Breast augmentation

Breast Augmentation is a plastic surgery procedure to enlarge breast size by inserting breast implants. Breast Augmentation is also performed in Breast Reconstruction surgery post-mastectomy and to correct breast asymmetry. 

Search terms: Breast Augmentation Surgery, Breast Implants, Silicone Implants, Saline Implants

Who should consider Breast Augmentation?

• you are bothered by the feeling that your breasts are too small
• clothes that fit well around your hips are often too large at the bustline
• you feel self-conscious wearing a swimsuit or form-fitting top
• your breasts have become smaller and less firm after having children
• weight loss has changed the size and shape of your breasts
• one of your breasts is noticeably smaller than the other

Breast Impant Options

Breast implant options include:

• Saline breast implants: Filled with sterile salt water.  Saline implants may be pre-filled to a predetermined size. Saline may also be  filled at the time of surgery to allow for minor modifications in implant size.
• Silicone filled breast implants: Filled with soft, elastic gel. All silicone breast implants are pre-filled and may require a longer incision for implant placement.

The U.S. Food & Drug Administration (FDA) announced November 2006 the approval and availability of silicone gel-filled breast implants, ending a 14-year ban on the use of silicone implants for cosmetic breast surgery. Now all women over 22 years old seeking cosmetic breast augmentation and women seeking breast reconstruction surgery have the option to select silicone breast implants.

Doctor Consultation: what to ask

• See the Breast Augmentation consultation checklist
• Read about the experiences of others who've had Breast Augmentation surgery. See real Breast Augmentation reviews.

During the consultation, you will be asked about your desired breast size and anything else related to the appearance of your breasts that you feel is important. This will help your surgeon to understand your expectations and determine whether they realistically can be achieved.

Your plastic surgeon will examine your breasts and perhaps take photographs for your medical record. He or she will consider such factors as the size and shape of your breasts, the quality of your skin and the placement of your nipples and areolas (the pigmented skin surrounding the nipples). If your breasts are sagging, a breast lift may be recommended in conjunction with augmentation.

You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries including breast biopsies, and medications that you currently take. You will be asked whether you have a family history of breast cancer and about results of any mammograms. It is important for you to provide complete information.

Breast Health: There is no scientific evidence that breast augmentation increases the risk of breast cancer. The presence of breast implants, however, can make it more technically difficult to take and read mammograms. This may be a special consideration for women who perhaps are at higher risk for breast cancer because of their family history or other reasons. Placement of the implant underneath the pectoral muscle may interfere less with mammographic examination, but other factors may also need to be considered with regard to implant placement. Your plastic surgeon will discuss this with you.

Weight Loss Plans: If you are planning to lose a significant amount of weight, be sure to tell your plastic surgeon. He or she may recommend that you stabilize your weight prior to undergoing surgery.

Pregnancy: If you think that you may want to become pregnant in the future, you should mention this to your surgeon. Pregnancy can alter breast size in an unpredictable way and could affect the long-term results of your breast augmentation. There is no evidence that breast implants will affect pregnancy or your ability to breast-feed, but if you have questions about these matters, you should ask your plastic surgeon. 

Getting ready for Surgery

In some instances, your plastic surgeon may recommend a baseline mammogram before surgery and another mammographic examination some months after surgery in order to help detect any future changes in your breast tissue. Following breast augmentation, you will still be able to perform breast self-examination.

If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.

Breast augmentation is usually performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.

During Surgery

Your breast augmentation surgery may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite. Medications are administered for your comfort during the surgical procedure. Frequently, local anesthesia and intravenous sedation are used for patients undergoing breast augmentation, although general anesthesia may be desirable in some instances.

Placement of Incisions: One of the advantages of a saline-filled implant is that, because it is filled with saltwater after being inserted, only a small incision is needed. Often, an incision of less than one inch is made underneath the breast, just above the crease, where it is usually quite inconspicuous.

Another possible location for the incision is around the lower edge of the areola. A third alternative is to make a small incision within the armpit.

Placement of Implants: Once the incision is made, the surgeon creates a pocket into which the implant will be inserted. This pocket is made either directly behind the breast tissue or underneath the pectoral muscle which is located between the breast tissue and chest wall. 

After Surgery

Prior to your discharge, you and your caregiver will be given detailed instructions about your post-surgical care including drains if they have been placed, the normal symptoms you will experience, and any potential signs of complication.

Where to recover:

• Home: When discharged, you will be released to the care of a responsible adult with safe, licensed transportation home. The adult may be a family member, friend or hired caregiver and must be competent to understand your recovery instructions and to monitor your health. Your caregiver must commit to stay with you at all times for a minimum of 24 hours after surgery.
• Licensed Recovery Facility: You will be released to the care of a licensed post-surgical recovery facility where nurses or specially trained medical professionals will monitor your health and comfort until you are able to return home and capably care for yourself.
• Hotel or spa: You may wish to recover at a hotel or spa location, where licensed healthcare professionals will monitor your recovery around the clock as recommended by your plastic surgeon.
• Overnight Hospital Stay: An overnight hospital stay may be offered to you or may be recommended. In this case your surgery will be performed at the hospital where you will stay overnight. You will be released from the hospital to a capable caregiver to continue your recovery at home, or to a licensed recovery facility.

Recovery process:

Day of surgery: You should be walking under your own strength immediately after your breast augmentation surgery.  It is very important that you walk a few minutes every few hours to reduce the risk of blood clot formation in your legs.

First 2-5 days after surgery: You may feel stiff and sore in the chest region. Any dressings will be removed within several days, and you may be instructed to wear a support bra. Your breasts may feel tight and sensitive to the touch, and your skin may feel warm or itchy. Your plastic surgeon will probably permit you to shower between three and seven days following surgery. Stitches will be removed in about a week. You may experience difficulty raising your arms. You should not lift, push or pull anything, or engage in any strenuous activity or twisting of the upper body. Some discoloration and swelling will occur initially, but this will disappear quickly. Most residual swelling will resolve within a month.

The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your plastic surgeon, or with a staff member in your surgeon's office.

Some of the potential complications that may be discussed with you include:

• Reactions to anesthesia
• Blood accumulation that may need to be drained surgically
• Infection
• Changes in nipple or breast sensation (usually temporary)

Capsular Contraction: When a breast implant is inserted, a scar capsule forms around it as part of the natural healing process. The capsule may sometimes tighten and compress the implant, causing the breast to feel firmer than normal. Capsular contracture can occur to varying degrees. If it is severe, it can cause discomfort or changes in the breast's appearance. In such cases, more surgery may be needed to modify or remove the scar tissue, or perhaps remove or replace the implant.

Implant Rupture: Breast implants are not lifetime devices and cannot be expected to last forever. If a saline-filled implant breaks, its contents are harmlessly absorbed by the body within hours. A definite change in the size of the breast is clearly noticed. Rupture can occur as a result of trauma to the chest, but more commonly it occurs spontaneously with no apparent cause. Surgery will be required to replace the implant, if desired.

Breast Cancer Screening: If you are at an age when mammographic examinations should be conducted on a periodic basis, it will be important for you to select a radiology technician who is experienced in taking x-rays of augmented breasts. Additional views of your breasts will be required. Your plastic surgeon, in some instances, may recommend other types of examinations such as ultrasound or magnetic resonance imaging. It is possible that the presence of breast implants could delay or hinder the early detection of breast cancer.

Some women with breast implants have reported problems including certain connective tissue and immune-related diseases. Women without implants also have these disorders, so the key question is whether breast implants increase the risk of developing the conditions. Several large studies have been completed that provide reassurance that women with breast implants do not have a significantly increased risk for these diseases.

Cost

Breast Augmentation surgery cost can vary widely as reflected in the Breast Augmentation Cost Data posted on RealSelf.com. A surgeon’s cost for Breast Augmentation may vary based on his or her experience, the type of procedure used, as well as geographic office location.

• Surgeon’s professional fee
• Facility fee
• Anesthesia fee
• Medications
• Surgical garments
• Medical tests

Terminology to know

• Augmentation Mammoplasty: Another term for Breast Augmentation.
• Breast Implants (Textured-Surface): The shell of textured-surface breast implants are made with the same silicone elastomer that is used for the shell of other types of breast implants, but a special manufacturing process creates a textured surface.
• Breast Lift (Mastopexy): Frequently, a woman elects this surgery after losing a considerable amount of weight, or losing volume and tone in her breasts after having children. The plastic surgeon relocates the nipple and areola (the pink skin surrounding the nipple) to a higher position, repositions the breast tissue to a higher level, removes excess skin from the lower portion of the breast and then reshapes the remaining breast skin. Scars are around the areola, extending vertically down the breast and horizontally along the crease underneath the breast. Variations on this technique, in some cases, may result in less noticeable scarring.
• Capsular Contracture: Capsular contracture is the most common problem associated with breast implants. It occurs when naturally forming scar tissue around the implant shrinks and tightens, making the breast feel firmer than normal and sometimes causing pain and an unnatural appearance of the breast.
• General anesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
• Intravenous sedation: Sedatives administered by injection into a vein to help you relax.
• Local anesthesia: A drug injected directly to the site of an incision during an operation to relieve pain.
• Lumen: Solid silicone rubber outer shell found on all breast implants
• Mastopexy: Another term for Breast Lift.
• Stem cell breast augmentation information