Breast augmentation — also known as augmentation mammoplasty — is surgery to increase breast size. It involves placing breast implants under breast tissue or chest muscles.
For some women, breast augmentation is a way to feel more confident. For others, it's part of rebuilding the breast for various conditions.
If you're considering breast augmentation, talk to a plastic surgeon. Make sure you understand what surgery involves, including possible risks, complications and follow-up care.
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Why it's done
Breast augmentation might help you:
- Enhance your appearance if you think your breasts are too small or that one is smaller than the other
- Adjust for a reduction in the size of your breasts after pregnancy
- Correct uneven breasts after breast surgery for other conditions
- Improve your self-confidence
Discuss your goals with your surgeon so that you can be realistic about 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
- Implant leakage or rupture
Correcting these complications might require more surgery, either to remove or replace the implants.
The Food and Drug Administration (FDA) has identified a possible association between breast implants and the development of breast implant-associated anaplastic large cell lymphoma (ALCL), a rare cancer of the immune system. The FDA believes that women with breast implants might have a very low but increased risk of developing ALCL. However, further research is needed to fully understand the relationship between ALCL and breast implants.
How you prepare
You'll consult with a plastic surgeon about your preferences for size, feel and 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.
Carefully review written information, such as the patient information from the manufacturer of the implant you'll be getting, and keep copies for your records.
Before you decide to have surgery, consider the following:
- 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. The average life span of an implant is 10 years. Implant rupture is a possibility. Also, your breasts will continue to age, and factors such as weight gain or weight loss might change the way your breasts look. These issues will likely lead to more surgery.
- Mammograms might be more complicated. If you have breast implants, in addition to routine mammograms, you'll require additional, specialized views.
- 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 does not cover breast implants. Unless it's medically necessary — such as after a mastectomy — breast augmentation isn't covered by insurance. Be prepared to handle the expenses, 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 restore your breasts' appearance.
- You might need an MRI scan. The FDA recommends routine monitoring with MRI after three years. However, recent studies show that there's little data to support routine screening unless you have symptoms.
You might need a baseline mammogram before your surgery. 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 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.
What you can expect
Breast augmentation incision sites
During breast augmentation, the surgeon makes an incision in one of three possible places: in the crease under your breast (inframammary), under your arm (axillary) or around your nipple (periareolar).
Placement of breast implants
After breast augmentation surgery, the implant lies either behind the glandular tissue in your breast (subglandular placement) or behind the chest wall muscle (submuscular placement).
Breast augmentation can be done in a surgical center or hospital outpatient facility. You'll probably go home the same day. The procedure rarely requires a hospital stay.
Sometimes, breast augmentation is done during local anesthesia — you're awake and your breast area is numbed. Often, though, breast augmentation is done during 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 surgeon will close the incision — typically with stitches (sutures) — and bandage it 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 scars to fade over time but not 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 weeks. 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 a follow-up appointment for removal.
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 have shortness of breath or chest pain.
Breast augmentation can change the size and shape of your breasts. The surgery might improve your body image and self-esteem. But keep your expectations realistic, and don't expect perfection.
Also, 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 more surgery to correct these issues.
Aug. 10, 2018