Breast augmentation (or augmentation mammoplasty) is a surgical procedure to increase the size and shape of the breasts. Women may consider having their breasts enlarged for several different reasons:
- To make the breasts more proportionate with the body and enhance self-esteem
- To correct a reduction in breast volume after pregnancy
- To reshape or enlarge breasts that have lost their shape from breast-feeding or aging
- To balance asymmetrical breasts (breasts that differ significantly in size or shape)
- To reconstruct the breast contour after breast removal surgery (mastectomy)
Breast augmentation involves the placement of an implant either behind the breast tissue or under the chest wall (pectoral) muscle. The insertion of an implant will push the breast tissue forward, making the breast appear larger and more full.
Breast augmentation is the most popular cosmetic surgical procedure performed in the United States. According to the American Society of Plastic Surgeons, more than 347,000 undergo breast augmentation each year. Most procedures are performed in an outpatient setting. The majority of women who undergo breast augmentation are between 19 and 34 years old.
| While breast augmentation will increase the size of a woman's breasts, it will not perfect them. Moreover, breast implants do not last forever and women will likely need additional surgeries throughout their lifetime. Physically healthy women who are realistic about the results of breast augmentation are usually the best candidates for the procedure. |
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Image of breast
implant courtesy |
In most cases, women who are considering breast augmentation will set up an initial consultation with a plastic surgeon. All plastic surgeons should be certified by the American Society of Plastic Surgeons (ASPS). The surgeon will evaluate the woman's health and determine which surgical techniques are best for the woman, based on her situation. While breast augmentation may increase a woman's self-confidence, she must be realistic about the results. Though breast augmentation will increase the size of a woman's breasts, it will not perfect them. Most plastic surgeons will discuss alternatives to plastic surgery as well as the risks and limitations of the procedure. Physically healthy women who are realistic about breast augmentation are usually the best candidates for the procedure.
Issues discussed in the initial consultation may include:
- Preparing for surgery
- Cost of the surgery (most insurance companies do not consider breast augmentation to be medically necessary, and therefore, do not cover the procedure)
- Type of facility where the operation will be performed
- Type of anesthesia that may be used during surgery
- The operation itself
- Recovery
- Possible side effects and complications
Women considering breast augmentation should tell their plastic surgeons about any medications, vitamins, or other drugs they may be taking. It is very important that women who smoke tell their plastic surgeons because smoking could possibly delay the healing process and cause additional complications. Most plastic surgeons will recommend the woman have a baseline mammogram before undergoing surgery.
In 1992, the U.S. Food and Drug Administration (FDA) imposed a ban on the general use of silicone gel-filled breast implants until additional medical trials determine their safety. In 2006, after extensive study, the FDA ruled that certain silicone-filled breast implants may be used during breast augmentation and reconstructive surgeries. Those implants must be made by Allergan or Mentor and can only be used for augmentation in women 22 years of age or older and for reconstruction in women of any age. By contrast, the FDA has approved saline-filled implants made by either Allergan or Mentor for breast augmentation in women aged 18 or older and for reconstruction in women of any age. The reason for the difference in age requirements is, according to the FDA, due to differences in risks among the implants. For example, silicone gel-filled implants will require frequent MRI monitoring to detect silent rupture (a rupture that can go undetected by the patient or physician). There is no risk of silent rupture for saline-filled implants. In addition, the health consequences of a ruptured saline-filled breast implant are different from those of a ruptured silicone gel-filled breast implant . Any implant other than the four named above is considered by the FDA to be "investigative" and women must be part of clinical trial in order to receive it.
Breast augmentation is almost always performed under general anesthesia. The procedure may be performed at an office facility, a surgical center, or a hospital outpatient facility. Occasionally, women must check into a hospital for the procedure.
The plastic surgeon will determine the best method of inserting the saline implant based on a woman's breast condition and personal situation. Surgical incisions may be placed either in the upper portion of the underarm (transaxillary), in the armpit (axillary), around the nipple (periareolar), or through the fold under the breast (inframammary). A small scar will remain after surgery, although most plastic surgeons will try to make the incision in an area that will minimize visibility of the scar (such as through the fold under the breast). The transaxillary incision, for example, is made in the armpit area, which places the scar away from the breast area.
Through the incision, the surgeon will lift the breast tissue and skin to create a pocket either directly behind the breast tissue or underneath the chest wall (pectoral) muscle. The saline implant will then be inserted. Many plastic surgeons prefer to place the implant under the chest wall muscle to separate the breast tissue from the newly inserted implant. This position may give the breast a more natural appearance, reduce the chances of capsular contracture (tightening of the scar around the implant), and help make mammograms easier to read (special mammography views are required for breasts with implants). Drainage tubes are usually inserted in the breast or under the arm to help remove blood or other fluids which may accumulate during the healing process. The tubes are typically removed several days after surgery. Breast augmentation surgery usually takes between one and two hours. Stitches will be placed to close incisions, and gauze bandages may be placed over the breasts to facilitate healing.
Most women will experience breast pain, discomfort, and fatigue during the first 24 to 48 hours after surgery. The breasts are usually swollen, bruised, and sensitive after augmentation surgery. Pain medications may be prescribed to help alleviate discomfort. Most women are able to resume normal daily activities within a week and strenuous activities within a month or two. A burning sensation may occur in the nipples during the first two weeks after surgery; swelling and increased sensitivity may last for up to a month. Stitches will usually be removed seven to 10 days after surgery.
Surgical scars will be firm and pink for up to two months after surgery. Scars will generally remain the same size for several months and may even appear to widen. Scars will fade after several months but will remain indefinitely.
Women over 40 years of age should continue having annual mammograms to screen for breast cancer after breast augmentation surgery. Because of the implant, several special mammography views must be taken to allow visualization of both the breast tissue and the implant. Diagnostic mammography is usually performed on women with breast implants rather than screening mammography. The x-rays used for mammographic imaging of the breasts cannot penetrate silicone or saline implants well enough to image the overlying or underlying breast tissue. Therefore, some breast tissue (approximately 25%) will not be seen on the mammogram, as it will be covered up by the implant. Because of the possibility of silent rupture of silicone breast implants, the FDA recommends that women with these implants receive MRI breast screening three years after implantation and every two years thereafter.
The most common side effect of breast implant surgery is capsular contracture: the scar or capsule around the implant begins to tighten and squeezes down on the soft implant, causing the breast to feel hard. Capsular contracture may be treated with additional surgery to remove the scar tissue. Occasionally, patients with capsular contracture may have to have the breast implant removed and replaced with a new one. However, a recent study shows that the likelihood of capsular contracture may be reduced if implants are treated with antibacterial agents during surgery.
Another risk associated with breast implants is the possibility of rupture. If a saline-filled breast implant ruptures, the patient and physician will know because the implant will deflate and the saline solution leaks into the body immediately or over a period of days. The implant will lose its original size or shape. On the other hand, silicone-filled implant ruptures are called silent rupture because the patient and physician must not know that a rupture has occurred. Thus, the FDA recommends that patients with silicone-filled implants received an MRI three years after implantation and then every two years thereafter to screen for a rupture. However, some patients will experience symptoms of a rupture, including hard knots or lumps surrounding the implant or in the armpit, change or loss of size or shape of the breast or implant, pain, tingling, swelling, numbness, burning, or hardening of the breast.
Health experts do not know all of the reasons that breast implants might rupture. However, according to the FDA, some of the causes include:
Other possible side effects of breast implants include:
- Calcium deposits in the breast tissue around the implant (usually non-cancerous but occasionally have to be surgically removed to assure they do not indicate cancer)
- Infection around the implant
- Hematoma or seroma (blood or fluid trapped in the wound)
- Delay in healing
- Shifting of implant (further surgery may be necessary)
- Temporary or permanent changes in the feeling of the nipple or breast (some women report areas of increased or decreased sensitivity or numbness near the incision)
Other less common factors that could affect breast appearance include:
- Incorrect implant size
- Visible scars
- Uneven appearance
- Wrinkling of the implant
Breast implants may deflate or rupture from injury to the breast or through normal wear over time. Saline implants deflate quickly and surgery is usually done immediately to remove or replace the implant. Saline (salt water) is absorbed naturally by the body and does not pose any health risks. Approximately 50% of implants need some type of modification or replacement after five or 10 years.
Breast-feeding is possible in most instances after breast augmentation surgery unless implants were placed to rebuild the contour of the breast following breast removal with mastectomy (as part of treatment for breast cancer). Women who have breast reconstruction often have the nipple and areola (dark pigmented region around the nipple) re-grafted on the breast, but because the glands and milk ducts were removed during surgery, they are unable to produce milk. On the other hand, women who have breast-fed within a year before augmentation may produce some milk for a few days following surgery. Though this may be uncomfortable, it can be treated with medications prescribed by a physician.
- The American Society of Plastic Surgeons provides information on breast augmentation at http://www.plasticsurgery.org/
- The FDA provides information on breast implants at http://www.fda.gov
- To find a plastic surgeon or to determine whether a surgeon is board-certified, please visit http://www.imaginis.com/breasthealth/reconstruction.asp#find_surgeon
- To learn more about breast reconstruction after mastectomy, please visit http://www.imaginis.com/breasthealth/reconstruction.asp
Updated: July 28, 2008
