Breast augmentation, also known as augmentation mammaplasty, is a very popular and common procedure that can increase your breast size by one or more sizes. By surgically inserting breast implants beneath the breast tissue or the chest muscle during breast augmentation, women can achieve larger, shapelier breasts.
This type of breast enhancement is sometimes performed in conjunction with a breast lift. Performing an augmentation along with a breast lift can create a breast that has more upper pole fullness, which is often desired. 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.
Breast Augmentation Considerations
Breast augmentation can dramatically improve the appearance of a woman’s breasts. During your breast augmentation consultation, you’ll learn more about your options for creating your ideal breast appearance, including:
- Implant size, style, and shape
- Implant material (silicone or saline)
- Implant position (typically below the pectoralis muscle or in a “dual-plane” pocket)
- Implant incision site
The goal is to create a natural and alluring look. The implant size that will work best for you must be individually determined with your input. We offer 3D imaging to help each patient choose which size is right for them. We also have a detailed consultation process where our patients can try on gel sizers to better understand how different sizes may feel. The size, shape, style, and type of implant will be decided after a comprehensive examination. Placing implants that are too large for the intended body size have greater chances of capsular contracture, discomfort and longer recovery times.
Breast Implant Information
IMPLANT SHELL: All implant shells are made out of silicone, but can be smooth or textured. Smooth implant shells tend to feel softer and are more able to move within the space created for them on the chest. This means that they will move more like a natural breast. They can be pushed into a different position with a bra, for example, to create the appearance of more cleavage. Less commonly used in our practice are textured implants. Textured implants feel slightly more firm and are relatively immobile after being placed. Textured shells become adherent to your internal tissues, so cannot be pushed into a position to increase cleavage.
IMPLANT FILL: Implants can be filled with silicone (gel) or saline (salt water). Silicone is softer and feels more comfortable and natural than saline, and, in general, is less likely to show rippling through the skin. It also has a lower rupture rate than saline. If saline ruptures, your implant will deflate over time and eventually go flat. This is because saline can be reabsorbed by the body. If silicone ruptures, you may not notice at all, or you may experience a change in the way the implant looks or feels, but the volume will stay the same.
Patients often ask about safety related to silicone implants. In the past, silicone implants were taken off the market due to concern that they were somehow connected to significant health problems. This claim was very intensely researched, and no connection was found between silicone implants and the reported health issues. Despite the many benefits of silicone implants over saline, however, some patients do still chose saline due to their personal worry about their safety. In general, we counsel patients to choose saline if the idea of silicone makes them nervous despite all evidence suggesting they are safe.
Recently, a new silicone implant has been released that is slightly overfilled. This means that for the same shell size, it is filled with more silicone. Although the silicone is not necessarily more cohesive, the overfill does contribute to a slightly more firm feel. The major benefit of this type of implant is that it reduces rippling and could potentially contribute to more upper pole fullness.
IMPLANT SHAPE: In general, implants will appear more round and full at the top than a natural breast. Although this is often desirable, it is less natural in appearance. Shaped implants were designed to provide a more natural shape. These implants are tapered, so they are flatter at the upper pole, and more full at the bottom, similar to the shape of a teardrop. They are often also filled with a more cohesive gel, so feel more firm, but have less chance of contributing to visible rippling. Keep in mind that all tapered implants must be textured so that they will remain in the correct orientation; texturing reduces natural appearing mobility. Despite texturing, there is still risk for rotation. For most people, the supposed advantage of a more natural shape may not actually provide the desired result. This is best discussed on an individual basis.
IMPLANTS USED IN OUR PRACTICE: In our practice, the most common implants used are smooth round silicone implants. We offer Mentor Gel and Allergan Inspira implants. Smooth round silicone filled implants optimize comfort, longevity, and natural feel, and create a shape that is most commonly desired. Although smooth round silicone implants often provide the most comfort and longevity, some patients are still interested in choosing a saline device. For patients who desire saline implants, we are now offering a saline implant called the Ideal Implant. This is a saline implant that has a more natural feel, similar to silicone gel. To learn more about this type of implant, you can click here.
Breast Implant Incision Site Options
INFRAMAMMARY INCISION: This incision is commonly thought of as the simplest approach and is made below the breast fold. This incision can be a great choice for women who naturally have a fold where their breast sits on the chest wall. This allows for concealment of the incision. However, if this fold does not exist or is not prominent, it can be considered less ideal.
TRANSAXILLARY INCISION: This incision is made under the arm. A lighted camera (endoscope) is used to help tunnel through the subcutaneous fat to create a pocket behind the breast where the implant will be placed. Although a more technically challenging approach, our office specializes in this technique and we believe it yields equally excellent results. This approach can be appealing for women who would like to conceal the incision in a natural fold underneath their armpit, therefore avoiding scarring on the breast itself.
PERIAREOLAR INCISION: This incision site is typically the most concealed due to the natural separation and color change that the eye expects to see between the breast and the areola. However, it is associated with a higher likelihood of affecting sensation in the nipple than the other incision options because the periareolar incision involves cutting through the breast tissue. This incision is more commonly used when breast augmentation is done in conjunction with a breast lift, because the periareolar incision is utilized for breast lift surgery.
Breast Implant Placement Options
SUB-MUSCULAR IMPLANT PLACEMENT: The breast implants are placed partially or wholly under the pectoralis major chest muscle. This is our preferred technique for several reasons. One advantage is a more natural appearance to the upper part of the breast, as there is more tissue in between the skin and the implant. This means you are less likely to see the border of the implant or to see rippling. The action of your muscle will help massage the implant and keep the scar tissue capsule soft. The muscle protects the implant from the natural bacteria in your breast to decrease the risk of infection and capsular contracture. This approach also offers easier mammographic imaging of the breast.
SUB-GLANDULAR OR SUB-FASCIAL IMPLANT PLACEMENT: The breast implant location is between your chest muscle and your breast tissue (under the gland, above the muscle). It may be less painful than sub-muscular placement and may make your breast implants easier to access if re-operation is necessary. However, implants that are sub-glandular may be easier to see and feel through your skin. This means you may be able to see the border of the implant or see rippling. There is also a slightly higher risk of capsular contraction with this approach.
Breast Augmentation – What to Expect
Breast augmentation can be done in a surgical center or hospital outpatient facility. Surgery usually takes one to two hours, and is performed under general anesthesia. You will most likely go home the same day of your surgery (rarely does the procedure require a hospital stay). Your surgeon will give you specific guidelines to follow during your recovery based on your personal needs. In general, you can expect to return to your usual routine after a few days, but you should avoid excessive lifting to minimize tension on incision lines, thereby ensuring minimal scar lines.
Feeling tired and mild soreness following breast augmentation surgery are common. Pain medication will be prescribed to help alleviate discomfort. A pain pump, placed at the time of surgery, is also available to deliver local anesthesia to the breasts. It is advised that you remain in a support bra with no underwires for approximately four to six weeks. Breast swelling may take up to five weeks to subside. Scars usually stay firm and pink for at least six weeks and will begin to fade after several months, taking on a flesh tone by 6 to 9 months postoperatively.
Breast Augmentation Surgery Risks
Each year thousands of women undergo successful breast augmentation surgery, experience no major problems and are happy with the results. Significant complications from a breast augmentation are infrequent. However, make sure you understand what surgery involves, including possible risks, complications and follow-up care. Breast augmentation poses various risks, including:
- Capsular contracture (a tightening of the scar tissue which can make the breast feel hard and can distort the shape of the breast implant).
- Changes in nipple and breast sensation (usually temporary).
- Breast pain
- Rare implant leakage or rupture. If the implant is saline-filled, it deflates and the body harmlessly absorbs the saline solution. If the implant is filled with silicone gel, although still safe, the gel may alter the shape of the breast and require implant replacement.
Correcting any of these complications might require additional surgery, either to remove or replace the implants.
Other Considerations for breast augmentation surgery include:
- Breast implants won’t prevent your breasts from sagging. A breast lift may be needed in addition to a breast augmentation to correct sagging breasts.
- Breast implants aren’t guaranteed to last a lifetime. In addition to the possibility of implant rupture or leakage, factors such as aging, weight gain and/or weight loss may 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. However, placing the implant below the muscle allows for easier mammographic imaging as it presses the breast tissue up.
- Breast implants could hamper breast-feeding. Most women are able to successfully breast-feed after breast augmentation. For others, however, breast-feeding can be 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 is not covered by insurance. Be prepared to handle any expenses that accompany breast augmentation, including related surgeries or future imaging tests.
- Additional surgery may be needed after breast implant removal. If you decide to have your implants removed at a later time in your life, you might need a breast lift or other corrective surgery to help your breasts maintain an aesthetically pleasing appearance.
Like any major surgery, breast augmentation surgery poses a risk of bleeding, infection and an adverse reaction to anesthesia. It’s also possible to have an allergic reaction to the surgical tape or other materials used during or after the procedure.