Your skin and tissue has a natural amount of stretchiness to it and can expand over time, such as when you gain weight.
The surgeon will do an exam pre-op and determine how large an implant your body will support.
During the surgery the surgeon will make a pocket for the implant by stretching the surrounding tissues. The implant is then placed in the pocket and expanded by filling it with saline or silicone.
Putting too large an implant in can cause damage or stretch the skin too tight and thin which can cause all sorts of post operative problems.
People that want larger implants have to go through multiple procedures steadily increasing the size of their implants over several years as that gives the skin a chance to stretch and the body to heal.
Expanders can be used as well. These are basically balloons that are placed where a breast implant would go and are expanded by increasing the amount of fluid in them over a couple of months. This allows the skin to stretch naturally the same way it would if you were just gaining weight.
These are commonly used in women that have mastectomies.
Trans people can support breast implants without any additional procedures, the size of which they can support will depend on their size and weight.
Expanders can be used for them as well if required. One common side effect though is the tissue in between the breasts can separate from the breastbone.
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