Breast Augmentation

Breast augmentation — also known as augmentation mammoplasty — is surgery to increase breast size. It involves placing breast implants under breast tissue or chest muscles.

For some women, breast augmentation is a way to feel more confident. For others, it's part of rebuilding the breast for various conditions.

If you're considering breast augmentation, talk to a plastic surgeon. Make sure you understand what surgery involves, including possible risks, complications and follow-up care.

Why it's done

Breast augmentation might help you:

  • Enhance your appearance if you think your breasts are small or that one is smaller than the other and this impacts how you dress or the type of bra needed to help with the asymmetry
  • Adjust for a reduction in the size of your breasts after pregnancy or significant weight loss
  • Correct uneven breasts after breast surgery for other conditions
  • Improve your self-confidence

Discuss your goals with your plastic surgeon so that you can be realistic about what breast augmentation can do for you.

Results

Breast augmentation can change the size and shape of your breasts. The surgery might improve your body image and self-esteem. But keep your expectations realistic, and don't expect perfection. Also, your breasts will continue to age after augmentation. Weight gain or weight loss might change the way your breasts look, too. If you become dissatisfied with the appearance of your breasts, you might need more surgery to correct these issues.

How you prepare

You'll consult with a plastic surgeon about your preferences for size, feel and appearance of your breasts. The surgeon will describe specific types of implants — smooth or textured, round or shaped like a teardrop, saline or silicone — as well as options for surgical techniques.

Carefully review written information, such as the patient information from the manufacturer of the implant you'll be getting, and keep copies for your records.

Before you decide to have surgery, consider the following:

  • Breast implants won't prevent your breasts from sagging. Your plastic surgeon may recommend a breast lift in addition to breast augmentation to correct sagging breasts.
  • Breast implants aren't guaranteed to last a lifetime. The average life span of an implant is about 10 years. Implant rupture is a possibility. Also, your breasts will continue to age, and factors such as weight gain or weight loss might change the way your breasts look. These issues will likely lead to more surgery.
  • Mammograms might be more complicated. If you have breast implants, in addition to routine mammograms, you'll need additional, specialized views.
  • Breast implants might hamper breast-feeding. Some women are able to successfully breast-feed after breast augmentation. For others, however, breast-feeding is a challenge.
  • Insurance doesn't cover breast implants. Unless it's medically necessary — such as after a mastectomy for breast cancer — breast augmentation isn't covered by insurance. Be prepared to handle the expenses, including related surgeries or future imaging tests.
  • You might need additional surgery after breast implant removal. If you decide to have your implants removed, you might need a breast lift or other corrective surgery to help restore your breasts' appearance.
  • Screening for silicone implant rupture is recommended. The FDA recommends routine monitoring with a breast MRI five to six years after placement to screen for silicone breast implant rupture. Then, a breast MRI is recommended every two to three years. An ultrasound may be an alternative screening method — unless you have symptoms. Talk to your plastic surgeon about the specific type of imaging needed for routine monitoring of your implants.

You might need a baseline mammogram before your surgery. Your doctor might adjust certain medications before the surgery as well. For example, it's important to avoid aspirin or other medications that can increase bleeding.

If you smoke, your surgeon will ask you to stop smoking for a time ― about four to six weeks ― before and after the surgery.

Arrange for someone to drive you home after the surgery and to stay with you for at least the first night.

Risks

Breast augmentation poses various risks, including:

  • Scar tissue that distorts the shape of the breast implant (capsular contracture)
  • Breast pain
  • Infection
  • Changes in nipple and breast sensation
  • Implant position changes
  • Implant leakage or rupture

Correcting these complications might require more surgery, to either remove or replace the implants.

During the surgery

To insert the breast implant, your plastic surgeon will make a single cut (incision) in one of three places:

  • The crease under your breast (inframammary)
  • Under your arm (axillary)
  • Around your nipple (periareolar)

After making an incision, the surgeon will separate your breast tissue from the muscles and connective tissue of your chest. This creates a pocket either behind or in front of the outermost muscle of the chest wall (pectoral muscle). The surgeon will insert the implant into this pocket and center it behind your nipple.

Saline implants are inserted empty and then filled with sterile salt water once they're in place. Silicone implants are pre-filled with silicone gel.

When the implant is in place, the surgeon will close the incision — typically with stitches (sutures) — and bandage it with skin adhesive and surgical tape.

After the procedure

Soreness and swelling are likely for a few weeks after surgery. Bruising is possible, too. Expect scars to fade over time but not disappear completely.

While you're healing, it might help to wear a compression bandage or sports bra for extra support and positioning of the breast implants. Your surgeon might prescribe pain medication as well.

Follow your surgeon's instructions about returning to regular activities. If you don't have a physically demanding job, you might be able to return to work within a few weeks. Avoid strenuous activities — anything that could raise your pulse or blood pressure — for at least two weeks. While you're healing, remember that your breasts will be sensitive to physical contact or jarring movements.

If your surgeon used sutures that don't absorb on their own or placed drainage tubes near your breasts, you'll need a follow-up appointment for removal.

If you notice warmth and redness in your breast or you have a fever, you might have an infection. Contact your surgeon as soon as possible. Also contact your surgeon if you have shortness of breath or chest pain.

Before - After 

Frequently Asked Questions 

Who is a candidate for breast augmentation?

To be a candidate for breast augmentation, you need to be physically healthy and have a good idea that breast implants will enhance the appearance of your body. Breast implants should not be sought to please someone else such as a spouse or a boyfriend or as a “quick fix” for other issues.

The best candidates typically are women who over a long period of time have had a desire to increase the size of their breasts to improve the shape of their body, fit better in a dress and clothing styles and otherwise to better proportion their body. Good candidates also are women who may have delivered and breastfed one or multiple children and have had significant changes in the shape, size and appearance of their breasts as a result.

Contrary to popular opinion, most women seeking breast augmentation live ordinary, everyday lives and otherwise work as householders, secretaries, teachers, professionals, mothers, nurses, lawyers, flight attendants, doctors, etc.

Who should not have a breast augmentation?

A woman should not have a breast augmentation to please someone else or to save an otherwise failing relationship. Implants should be placed only for her own self-image, not a perceived image that she has of someone else.

Should I wait to have a breast augmentation until after childbirth?

The decision to have a procedure is a personal one. There is never a “right” or a “wrong” time. A woman may enjoy the results of an augmentation prior to her decision to have a family. Breast augmentation will be unlikely to change the ability to breastfeed a baby. However, there is a slight risk that sensation could decrease following augmentation and may possibly interfere with the reflexes required for breastfeeding.

Breasts, whether they are augmented or not, will often lose volume and fall after the increase and subsequent decrease in size after childbirth and breast feeding. This volume loss may occur due to natural hormonal changes and may occur whether or not a woman actually breastfeeds her baby.

What are the different types of breast implant incisions and which one should I have?

The placement of incision for breast augmentation is highly individual and falls into four categories:

  • Underneath the breast in the breast fold.
  • Around the nipple and areola.
  • In the axilla (armpit).
  • Through the bellybutton.

This is a very frequently asked question from women who have never had breast implants, and they tend to worry quite a lot about where the incisions will be. However, it is extremely unusual for any woman to have issues or complaints with the appearance or location of the incisions after the surgery is completed and the incisions have healed.

Most breast implants placed in the United States are placed through an incision around the nipple or underneath the breast. The advantage of these approaches are that the position of the breast tissue in relation to the breast muscle and implant can be better and more accurately shaped from these approaches. This can allow a “dual plane” procedure to be performed where the implant is partially or mostly placed underneath the muscle with only a small amount of exposure underneath the breast tissue itself. This provides for a greater chance of a better result and a more natural appearing augmented breast. These approaches are also hidden in even a very tiny bikini as they are placed underneath the standard bikini lines.

The axillary (armpit) approach is used by some surgeons. It is more difficult to shape the breast tissue from this and implants tend to sit higher in the chest and take longer to come down to the proper position lower in the breast on the chest wall. These incisions typically also heal quite well, although they may be visible in a bikini or tank top.

A bellybutton (umbilical) incision has also been touted by some surgeons as a new way to “keep an incision off the breasts.” Special instrumentation is required and a long tunnel is made underneath the skin to place the implant in the breast. This approach carries significant disadvantages, including the fact that only saline and not silicone implants can be placed through this approach. It is also much more difficult to place an implant underneath the muscle using this approach and it is much more difficult to release the pectoralis (chest wall) muscle properly for optimal implant placement, especially without lifting or tearing the muscle.

Will breast implants interfere with a mammography?

Breast implants may interfere with mammography readings in some patients, primarily those that have implants which are placed subglandularly (above the muscle). However, this obstruction is greatly reduced with submuscular implants (behind the muscle). This is a very important issue for a woman with a strong family history of breast cancer.

What is the recovery time following surgery?

Recovery times for breast augmentation vary considerably, however most of Dr. Granzow’s patients return to the majority of their normal activities 48 to 72 hours after surgery. Dr. Granzow will discuss this in further detail with you at your first consultation.

Will breast implants interfere with physical activities?

In the long term, breast implants are unlikely to affect range of motion, muscle strength or other physical abilities.

What size breast implants should I get?

The size of implants you choose depends on a number of factors, including your ultimate appearance goals and your individual frame. Just as the same bra or even a T-shirt may fit different individuals completely differently according to their chest size and shape, the same size implant may look completely different from patient to patient. During the consultation the implant size and placement will be carefully chosen to fit each patient individually.

Do my breast implants need to be replaced every 10 years?

Breast implants do not need to be replaced after 10 years or any other specific time period. Although the exact source of this statement is uncertain, this is a myth possibly related to the fact that some models of older implants carried warranties which lasted only 10 years.

What are “gummy bear” breast implants?

“Gummy bear implants” is a term often heard to describe silicone gel implants which are firmer than average and hold their shape more closely. The implication is that some current breast implants do not hold their shape. In fact, all silicone breast imlpants currently sold in the USA are contain some form of cohesive silicone. This means that a current US silicone implant which is cut in halfon a table will still hold most of its original form without the silicone material inside simply running out. The material inside has the consistency more of a “gummy snake” than, for example, maple syrup. Implants containing such syrup-like liquid silicone are no longer sold in the USA. Both silicone and saline implants may leak, although this is unlikely.

Are silicone implants safe?

Properly performed studies reported in the medical literature have failed to show any differences between the safety of silicone filled and saline filled breast implants.

Is there a chance that I might lose sensation in my nipple after breast augmentation?

The chance of losing nipple sensation, or sensitivity, after breast augmentation is present but it is quite low. Overall, the chance of losing sensation in one or the other nipple is several percent.

Can a sagging breast be “lifted” with placement of a breast implant?

Most breasts will be “lifted” at least moderately with the placement of a breast implant. The degree to which this happens is quite variable and depends mostly on the individual characteristics and stretch of a woman’s skin and the size of the implant that’s placed. Dr. Barış Çin will review these questions carefully with you during the consultation.