mdrs for bia-alcl involved textured breast implants, 37 mdrs involved smooth-surfaced implants, and 295 mdrs did not specify whether the implants were textured or smooth. in some cases, the women who developed bia-alcl after smooth breast implants had textured expanders prior to their implants. most patients had bia-alcl affect only one breast with only 8 patients diagnosed with bilateral bia-alcl. the most common reported symptom of bia-alcl according to the fda was seroma, followed by breast swelling and pain, capsular contracture, and peri-implant mass or lump. furthermore, 84 percent of the reported implants were made by allergan. a study conducted at memorial sloan kettering cancer center of women undergoing prophylactic mastectomies indicated that 1 in 355 women were subsequently diagnosed with bia-alcl. almost all those women had allergan biocell implants and expanders. these reports strongly suggest that bia-alcl develops primarily in patients with textured implants or expanders. in all cases, however, many researchers suspect that bia-alcl is an under-recognized, misdiagnosed, and under-reported complication of breast implants. the asps and the plastic surgery foundation (psf) have partnered with the fda to study this condition and in doing so created the patient registry and outcomes for breast implants and anaplastic large cell lymphoma etiology and epidemiology (profile). the united states fda strongly encourages all physicians to report cases to profile in an effort to better understand the role of breast implants in alcl and the management of this disease. other lymphomas and squamous-cell carcinoma in september, 2022, the fda announced new information regarding other types of cancers related to breast implants, based on medical device reports (mdrs) of cases of patients with squamous-cell carcinoma or various lymphomas found in the scar tissue around breast implants. the agency reported 10 mdrs about squamous-sell carcinoma found in the capsule scar tissue and 12 mdrs about various lymphomas also in the scar tissue around the breast implants. these new cases do not overlap with cases of bia-alcl. scc and other lymphomas have been found in smooth-surface and textured implants as well as silicone-gel-filled and saline-filled implants. patients who reported symptoms specified swelling, pain, lumps, and changes to their skin. as of 2022, neither the incidence rate nor prevalence is known. surgical procedures incision types breast implant emplacement is performed with five types of surgical incisions: inframammary: an incision made to the inframammary fold (natural crease under the breast), which affords maximal access for precise dissection of the tissues and emplacement of the breast implants. it is the preferred surgical technique for emplacing silicone-gel implants, because it better exposes the breast tissue–pectoralis muscle interface; yet, imf implantation can produce thicker, slightly more visible surgical scars. periareolar: a border-line incision along the periphery of the areola, which provides an optimal approach when adjustments to the imf position are required, or when a mastopexy (breast lift) is included to the primary mammoplasty procedure. in periareolar emplacement, the incision is around the medial-half (inferior half) of the areola's circumference. silicone gel implants can be difficult to emplace via periareolar incision, because of the short, five-centimetre length (~ 5.0 cm) of the required access-incision. aesthetically, because the scars are at the areola's border (periphery), they usually are less visible than the imf-incision scars of women with light-pigment areolae; when compared to cutaneous-incision scars, the modified epithelia of the areolae are less prone to (raised) hypertrophic scars. transaxillary: an incision made to the axilla (armpit), from which the dissection tunnels medially, to emplace the implants, either bluntly or with an endoscope (illuminated video microcamera), without producing visible scars on the breast proper; yet, it is likelier to produce inferior asymmetry of the implant-device position. therefore, surgical revision of transaxillary emplaced breast implants usually requires either an imf incision or a periareolar incision. transumbilical: a trans-umbilical breast augmentation (tuba) is a less common implant-device emplacement technique wherein the incision is at the umbilicus (navel), and the dissection tunnels superiorly, up towards the bust. the tuba approach allows emplacing the breast implants without producing visible scars upon the breast proper; but makes appropriate dissection and device-emplacement more technically difficult. a tuba procedure is performed bluntly—without the endoscope's visual assistance—and is not appropriate for emplacing (pre-filled) silicone-gel implants, because of the great potential for damaging the elastomer silicone shell of the breast implant during its manual insertion through the short (~2.0 cm) incision at the navel, and because pre-filled silicone gel implants are incompressible, and cannot be inserted through so small an incision. transabdominal: as in the tuba procedure, in the transabdominoplasty breast augmentation (taba), the breast implants are tunneled superiorly from the abdominal incision into bluntly dissected implant pockets, whilst the patient simultaneously undergoes an abdominoplasty. implant pocket placement implant placement comparisonsubglandular implantsubpectoral implantsubmuscular implant the five surgical approaches to emplacing a breast implant to the implant pocket are often described in anatomical relation to the pectoralis major muscle. subglandular: the breast implant is emplaced to the retromammary space, between the breast tissue (the mammary gland) and the pectoralis major muscle (major muscle of the chest), which most approximates the plane of normal breast tissue, and affords the most aesthetic results. yet, in women with thin pectoral soft-tissue, the subglandular position is likelier to show the ripples and wrinkles of the underlying implant. moreover, the capsular contracture incidence rate is slightly greater with subglandular implantation. subfascial: the breast implant is emplaced beneath the fascia of the pectoralis major muscle; the subfascial position is a variant of the subglandular position for the breast implant. the technical advantages of the subfascial implant-pocket technique are debated; proponent surgeons report that the layer of fascial tissue provides greater implant coverage and better sustains its position. subpectoral (dual plane): the breast implant is emplaced beneath the pectoralis major muscle, after the surgeon releases the inferior muscular attachments, with or without partial dissection of the subglandular plane. resultantly, the upper pole of the implant is partially beneath the pectoralis major muscle, while the lower pole of the implant is in the subglandular plane. this implantation technique achieves maximal coverage of the upper pole of the implant, whilst allowing the expansion of the implant's lower pole; however, "animation deformity", the movement of the implants in the subpectoral plane can be excessive for some patients. submuscular: the breast implant is emplaced beneath the pectoralis major muscle, without releasing the inferior origin of the muscle proper. total muscular coverage of the implant can be achieved by releasing the lateral muscles of the chest wall—either the serratus muscle or the pectoralis minor muscle, or both—and suturing it, or them, to the pectoralis major muscle. in breast reconstruction surgery, the submuscular implantation approach effects maximal coverage of the breast implants. this technique is rarely used in cosmetic surgery due to high risk of animation deformities. prepectoral or subcutaneous: in a breast reconstruction following a skin-sparing or skin- and nipple-sparing mastectomy, the implant is placed above the pectoralis major muscle without dissecting it so that the implant fills directly the volume of the mammary gland that has been removed. to avoid the issue of capsular contracture, the implant is often covered frontally or completely with a mesh in biomaterial, either biological or synthetic. post-surgical recovery the surgical scars of a breast augmentation mammoplasty develop approximately at 6-weeks post-operative, and fade within months. depending upon the daily-life physical activities required of the woman, the breast augmentation patient usually resumes her normal life at 1-week post-operative. moreover, women whose breast implants were emplaced beneath the chest muscles (submuscular placement) usually have a longer, slightly more painful convalescence, because of the healing of the incisions to the chest muscles. usually, she does not exercise or engage in strenuous physical activities for approximately 6 weeks. during the initial post-operative recovery, the woman is encouraged to regularly exercise (flex and move) her arm to alleviate pain and discomfort; if required, analgesic indwelling medication catheters can alleviate pain moreover, significantly improved patient recovery has resulted from refined breast-device implantation techniques (submuscular, subglandular) that allow 95 per cent of women to resume their normal lives at 24-hours post-procedure, without bandages, fluid drains, pain pumps, catheters, medical support brassières, or narcotic pain medication. types saline-solution-filled breast implant device models. late-generation models of silicone gel-filled prostheses. today, there are three types of breast implants commonly used for mammaplasty, breast reconstruction, and breast augmentation procedures: saline implant filled with sterile saline solution. silicone implant filled with viscous silicone gel. structured implants using nested elastomer silicone shells and two saline filled lumen. a fourth type of implant, composite (or alternative-composite) implants, have largely been discontinued. these types featured fillers such as soy oil and polypropylene string. other discontinued materials include ox cartilage, terylene wool, ground rubber, silastic rubber, and teflon-silicone prostheses. saline implants the saline breast implant—filled with saline solution (biological-concentration salt water 0.90% w/v of nacl, ca. 300 mosm/l.)—was first manufactured by the laboratoires arion company, in france, and was introduced for use as a prosthetic medical device in 1964. the contemporary models of saline breast implant are manufactured with thicker, room-temperature vulcanized (rtv) shells made of a silicone elastomer. the study in vitro deflation of pre-filled saline breast implants (2006) reported that the rates of deflation (filler leakage) of the pre-filled saline breast implant made it a second-choice prosthesis for corrective breast surgery. nonetheless, in the 1990s, the saline breast implant was the prosthesis most common device used for breast augmentation surgery in the united states, because of the u.s. fda's restriction against the implantation of silicone-filled breast implants outside of clinical studies. saline breast implants have enjoyed little popularity in the rest of the world, possessing negligible market share. the technical goal of saline-implant technology was a physically less invasive surgical technique for emplacing an empty breast implant device through a smaller surgical incision. in surgical praxis, after having emplaced the empty breast implants to the implant pockets, the plastic surgeon then filled each device with saline solution, and, because the required insertion-incisions are short and small, the resultant incision-scars will be smaller and shorter than the surgical scars usual to the long incisions required for inserting pre-filled, silicone-gel implants. when compared to the results achieved with a silicone-gel breast implant, the saline implant can yield acceptable results, of increased breast-size, smoother hemisphere-contour, and realistic texture; yet, it is likelier to cause cosmetic problems, such as the rippling and the wrinkling of the breast-envelope skin, accelerated lower breast pole stretch, and technical problems, such as the presence of the implant being noticeable to the eye and to the touch. the occurrence of such cosmetic problems is likelier in the case of the woman with very little breast tissue, and in the case of the woman who requires post-mastectomy breast reconstruction; thus, the silicone-gel implant is the technically superior prosthetic device for breast augmentation, and for breast reconstruction. in the case of the woman with much breast tissue, for whom sub-muscular emplacement is the recommended surgical approach, saline breast implants can produce an aesthetic result much like that afforded by silicone breast implants. ultrasound examination and outcome studies have revealed that saline and silicone breast implants look and feel similar. silicone gel implants as a medical device technology, there are five generations of silicone breast implant, each defined by common model-manufacturing techniques. the modern prosthetic breast was invented in 1961 by the american plastic surgeons thomas cronin and frank gerow, and manufactured by the dow corning corporation; in due course, the first augmentation mammoplasty was performed in 1962. first generation the cronin–gerow implant, prosthesis model 1963, was a silicone rubber envelope-sac, shaped like a teardrop, which was filled with viscous silicone-gel. to reduce the rotation of the emplaced breast implant upon the chest wall, the model 1963 prosthesis was affixed to the implant pocket with a fastener-patch, made of dacron material (polyethylene terephthalate), which was attached to the rear of the breast implant shell. second generation in the 1970s, manufacturers presented the second generation of breast implant prostheses that featured functional developments and aesthetic improvements to the technology: the first technological developments were a thinner-gauge device-shell, and a filler gel of low-cohesion silicone, which improved the functionality and the verisimilitude (size, appearance, and texture) of the silicone-gel breast implant. yet, in clinical practice, second-generation breast implants proved fragile, and had greater incidences of shell rupture, and of filler leakage ("silicone-gel bleed") through