Breast augmentation — also known as augmentation mammoplasty — is a surgical procedure to increase breast size. During breast augmentation, breast implants are placed under the breast tissue or chest muscles.
For some women, breast augmentation is a way to enhance self-image and self-confidence. For others, breast augmentation is part of breast reconstruction after surgery for breast cancer or other conditions affecting the breast.
If you're considering breast augmentation, consult a plastic surgeon. Make sure you understand what surgery involves, including possible risks, complications and follow-up care.
A woman's reasons for choosing breast augmentation are highly personal.
Breast augmentation might help you:
- Enhance your breast appearance if you feel your breasts are too small or you're concerned that one breast is smaller than the other
- Adjust for a reduction in the size of your breasts after pregnancy
- Reconstruct your breast after having breast surgery for cancer or other conditions
- Improve your self-image or self-confidence
Discuss your goals with your surgeon so that you can develop a realistic expectation of what breast augmentation can do for you.
Breast augmentation poses various risks, including:
- Scar tissue that distorts the shape of the breast implant (capsular contracture)
- Breast pain
- Changes in nipple and breast sensation, usually temporary
- Implant leakage or rupture
Correcting any of these complications might require additional surgery, either to remove or replace the implants.
A 2011 Food and Drug Administration (FDA) review found a possible association between breast implants and anaplastic large cell lymphoma (ALCL) — a rare cancer of the immune system. However, the connection isn't well-defined or clearly supported. The number of women in the general population who have ALCL is exceedingly low, and the number is even lower among women who have breast implants.
Initially, you'll consult with a plastic surgeon about your preferences for size, feel and overall appearance of your breasts. The surgeon will describe specific types of implants — smooth or textured, round or shaped like a teardrop, saline or silicone — as well as options for surgical techniques.
Review any documentation carefully and keep copies of all pertinent information for your records.
Before you decide to go ahead with surgery, consider some important factors about breast augmentation:
- Breast implants won't prevent your breasts from sagging. To correct sagging breasts, you might need a breast lift in addition to breast augmentation.
- Breast implants aren't guaranteed to last a lifetime. Implant rupture is a possibility. Also, your breasts will continue to age after augmentation — and factors such as weight gain or weight loss might further change the way your breasts look. Any of these issues might lead to additional surgery.
- Mammograms might be more complicated. If you have breast implants, routine mammograms might require additional, specialized views.
- You might need routine MRI scans. The Food and Drug Administration recommends monitoring silicone breast implants with routine MRI scans every two years, starting three years after the initial implant surgery. Debate continues, however, on whether the benefit of routine MRI scans justifies the cost. There's also a concern that routine MRI scans have the potential to lead to unnecessary surgery.
- Breast implants might hamper breast-feeding. Some women are able to successfully breast-feed after breast augmentation. For others, however, breast-feeding is a challenge.
- Insurance might not cover breast implants. Unless it's medically necessary — such as the need for implant reconstruction after a mastectomy — breast augmentation isn't covered by insurance. Be prepared to handle any expenses that accompany breast augmentation, including related surgeries or future imaging tests.
- You might need additional surgery after breast implant removal. If you decide to have your implants removed, you might need a breast lift or other corrective surgery to help your breasts maintain an aesthetically pleasing appearance.
If you decide to have the surgery, you might need lab tests or a baseline mammogram ahead of time. Your doctor might adjust certain medications before the surgery as well. For example, it's important to avoid aspirin or other medications that can increase bleeding.
If you smoke, your surgeon will ask you to stop smoking for a certain period of time before the surgery.
Arrange for someone to drive you home after the surgery and to stay with you for at least the first night.
Breast augmentation can be done in a surgical center or hospital outpatient facility. You'll probably go home the same day. Rarely, the procedure requires a hospital stay.
In select cases, breast augmentation is done with local anesthesia — in which you're awake and only your breast area is numbed. In most cases, though, breast augmentation is done under general anesthesia — in which you're asleep for the surgery.
During the procedure
To insert the breast implant, your surgeon will make a single cut (incision) in one of three places:
- In the crease under your breast (inframammary)
- Under your arm (axillary)
- Around your nipple (periareolar)
After making an incision, the surgeon will separate your breast tissue from the muscles and connective tissue of your chest. This creates a pocket either behind or in front of the outermost muscle of the chest wall (pectoral muscle). The surgeon will insert the implant into this pocket and center it behind your nipple.
Saline implants are inserted empty, and then filled with sterile salt water once they're in place. Silicone implants are pre-filled with silicone gel.
When the implant is in place, the incision will be closed — typically with stitches (sutures) — and bandaged with skin adhesive and surgical tape.
After the procedure
Soreness and swelling are likely for a few weeks after surgery. Bruising is possible, too. Expect your scars to fade gradually over time, although they won't disappear completely.
While you're healing, it might help to wear a compression bandage or sports bra for extra support and positioning of the breast implants. Your surgeon might prescribe pain medication as well.
Follow your surgeon's instructions about returning to regular activities. If you don't have a physically demanding job, you might be able to return to work within a few days to a week. Avoid strenuous activities — anything that could raise your pulse or blood pressure — for at least two weeks. While you're healing, remember that your breasts will be sensitive to physical contact or jarring movements.
If your surgeon used sutures that don't absorb on their own or placed drainage tubes near your breasts, you'll need to have them removed at a follow-up appointment.
If you notice warmth and redness in your breast or you run a fever, you might have an infection. Contact your surgeon as soon as possible. Also contact your surgeon if you experience shortness of breath or chest pain.
As you anticipate the outcome of breast augmentation, keep your expectations realistic.
Breast augmentation can change the size and shape of your breasts. The surgery might even improve your body image and self-esteem. If you're looking for perfection, however, you might be disappointed.
Also, remember that your breasts will continue to age after augmentation. Weight gain or weight loss might change the way your breasts look, too. If you become dissatisfied with the appearance of your breasts, you might need a revision operation to correct these issues.
Aug. 16, 2012
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