Breast Implant Technology: What's Changed in 20 Years

A Brief History of Breast Implants

Breast implants have been around for over 60 years, and they've gone through dramatic improvements. Understanding this evolution helps explain why modern implants are safer and more reliable than ever before.

When I explain implant generations to patients, I often use the analogy of car safety. A car from the 1960s was fundamentally the same concept as today's car, but would you feel as safe in it? The advances in crumple zones, airbags, and electronic stability control have made modern cars vastly safer. The same is true for breast implants.

The Generations of Breast Implants

First Generation (1960s)

The original implants had thick shells and thin, liquid silicone gel. They felt quite firm and unnatural. Shell failure was common.

Second Generation (1970s-1980s)

Thinner shells and more liquid gel made these implants feel more natural, but they had high rupture rates and significant gel bleed (silicone seeping through intact shells).

Third Generation (late 1980s)

Improved shell technology reduced gel bleed, and the gel became slightly more cohesive. These were better but still had issues.

Fourth Generation (1990s-2000s)

Introduction of cohesive gel and more durable shells. Significant improvements in longevity and safety. Many surgeons were still using these when I started as a consultant.

Fifth Generation (2010s)

Highly cohesive gel (form-stable or "gummy bear" implants) that maintains shape. Better shells. When I remove fifth generation implants today, they typically come out completely intact with no rupture or gel bleed.

Sixth Generation (2020s)

Further refinements in gel consistency, shell technology, and surface texture. These are the implants I currently use. They feel natural, have excellent longevity data so far, and importantly, have addressed concerns about rare complications associated with textured surfaces.

The Two Components: Shell and Filler

A breast implant is made of two things: the outer shell (what touches your body) and the filler material inside.

Shell Technology

The shell is the barrier between the silicone gel and your body. Modern shells are:

• Multi-layered for durability
• Barrier-coated to minimise gel bleed
• Carefully textured (or smooth) based on evidence

The surface texture of the shell has become increasingly important. More on this below.

Filler Material

Modern implants use cohesive silicone gel. "Cohesive" means the gel holds together rather than flowing like liquid. If you were to cut through a modern implant, the gel would stay in place rather than leaking out.

This is a significant safety improvement. In older implants with liquid gel, a shell rupture meant silicone could spread through the breast tissue. With cohesive gel, even if the shell fails, the gel tends to stay contained.

The consistency of the gel has also been refined over the generations. Early cohesive gels were quite firm, which some patients found unnatural. Modern formulations are softer and feel more like natural breast tissue.

The Textured vs Smooth Debate

For many years, textured implants were preferred by many surgeons. The textured surface was designed to reduce capsular contracture (the hardening of scar tissue around the implant) by encouraging tissue to grow into the rough surface.

Then we learned about BIA-ALCL.

What Is BIA-ALCL?

Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare cancer of the immune system. It's not breast cancer, it's a lymphoma that develops in the scar tissue capsule around the implant.

The key finding was that BIA-ALCL is almost exclusively associated with textured implants. The rougher the texture, the higher the risk. With the most aggressively textured implants, the risk is approximately 1 in 24,000.

For smooth implants, the risk appears to be essentially zero. No confirmed cases have been linked to truly smooth-surfaced implants.

This led to a significant shift in practice. Many surgeons, myself included, moved away from textured implants toward smoother surfaces.

The Implants I Use Today

The implants I currently use are sixth generation with a nano-textured surface. "Nano-textured" means the surface has microscopic undulations (about 5 microns) that classify it as smooth by regulatory standards.

Why this surface texture?

• It's smooth enough to avoid BIA-ALCL risk
• The slight texture helps reduce rotation
• Clinical data shows low capsular contracture rates

I've been using these implants for about five years now. When I audit my results, I see capsular contracture rates that are lower than with the textured implants I used previously. And to date, there have been no reported cases of BIA-ALCL or breast implant illness with these devices.

That's reassuring, but five years is not a lifetime. I continue to follow the data and would change my practice if evidence suggested a better option.

What Happens When Implants Are Removed

As a surgeon who's been practicing for 20 years, I now see patients returning from earlier in my career who want their implants changed. This gives me valuable information about long-term performance.

When I remove fifth generation implants (the ones I was using 10-15 years ago), they typically come out looking like they did when I put them in. Intact shell, no rupture, no visible gel bleed. This is a stark contrast to what I've seen with fourth generation and earlier implants, which sometimes come out ruptured or showing signs of deterioration.

This gives me confidence that the sixth generation implants I'm using now will perform even better over time.

Why Patients Have Implants Changed

When my patients come back years later for revision surgery, it's rarely because something has gone wrong with the implant itself. The common reasons are:

• "My body has changed and they don't look right anymore"
• "I want to go bigger/smaller than I originally chose"
• "I've had children and want an uplift at the same time"
• "I think I'd prefer not to have implants anymore"

These are all valid reasons for revision. The key point is that patients are choosing to have another operation rather than being forced to by implant failure.

That said, implants are not lifetime devices. At some point, you may need or want to replace them. The question is whether this is a matter of "I want to" versus "I have to." Modern implants shift that balance strongly toward the former.

Breast Implant Illness

I should address breast implant illness (BII), as patients increasingly ask about it.

Some women report systemic symptoms they attribute to their breast implants: fatigue, brain fog, joint pain, skin problems, and various other complaints. When they have their implants removed, some report improvement in these symptoms.

The medical evidence is inconclusive. There is no diagnostic test for BII, and no scientific consensus on whether it represents a real physiological phenomenon or a collection of symptoms with other causes that improve due to placebo effect from explantation.

What I can tell you is that with the smooth implants I've been using for five years, there have been no reported cases of BII. Whether this is because these implants are genuinely less likely to cause such symptoms, or because BII is unrelated to implant type, I cannot say with certainty.

If you're concerned about BII, we can discuss it during your consultation. I believe in giving patients complete information so they can make informed decisions.

Making Your Decision

Breast implants are safer and more natural-feeling than ever before. The technology has genuinely improved over the decades. But they're still medical devices that carry some risk and require informed decision-making.

During your consultation, I'll show you the actual implants, let you feel the different profiles, and explain how each option might work for your specific anatomy. Understanding what you're putting in your body is an important part of the process.