm and less "natural". In general, this is true. Saline implants are essentially balloons filled with salt water. Water is not easily compressible. It is not very squishy, particularly if the balloon shell is fairly stiff. If you want a deeper dive on this topic, look up water hammer effect here (https://www.alamoplasticsurgery.com/surgical-procedures/breast-augmentation-san-antonio-tx). So a high filled saline implant (how they are typically used) is on the firm side.
If you fill a saline implant shell with less water (lower fill), then the shell will allow the water to displace more easily when compressed and can feel less firm. However an underfilled saline implant has a lot of folds and ripples and is not how these implants are typically used.
Silicone gel is a semisolid (...polymer of silicone chains with crosslinking between the chains). Silicone implants vary on how 'semi-solid' they are. The amount of firmness varies depending on the length of the chains and the amount of crosslinking. This is represented by the cohesiveness of the gel. More cohesive implants are commonly described as "gummy bear" implants. These implants are more firm and tend to maintain their shape better (that's why the teardrop shaped implants tend to be firm). However, the silicone gel filling can be made to feel softer / more compressible / more squishy. These softer gel fills tend to balance out the "too firm" feel that many women worry about with breast augmentation. Thus silicone gel implants get a reputation for being softer and "more natural" feeling.
Where the implant is placed has a HUGE impact on ability to feel the implant. If you have a lot of tissue covering the implant, then you are less likely to feel the implant. You will be feeling your own tissue (glandular vs fatty), which will be the main determinant of firm or squishy. If you have very little tissue covering the implant, then the implant filling (saline - firm versus silicone - squishy) will determine the overall feel. Additionally, with less tissue hiding the implant, you may start to feel the implant shell itself (folds/ripples). Check out the infographic below or my video to learn more about implant pockets (https://www.alamoplasticsurgery.com/surgical-procedures/breast-augmentation-sa)
While there are certain factors like implant type and implant pocket that can affect implant feel, it is also important to consider the surgeon that will be conducting the operation. You want a surgeon that can produce the breast shape/look/feel that you are wanting to achieve.
A board-certified plastic surgeon should be consulted. It is important for the patient to get all of her questions answered. American Society of Plastic Surgeons will be able to provide recommendations for surgeons near the patient's location. Dr. William Albright at Alamo Plastic Surgery is a Board Certified Plastic Surgeon can customize a breast augmentation to your cosmetic goals. Whether you want a natural breast shape and feel, or something a bit more firm and 'augmented' looking, he is ready to help you achieve your goals!
Breast feel is variable, and augmentation techniques (implant type/position) can effect the overall feel of the final breast.
Undergoing breast implant surgery brings up a number of questions for women. A common concern is whether these implants will feel 'real'. Women are often also concerned about whether a partner would be able to notice the implants. Fortunately, when choosing the right surgeon and the appropriate implant type and position, the implants can feel and look 'natural'.