Breast augmentation

Definition

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 a way to reconstruct a breast 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.

Why it's done

A woman's reasons for choosing breast augmentation are highly personal. Breast augmentation may 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

The best candidate for breast augmentation is a woman looking for an improvement — but not perfection — in her appearance. Discuss your goals with your surgeon so that you can develop a realistic expectation of what breast augmentation can provide.

Risks

Breast augmentation poses various risks, including:

• Infection
• Breast pain
• Potentially permanent changes in nipple or breast sensation
• Scar tissue that causes pain or distorts the shape of the breast implant (capsular contracture)
• Implant leakage or rupture

Correcting any of these complications may require additional surgery, either to remove or replace the implants.

How you prepare

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-filled or gel-filled — 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 aren't lifelong devices. Your breast implants will likely need to be removed or replaced at some point.
• You might need more surgery after breast implant removal. If you have your breast implants removed for any reason, you may experience unacceptable cosmetic changes — such as wrinkling, dimpling or droopy excess skin — which might require replacing the implants. Or you may need a breast lift (mastopexy) to remove excess skin and reposition your nipple.
• Breast implants won't prevent your breasts from sagging. To correct sagging breasts, some women need to consider a breast lift in addition to breast augmentation. In addition, depending on how it's done, breast augmentation may make breast-feeding more challenging.
• Mammograms may be more complicated. Routine mammograms often require additional, specialized views. The quality of the mammogram will depend on the experience and expertise of the technician and the facility you select.
• Insurance probably won't pay for the procedure. Unless it's medically necessary, breast augmentation may not be covered by your insurance plan. Be prepared to handle any expenses that accompany breast augmentation, including related surgeries or future imaging tests.

If you decide to have the surgery, you may need lab tests or a baseline mammogram ahead of time. If you're a smoker, your surgeon will ask you to stop smoking for a certain period of time before your surgery. You may also need to avoid aspirin or other medications that could increase bleeding during surgery.

What you can expect

Breast augmentation can be done in a surgical center or hospital outpatient facility. You'll probably go home the same day, but on occasion the procedure requires a hospital stay. In some cases, breast augmentation is done with local anesthesia — in which you're awake and only your breast area is numbed. In other cases, 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 an incision in one of three places:

• Along the crease at the underside of the breast (inframammary)
• Around the nipple (periareolar)
• Under the arm (axillary)

After making an incision, the surgeon will separate your breast glandular tissue from the muscles and connective tissue of your chest to create 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 generally empty when inserted and then filled with sterile saline once they're in place. Silicone implants are already filled at the time they're placed. When the implant is in place, the surgeon will close the incision with stitches (sutures), skin adhesive or surgical tape.

After the procedure
Expect soreness and swelling for a few weeks after breast augmentation. You may also notice bruising, numbness or a burning sensation in your nipples as you heal. Your scars may initially appear firm and pink. It may help to wear a compression bandage or sports bra for extra support and positioning of the breast implants during this time. Your surgeon can prescribe pain medication as well.

If you don't have a physically demanding job, you may be able to return to work within a few days to a week. Getting back to normal activities may take longer — about two to three weeks — because your breasts will be sensitive to physical contact or jarring movements. Follow your surgeon's instructions about returning to regular activities.

If your surgeon used nonabsorbable sutures 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.

Breast augmentation incision sites

Breast augmentation incision sites

During breast augmentation, the surgeon makes an incision in one of three possible places: under your arm (axillary), along your nipple (periareolar) or in the crease underneath your breast (...

Placement of breast implants

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). ...

Results

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 may even improve your body image and self-esteem. If you're looking for perfection, however, you may be disappointed.

Expect your scars to fade gradually over time, but they won't go away completely. The darker your skin, the more noticeable the scars may be.

In addition, remember that breast augmentation results aren't necessarily permanent. If you become dissatisfied with the appearance of your breasts, you may consider a breast lift or having the implants removed or replaced.