Breast implants — how to choose and what to check
The decision to have breast augmentation is the easiest part. After it come questions to which the internet gives opposite answers: which implant, which shape, which size, what the warranty is worth and what is included in the price. This page sets out what we know about it from more than twenty years of placing implants — without recommending a brand and without judging anyone else's work.
What is a registered implant?
A breast implant is a medical device that is placed in the body, so it must have a known manufacturer, registration in Croatia (Agency for Medicinal Products and Medical Devices, HALMED), an importer and documentation. All implants registered in Croatia have passed the same checks; there are differences between manufacturers, but they are smaller than advertising suggests. Even the most expensive implant does not by itself give a more beautiful breast — a good outcome depends least on the brand of the implant and most on the plan, the patient's anatomy and the surgeon.
For every implant placed you receive an implant label sheet: stickers with the manufacturer, type, volume and serial number. Keep it — without it there is later neither a warranty nor a reliable way to assess what was placed. At Barbel you receive it with the discharge letter.
Shape, size and filling — what decides?
Filling. Today silicone gel is used almost always; saline-filled implants are placed only exceptionally. Neither is “healthier” — each has advantages and drawbacks, and gel gives a more stable shape and feel.
Shell. Smooth or finely textured. Older-generation, coarsely textured shells have been linked to an extremely rare lymphoma associated with the implant (BIA-ALCL), so they are watched with particular care at check-ups, and new ones are not placed.
Shape. Round or anatomical (teardrop). Neither is “more natural” in itself. The shape of the breast after the operation is the result of the build of the chest, the height at which the breast starts, its shape and width, the amount of your own tissue and the placement of the implant — and only then the shape of the implant. When there is doubt, both are tried during the operation with a test sizer and the one that gives the better shape is placed.
Size. What you want is the starting point; measurement is the decision. An implant larger than the space the breast has cannot fit into it; the larger it is, the heavier it is, and a heavier breast relaxes faster. Two women with the same implant do not have the same breasts, because they differ in the build of the chest and muscles — the “numerical” volume and the “visible” volume are not the same.
Placement. Under the chest muscle or under the gland. Under the muscle the operation is longer and hurts more in the first days, but capsular contracture (the tightening of the capsule around the implant) is less common, the edge of the implant is not visible and the breast relaxes more slowly; at Barbel this is the standard. Under the gland is chosen only when there is enough of your own tissue at the edges of the breast.
What can an implant not do?
It does not lift a sagging breast — it adds weight to it, so a sagging breast with an implant and no lift will, over time, sag even more. It does not stop ageing or relaxation. It is not permanent — how it is monitored is described just below. And it does not do away with the need for a bra — a breast with an implant always needs one, a special one for the first six weeks.
Check-ups and magnetic resonance imaging
An implant has no fixed expiry date, but it is monitored: a check-up once or twice a year, and magnetic resonance imaging (MRI) every five years. It is replaced when there is a reason — a hardened capsule (capsular contracture), a rupture or a change in the shape of the breast. For patients who are satisfied, have no symptoms and have implants under the muscle, we do not suggest replacement just because of the age of the implant — regular check-ups are enough.
An implant can rupture, rarely. A rupture is seen on ultrasound or MRI, sometimes without any symptoms; the imaging finding does not always match what is found at the operation, and this is discussed before the procedure. A tight capsule and a ruptured implant sometimes occur together, so in capsular contracture an MRI also checks whether the implant is intact.
Mammography is done with implants too, with additional views; tell the radiologist that you have them. An implant under the muscle interferes less with examination of the gland. Ultrasound and MRI show both the gland and the implant.
Manufacturer's warranty — five conditions
Manufacturers give a warranty on the implant, some call it lifetime. As a rule it covers a new implant in the event of a rupture or contracture that is the result of a defect in the implant, and the operation only rarely and under the manufacturer's conditions. A “lifetime warranty” applies to the implant, not to the breast. For it to be valid, five things must line up: the manufacturer, an authorised distributor in Croatia, registration of the implant in Croatia, a surgeon who is a specialist in plastic surgery, and an institution registered for plastic surgery with a full-time plastic surgeon. If any condition is missing, there is no warranty — however good the implant is.
If an implant is damaged, the whole implant is removed in the operation, the area is cleaned, photo and video documentation is made of everything, and the implant is returned to the distributor for expert analysis — this establishes whether the fault is in manufacture or arose during placement, and it is a condition for the warranty.
Implants without documentation
When the breast is operated on, an implant without documentation of its origin is always replaced, because it is not known when it was made, how it was stored or whether it was registered — and without documentation there is no warranty either. Whether to operate straight away is decided at the examination: if the implant was placed recently and everything is in order, it can also be monitored. When the operation is done, safety matters more than waiting: the implant is removed or replaced, and afterwards it is established whether everything was in order with it.
If you do not have the documentation, the clinic where you were operated on is obliged to keep it and give you a copy on request; from abroad it is harder to get, so ask for it before you come. If it does not exist, come for an examination: the assessment is made by examination and imaging. The type of filling and the approximate volume can be seen on ultrasound or MRI; the manufacturer often cannot be determined. For the decision on replacement that is usually not even necessary: the new implant is chosen according to the measurements of your body, not according to the old one.
What to ask before the operation, at any clinic
What is worth checking before any procedure, anywhere (the surgeon's licence, who gives the anaesthesia, what is included in the price, what happens if the result is not as agreed), is set out in one place.
→ How do you choose a clinic and a surgeon?
In addition, with implants there are questions on which the warranty depends. Our answer is given with each.
What is the surgeon's specialty, and will they operate? — At Barbel, implants are placed by a specialist in plastic, reconstructive and aesthetic surgery, and you arrange the operation with them.
Is the institution registered for plastic surgery, and does it have a full-time plastic surgeon? — Poliklinika Barbel has been registered for plastic and general surgery since 2000.
Which implant is it, where is it registered, and do I receive the implant label sheet? — We place only implants registered in Croatia; you receive the implant label sheet with the discharge letter.
Can I get all the documentation for a second opinion? — Yes, always.
What do we advise?
Do not rush. Better later than sooner, and if you are planning children, better after childbirth than before. Do not choose an implant that is too big — it is a burden for the breast and a limitation in many ways that only show later. If you have enough volume of your own and your breasts sag, a lift without an implant will give a lighter breast that keeps its shape longer. Talk to your gynaecologist or family doctor — they know more about surgeons than you think. Friends' experiences and forums are useful for questions, not for decisions: it is not known who is writing and nothing can be checked. You will get the most answers from the surgeon and the nurse who looks after you.
→ Breast augmentation · Breast lift, with or without an implant · Breast implant replacement · Capsular contracture
Frequently asked questions about implants
What is capsular contracture? Tightening of the capsule that the body forms around the implant — the breast hardens and changes shape. It is less common with placement under the muscle.
Medical review: doctors of Poliklinika Barbel · October 2026.