Cosmetic Surgery

Breast Enlargement at Mayo Clinic

(Synonyms: augmentation mammoplasty)

It is not uncommon for a woman to want to change her breast size, shape or position to achieve a more natural appearance. Reasons for choosing surgery are highly personal and many women consider the option of breast surgery for years before deciding to proceed. Potential candidates should discuss with the cosmetic surgeon the options, risks and anticipated results of breast surgery.

Women who have small breasts or whose breasts are smaller and less firm following pregnancy may be interested in increasing the size and proportion of their breasts. Some women may have mildly saggy breast skin while others desire to bring a significantly smaller breast into balance with the other.

It is important that patients discuss with the surgeon their reasons for wanting breast enlargement and their expectations of the results. The goal of the procedure is improvement of appearance and proportion, not perfection. For example, breast enlargement will not improve stretch marks on the breast or change breast nipple position. A slightly droopy breast may be improved with enlargement, but the improvement may only be temporary. A breast lift procedure (mastopexy) may be necessary to address droopy breasts.

Patients need to talk with your surgeon about the advantages and disadvantages of the various surgical options, including the size of the implant, its surface texture and shape, placement of the incision and position of the implant.

Make sure that the surgeon addresses all questions and concerns about the surgery, the implants or anything related to how the implants may change or interfere with health or well-being. The more clear and open patients are about their goals and concerns, the more likely that they will be pleased with the results.

Take time to get used to the new appearance and sensations of implants. They may feel slightly firmer than a natural breast. Breast implants are not permanent and will need replacement. How often varies with each patient.

Implant Considerations

Implant considerations include the shape, implant surface (smooth or textured), position, incision placement, size and implant filling.

What to Expect

The breast consists of milk ducts and glands, surrounded by fatty tissue that provides its shape and feel. Situated beneath the breast is the pectoralis major muscle. Incisions may be made under the breast in the inframammary crease, at the border of the areola (the colored skin around the nipple), or in the axilla (armpit). A saline implant, filled to the desired volume during surgery, can be positioned under the breast tissue or under the pectoralis muscle.

Breast implants filled with saline (a sterile, salty solution) are almost always used. The shell of these soft sacs is made of silicone, an inert man-made substance that the body tolerates well. They are available in two shapes: round or teardrop with a smooth or textured surface. The size of the implant is chosen to match the person's body size and goals.

The procedure may be performed using intravenous sedation or more commonly with general anesthesia.

Silicone gel implants

Millions of women received silicone gel implants from 1963 to 1992. Since 1992, when the Food and Drug Administration restricted the use of silicone gel-filled breast implants, saline-filled implants have been the only type of implant available for general use in cosmetic surgery in the United States. Even though there is no scientific proof that silicone gel implants cause connective tissue diseases, such as rheumatoid arthritis and lupus, some women have chosen to have the implants removed. Today they are only available to women under certain criteria as part of a national study evaluating silicone implants.

Before Surgery

Patients must refrain from all nicotine products and avoid secondhand smoke before and after any breast surgery. Depending on age, family or personal history of breast cancer, a preoperative mammogram may be required. Nursing mothers should wait at least four months following nursing before consulting a surgeon regarding breast surgery.

Risks

Risks associated with breast enlargement include, but are not limited to:

• Problems related to anesthesia
• Bleeding. If this occurs and blood collects to form a hematoma, another surgery may be needed to remove the blood.
• Infection is uncommon, but if it occurs adjacent to the implant, removal of the implant may be necessary to address the infection.
• Loss of nipple sensation or nipple hypersensitivity may occur, but is usually temporary.
• Differences in the shape of the breasts occasionally occur. If there is a significant difference, additional procedures may be recommended.

Since the implants are made of man-made silicone material, they can rupture and leak. With saline-filled implants, this is corrected by replacing the implant. Other temporary sensation changes could include rippling or sloshing, sensations which can be minimized by overfilling the implants. In some breasts, firmness develops as a result of scar tissue that forms around the implant. This is known as capsular contracture and may require an additional surgery to correct.

The implant is centered under the nipple and areola during surgery. Sometimes the implant shifts and becomes too high or low, which may also require surgery to correct.

Manufacturers have limited warranties on implants and some replace them for a limited time. Surgical charges to replace the implant are commonly the responsibility of the patient. Each circumstance is different and it is important to inquire about the specific warranty related to an implant. Because all implants are man-made devices, they do wear out.

This surgery is done by specialists in Plastic and Reconstructive Surgery.