Breast Augmentation

Breast augmentation surgery involves using breast implants or fat, referred to as fat transfer breast augmentation, to increase the size of your breasts or restore breast volume that has been lost after weight reduction or pregnancy.

Breast augmentation is clinically referred to as augmentation mammaplasty.

Breast augmentation can:

• Increase fullness and projection of your breasts
• Improve the balance of your figure
• Enhance your self-image and self-confidence

Breast implants may also be used for breast reconstruction after mastectomy or injury.

What breast augmentation surgery won’t do

Breast augmentation does not correct severely drooping breasts. If you want your breasts to look fuller and to be lifted due to sagging, a breast lift may be required in conjunction with breast augmentation.

Breast lifting can often be done at the same time as your augmentation or may require a separate operation. Your plastic surgeon will assist you in making this decision.

Your cost will be based on your individual plan and procedure.
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Breast augmentation cost may include:

• Anesthesia fees
• Hospital or surgical facility costs
• Medical tests
• Post-surgery garments
• Prescriptions for medication
• Surgeon’s fee

Your satisfaction involves more than a fee. When choosing a board-certified plastic surgeon for breast augmentation surgery, remember that the surgeon’s experience with breast implants and your comfort with him or her are just as important as the final cost of the surgery.

Breast augmentation surgery and health insurance coverage

Most health insurance plans will not cover cosmetic breast augmentation costs, related complications or another surgery to revise the appearance of your breasts.

Some carriers even exclude breast diseases in patients who have breast implants.

You must carefully review your health insurance policy.

Breast augmentation is a very personal procedure and you should do it for yourself, not for someone else.

You may be a candidate for breast augmentation surgery if:

• You are physically healthy
• You have realistic expectations
• Your breasts are fully developed
• You are bothered by the feeling that your breasts are too small
• You are dissatisfied with your breasts losing shape and volume after pregnancy, weight loss, or with aging
• You are unhappy with the upper part of your breast appearing “empty”
• Your breasts are asymmetrical
• One or both breasts failed to develop normally or have an elongated shape

Many patients find it helpful to review breast augmentation photos and learn about what to expect during recovery as they navigate the decision-making process to have surgery.

During your breast augmentation recovery, you will be taken into a recovery area to be closely monitored following surgery.

Your breasts will be wrapped in gauze dressings and an elastic bandage or support bra will minimize swelling and support the breasts as they heal.

You may be permitted to go home after a few hours.

Before leaving, you will be given specific instructions that may include how to care for your breasts following surgery, medications to apply or take orally to aid healing and reduce the risk of infection, and when to follow-up with your plastic surgeon.

You may be instructed to wear a support bra around the clock for the first week or two. It will be important to cleanse the incision sites and apply ointment as directed. Be sure to follow all instructions carefully.

After a post-surgical breast augmentation recovery period of 24 to 48 hours and an additional reduced-activity period of a few days, you will likely experience soreness and swelling for a few weeks.

Exercise and normal activity can resume at the direction of your plastic surgeon.

Breast augmentation results are immediately visible. Over time, post-surgical swelling will subside and incision lines will fade.

Satisfaction with your new image should continue to grow as you fully recover from surgery.

In order to achieve optimal breast augmentation results, it is important that you follow your surgeon’s post-operative instructions and return for follow-up visits.

Breast implant replacement

It’s important to know that breast implants are not designed to last a lifetime.

Your implants may need to be replaced. You should plan for an annual examination by your plastic surgeon to evaluate your breast health and implant integrity.

Over time, your breasts can change due to aging, weight fluctuations, hormonal factors and gravity. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast lift or implant exchange to restore a more youthful contour.

Saline breast implants

Saline breast implants are filled with sterile salt water. Should the implant shell leak, a saline implant will collapse and the saline will be absorbed and naturally expelled by the body.

Saline breast implants provide a uniform shape, firmness and feel, and are FDA-approved for augmentation in women age 18 or older.

Silicone breast implants

Silicone breast implants are filled with silicone gel. The gel feels a bit more like natural breast tissue. If the implant leaks, the gel may remain within the implant shell, or may escape into the breast implant pocket. A leaking implant filled with silicone gel will not collapse.

If you choose silicone implants, you may need to visit your plastic surgeon regularly to make sure the implants are functioning properly. An ultrasound or MRI screening can assess the condition of breast implants.

Silicone breast implants are FDA-approved for augmentation in women age 22 or older.

Gummy bear breast implants

Form-stable implants are sometimes referred to as gummy bear breast implants because they maintain their shape even when the implant shell is broken.

The consistency of the silicone gel inside the implant is thicker than traditional silicone gel implants. These implants are also firmer than traditional implants, but are thought to be less likely to break.

Gummy bear breast implants are shaped rather than round. They have more projection at the bottom and are tapered towards the top. If a shaped implant rotates, it may lead to an unusual appearance of the breast.

Placement of gummy bear implants requires a longer incision in the skin.

Round breast implants

Round breast implants have a tendency to make breasts appear fuller than form-stable implants. Higher profile options can achieve even more projection.

Because round implants are the same shape all over, there is less concern about them rotating out of place.

Smooth breast implants

Smooth breast implants are the softest feeling. These implants can move with the breast implant pocket, which may give more natural movement.

Smooth implants may have some palpable or visible rippling.

Textured breast implants

Textured breast implants develop scar tissue to stick to the implant, making them less likely to move around inside of the breast and get repositioned.

Texturing offers some advantage in diminishing the risk of a tight scar capsule.

Implant manufacturers occasionally introduce new styles and types of breast implants, so there may be additional options available.

Whether you choose saline or silicone implants, it is important for you to monitor your breast implants and follow-up with your plastic surgeon for appropriate checkups.

Fat transfer breast augmentation essentially uses liposuction to take fat from other parts of your body and inject it into your breasts.

This is an option for women who are looking for a relatively small increase in breast size and would prefer natural results.

The decision to have plastic surgery is extremely personal and you will have to decide if the benefits will achieve your goals and if the risks and potential complications of breast augmentation are acceptable.

You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks and potential complications.

Possible breast augmentation surgery risks include:

• Anesthesia risks
• Bleeding
• Infection
• Changes in nipple or breast sensation
• Poor scarring of skin
• Wrong or faulty position of the implant
• Implant leakage or rupture
• The formation of tight scar tissue around the implant (capsular contracture)
• Fluid accumulation (seroma)
• Wrinkling of the skin over the implant
• Pain, which may persist
• Possibility of revisional surgery

These risks and others will be fully discussed prior to your consent. It is important that you address all your questions directly with your plastic surgeon.

Breast implant safety

Breast implants do not impair breast health.

Careful reviews of scientific research by independent groups such as the Institute of Medicine have found no link between breast implants and autoimmune or other systemic diseases.

Other important considerations:

• Breast implants are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants
• Pregnancy, weight loss, and menopause may influence the appearance of augmented breasts over the course of your lifetime
• Breast augmentation requires regular examinations of your breasts’ health and to evaluate the condition of your breast implants

A breast augmentation procedure includes the following steps:

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The incision

Incisions are made in inconspicuous areas to minimize visible scarring. You and your plastic surgeon will discuss which incision options are appropriate for your desired outcome. Incision options include:

Incisions vary based on the type of breast implant, degree of enlargement desired, your particular anatomy and patient-surgeon preference.

Step 3 – Inserting and placing the breast implant

After the incision is made, a breast implant is inserted into a pocket either:

A. Under the pectoral muscle (a submuscular placement), or

B. Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)

The method for inserting and positioning breast implants depends on the type of implant, degree of enlargement desired, your body type and your surgeon’s recommendations.

Step 4 – Closing the incisions

Incisions are closed with layered sutures in the breast tissue and with sutures, skin adhesive or surgical tape to close the skin.

Over time the incision lines will fade.

Step 5 – See the results

The results of breast augmentation are immediately visible.

In preparing for breast augmentation surgery, you may be asked:

• Get a blood test
• Take certain medications or adjust your current medications
• Stop smoking
• Avoid taking aspirin and certain anti-inflammatory drugs as they can increase bleeding

Breast augmentation surgery may be performed in an accredited outpatient or ambulatory surgical center or a hospital.

If your breast augmentation is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.

During your breast augmentation consultation be prepared to discuss:

• Why you want breast augmentation surgery, your expectations and the desired outcome
• Medical conditions, drug allergies and previous medical treatments
• Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use
• Family history of breast cancer and results of any mammograms or previous biopsies

Your plastic surgeon will also:

• Evaluate your general health status and any pre-existing health conditions or risk factors
• Examine and measure your breasts, including detailed measurements of their size and shape, skin quality, and placement of your nipples and areolas
• Take photographs
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes of breast augmentation and any risks or potential complications

Be sure to ask your plastic surgeon questions. To help, we have prepared a checklist of questions to ask your breast augmentation surgeon that you can take with you to your consultation (see tab titled “Questions to ask your breast augmentation surgeon).

It’s very important to understand all aspects of your breast augmentation surgery. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.

• Areola: Pigmented skin surrounding the nipple.
• Augmentation mammaplasty: Breast enlargement or breast enhancement by surgery.
• Breast Augmentation: Also known as augmentation mammaplasty; breast enlargement or breast enhancement by surgery.
• Breast Implants: Medical devices placed in your body to enhance an existing breast size or to reconstruct your breast. Breast implants fall into two categories: saline breast implants and silicone breast implants.
• Capsular contracture: A complication of breast implant surgery which occurs when scar tissue that normally forms around the implant tightens and squeezes the implant and becomes firm.
• General anesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
• Hematoma: Blood pooling beneath the skin.
• Inframammary incision: An incision made in the fold under the breast.
• 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.
• Mammogram: An x-ray image of the breast.
• Mastectomy: The removal of breast tissue, typically to rid the body of cancer.
• MRI: Magnetic Resonance Imaging; a painless test to view tissue similar to an x-ray.
• Periareolar incision: An incision made at the edge of the areola.
• Saline implants: Breast implants filled with salt water.
• Silicone implants: Breast implants filled with an elastic gel.
• Submammary or subglandular placement: Breast implants placed directly behind the breast tissue, over the pectoral muscle.
• Submuscular or subpectoral placement: Breast implants placed under the pectoral muscle, which is located between the breast tissue and chest wall.
• Sutures: Stitches used by surgeons to hold skin and tissue together.
• Transaxillary incision: An incision made in the underarm area.
• Ultrasound: A diagnostic procedure that projects high frequency sound waves into the body and records the echoes as pictures.

Use this checklist as a guide during your breast augmentation consultation:

• Are you certified by the American Board of Plastic Surgery?
• Were you trained specifically in the field of plastic surgery?
• How many years of plastic surgery training have you had?
• Do you have hospital privileges to perform this procedure? If so, at which hospitals?
• Is the office-based surgical facility accredited by a nationally-or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
• Am I a good candidate for breast enhancement or breast enlargement?
• What will be expected of me to get the best results?
• Where and how will you perform my breast augmentation surgery?
• What shape, size, surface texturing, incision site and placement site are recommended for me?
• How long of a recovery period can I expect, and what kind of help will I need during my recovery?
• What are the risks and complications associated with my procedure?
• How are complications handled?
• How many additional implant-related operations can I expect over my lifetime?
• How will my ability to breastfeed be affected?
• How can I expect my implanted breasts to look over time? After pregnancy? After breastfeeding?
• What are my options if I am dissatisfied with the cosmetic outcome of my implanted breasts?
• How will my breasts look if I choose to have the implants removed in the future without replacement?
• Do you have breast augmentation before-and-after photos I can look at for this procedure and what results are reasonable for me?

Breast augmentation surgery involves many choices. The first and most important is selecting a member of the American Society of Plastic Surgeons (ASPS) surgeon you can trust.

• ASPS member surgeons meet rigorous standards:
• Board certification by the American Board of Plastic Surgery® (ABPS) or in Canada by The Royal College of Physicians and Surgeons of Canada®
• Complete at least six years of surgical training following medical school with a minimum of three years of plastic surgery residency training
• Pass comprehensive oral and written exams
• Graduate from an accredited medical school
• Complete continuing medical education, including patient safety, each year
• Perform surgery in accredited, state-licensed, or Medicare-certified surgical facilities

Do not be confused by other official sounding boards and certifications.

The ABPS is recognized by the American Board of Medical Specialties (ABMS), which has approved medical specialty boards since 1934. There is no ABMS recognized certifying board with “cosmetic surgery” in its name.

By choosing a member of the American Society of Plastic Surgeons, you can be assured that you are choosing a qualified, highly trained plastic surgeon who is board-certified by the ABPS or The Royal College of Physicians and Surgeons of Canada.