For breast augmentation, the plastic surgeon makes an incision at the bottom crease of the breast, armpit or along the lower edge of the areola. The implant is inserted through the incision either under the chest muscle beneath the breast or simply under the breast tissue. Some plastic surgeons prefer placing the implant behind the chest muscle in order to reduce the risk of capsular contraction, in which the surrounding tissue hardens around the implant.

The surgical placement of an implant following a mastectomy is similar in that it can be placed either behind the remaining breast tissue or behind the chest wall. However, the mastectomy incision is often used to insert the implant. There are two common ways for a plastic surgeon to perform immediate reconstruction following a mastectomy. These include:

• One-stage breast reconstruction. This takes place at the same time as the mastectomy. An implant is placed under the skin where the breast tissue was removed. Very few women are able to achieve a one-step process because additional adjustments are usually required.
  
  
• Two-stage breast reconstruction. This procedure is more common. The first stage requires the placement of an expander at the time of the mastectomy. These expanders are silicone shells filled with saline also regulated by the FDA. Since they are only intended to be in place for a maximum of six months, they have different specifications than regular breast implants. These expanders stretch the skin and gradually create a larger pocket for the breast implant. In all, the process takes about four to six months until the expander is replaced with a breast implant. Women who are extremely active and want to avoid spending long periods recuperating tend to opt for this procedure. Even though patients have soreness and tenderness in the chest, they are able to return to their normal routines in a shorter period of time.

A third option for breast cancer patients is delayed reconstruction. The patient may decide months or even years after treatment for breast cancer has been completed that she would like breast implant surgery. The medical, financial and emotional considerations of choosing immediate versus delayed reconstruction should be discussed with the surgeon, plastic surgeon and oncologist.