Breast Augmentation: What You Need to Know

Pros 

• Patient satisfaction is high: breast augmentation has a 95% Worth It Rating from reviewers on RealSelf.
• Breasts will be larger, higher, fuller, and more youthful-looking, which can boost self-confidence.
• Both saline and silicone gel implants are highly customizable, so you can pick a size and shape that works best for your body type and lifestyle. 
• Breast fat transfer uses your own tissue to add natural-looking volume.
• Results are long-lasting: implants can last well over 10 years, while the volume from fat transfer is considered permanent.

Cons

• Pregnancy, menopause, and weight loss or gain after surgery can affect your results. 
• Fat grafting cannot give the dramatic size boost or rounded shape of an implant.
• Fat transfer results can be unpredictable, since only about 50–70% of the fat cells survive.
• Risks from breast fat transfer include lumps, calcifications, fat necrosis, and asymmetry.
• Implants aren’t lifetime devices. The longer you have them, the more likely it is that you’ll need to have them replaced, and correcting implant complications typically requires an additional surgical procedure.
• As with all cosmetic procedures, there are risks associated with silicone and saline implants, including capsular contracture and implant rupture.
• Some women, especially those with autoimmune disease, can develop what’s colloquially known as breast implant illness—systemic symptoms related to their saline and silicone breast implants.
• Cases of rare breast implant-associated cancers, like ALCL (a cancer of the immune system), have been reported, mainly with textured-surface implants.

• Average Cost:
• $6,675

• Range:
• $3,900 - $12,500

Several factors can affect the cost of your procedure, including:

• the type of augmentation you have and the surgical technique used
• the type of implant you choose
• the experience level of your plastic surgeon
• where the surgery is performed
• who administers your anesthesia

Breast augmentation is a cosmetic surgery, so it's not covered by insurance. However, health insurance providers are legally obligated in the U.S. to cover the breast reconstruction or reconstructive surgery after a mastectomy or lumpectomy. 

Most surgeons offer monthly payment plans or accept third-party financing options, such as CareCredit.

• Learn which factors can make a breast augmentation cost more
• See our complete guide to breast implant costs

As you're choosing a plastic surgeon, look for breast augmentation before and after pictures that show patients who look like you, with the kind of results you're after (and no conspicuous scars).

The breast augmentation photos in our gallery have been shared by the surgeon who performed the procedure, with the patient's consent.

You’ll start with a consultation with one or more prospective plastic surgeons. Choosing a board-certified plastic surgeon who specializes in breast surgery will ensure that you're in the safest, most experienced hands.

Related: 20 Questions to Ask at Your Breast Augmentation Consultation

Your surgeon will perform a physical exam, which includes taking measurements of the chest wall and breasts.

They'll make their recommendations for the surgery (including incision locations), walk you through the risks, and give you a run-down of the recovery process and timeline.

Dr. Jerome Edelstein, a plastic surgeon in Toronto, notes that many surgeons also require a pre-surgery mammogram, particularly if you are over age 50.

If you’re getting breast implants, your surgeon will help you determine the best size, type, incision location, and placement for your body and desired outcome.

Many surgeons offer 3D imaging, so you can virtually see the results of different types of breast implants. Others will have you try on a variety of implants by placing them in your bra, so you can feel their weight and imagine how they’ll impact the size of your breasts.

Related: The 6 Most Common Reasons a Plastic Surgeon Will Turn You Down for Breast Augmentation

Breast surgery is performed under local anesthesia with IV sedation, or under general anesthesia.

Breast implant surgery

• Your surgeon will start by making an incision around the nipple, in the inframammary fold (under your breast), or in the armpit.
• They’ll create a pocket, either above (subglandular) or below (submuscular placement) your pectoralis or chest muscles, and insert the implants.
• The incision is closed with layers of internal sutures, and the skin is closed with stitches, skin adhesive, or surgical tape.
• The surgery takes about an hour and doesn’t require an overnight stay in the hospital.

Get all the details on breast implant surgery

Fat transfer breast augmentation

• A breast fat transfer starts with lipo to remove fat from an area that has some to spare, usually the belly or thighs.
• The fat is then purified, injected into the breasts, and molded into shape.
• In general, fat transfer can give you a breast volume increase of one cup size.

RealSelf Tip: Brava, a bra-like expansion device, may or may not be necessary before your fat transfer. For some patients, the device is needed to stretch the skin to make room for the fat. Doctors on RealSelf see great results with and without Brava.

Get all the details on breast fat transfer

Breast lift sugery (mastopexy)

• A breast lift starts with an incision around the nipple, which may be extended from the bottom of the areola, down to the crease, and across the breast fold.
• Surgeons lift and reshape the breast tissue, removing excess in the process.
• If you want to add volume or create cleavage, they'll either place a breast implant or perform a fat transfer, as described above.
• As a final step, they lift and reposition the nipple (which is never detached). If you're unhappy with the size of your areolas, those can be reduced as well.

Get all the details on breast lifts or a lift with implants

Most people need about a week of recovery time immediately after a breast augmentation, unless the surgeon uses a technique called flash recovery augmentation.

Here’s what to expect during that time: 

• Your incision will be covered in dressings. You’ll be given instructions on how often to change them and how to clean your incision, to help prevent infection.
• You’ll wear a sports bra to provide support and minimize swelling. “Generally, my breast augmentation patients wear a sports bra day and night the first week after surgery, except for when they take a shower,” says Dr. Ted Eisenberg, a board-certified plastic surgeon in Philadelphia.
• If you have drainage tubes, they’ll remain in place for up to two weeks until they're removed at a follow-up appointment.
• Most people are back to work within a week, but you’ll need to hold off on sex for about two weeks and vigorous activity like running for four weeks.
• Some surgeons recommend sleeping on your back for about six weeks, to prevent implant deformation.

Related: Expectation vs. Reality: 5 Women on What Breast Augmentation Recovery Was Really Like

There are several risks associated with breast implants. See our complete guide to breast implant safety.

During your initial consultation, your surgeon should talk you through the possibility of:

• implant leakage or rupture 
• seroma (fluid buildup)  
• capsular contracture (a capsule of hard, painful scar tissue that can form around the implant) 
• visible skin wrinkling or implant rippling
• BIA-ALCL, a rare cancer of the immune system associated linked to some types of textured implants, which have since been recalled
• breast implant illness (BII)

Your doctor should thoroughly explain these risks and how they’ve handled complications with past patients.

Some women experience symptoms—include cognitive issues, chronic fatigue, and joint pain—known as breast implant illness (BII). They associate these symptoms with their silicone and saline breast implants, though studies show no evidence of implants directly causing these symptoms, according to the FDA. While research is ongoing, many women are opting for breast implant removal to prevent or improve BII symptoms.

The risks of breast fat transfer, according to the American Society of Plastic Surgeons, include:

• cysts
• infection
• microcalcifications (hard lumps)
• necrosis (death) of fat cells
• possibility that some of the transferred fat cells will leave the breast area

Some surgeons worry that fat-related cysts and calcifications can potentially interfere with mammograms and breast cancer detection by obscuring cancerous cells, causing unnecessary biopsies, or delaying critical diagnoses.

Related: Breast Implant Illness Patients Are Demanding a Say in How Their Implants Are Removed

After augmentation with breast implants, your breasts, which initially sit high, will begin to “drop and fluff” as the skin stretches and muscles relax, moving the implants to a more natural position. “It’ll be about six weeks before the implants even begin to settle down, but they’ll be close to 80% settled at three months,” says Dr. Eisenberg.  

After a fat transfer, you’ll have more volume immediately, but your body will absorb some of the injected fat within the first three months. By six months, most of the swelling should have resolved and your results should be fully apparent. Within a year, the new fat will act like natural breast tissue. 

Related: My Breast Augmentation Gave Me a New Lease on Life

Results from breast implant surgery typically last at least a decade. It’s a misconception that implants need to be replaced every 10 years, but it is true that they’re not meant to last a lifetime. A 2011 report from the FDA showed that about 1 in 5 women with silicone implants need some sort of revision due to capsular contracture, leaks, or other concerns within 10 years.

If you don't experience a complication like that, modern implants could last 20 years or more.

The results of a fat transfer can last even longer, though your breasts will continue to age, expand, or shrink as your weight changes. They may also begin to sag with age, as skin becomes less firm, which is why many patients opt for revision surgery after about 10 years.

You should still be able to safely breastfeed with implants, but research published in the International Breastfeeding Journal shows that any breast surgery (and specifically the incision around the nipple) can potentially damage milk ducts, so there is a risk of insufficient milk production.

Fat transfer breast augmentation carries a lower risk of impacting your ability to breastfeed, provided you're not also having some kind of nipple surgery.

Related: I Got a Breast Augmentation After Having Children