Surgery Overview

Breast enlargement is surgery to make the breasts bigger and improve their shape. This surgery may also be called breast augmentation or augmentation mammoplasty. During breast enlargement, the surgeon places an implant in the breast. An
implant is a soft silicone shell filled with silicone gel or saline (salt water).

To position
the implant, the surgeon makes a cut (incision) in the bottom crease of the breast, in the
armpit, or along the lower edge of the areola. (The areola is the colored area around the
nipple). The surgeon carefully
adjusts the implant to the correct shape and position. Then the incision is closed with
stitches.

The implant may be placed under
the breast tissue or under the chest muscle beneath the breast. Some doctors
think that putting the implant under the chest muscle lowers the risk for a
problem called capsular contracture (hardening of tissue around the
implant). This placement may also interfere less with
mammography.

A breast lift may be done at the same time
as a breast enlargement. This surgery can raise sagging breasts as well as the nipple and areola. For a breast lift, the surgeon removes excess skin from the
bottom of the breast and around the areola. The remaining
skin is then brought together. This tightens and raises the breast.

A breast
lift requires a larger incision than a breast enlargement alone. The incision may
go from the areola to the crease below the breast.

Breast enlargements and lifts are usually done in a hospital or
surgery center. You will not need to stay overnight in the
hospital unless problems occur during surgery. You will probably get medicine to make you sleep during the surgery (general anesthesia). Or you might be awake and get medicine that makes the area numb (local anesthesia or epidural).

Most women who get
breast implants will need at least one more implant surgery in their
lives. Implants don’t last forever. They may need
to be removed or replaced if they leak, rupture, change
shape, or develop other problems.

Newer silicone
implants have gel in them instead of liquid. These types of
implants don’t leak if they are punctured or cut. About 1 out of 100 saline implants ruptures each
year.footnote 1

The U.S. Food and Drug Administration (FDA) recommends
having a breast
MRI 3 years after getting implants and then every 2
years after that.footnote 2 The MRI is done to check if the
implants are intact and the breast tissue looks healthy. This
testing can cost more than getting the
implants, and it may not be covered by insurance.

Also keep in mind that:

  • Breast
    implants will not keep the breasts from sagging as a result of future
    pregnancy, weight gain or loss, or aging.
  • Implants cause lasting changes in the breast
    tissue and skin. If you later have the
    implants removed, your breasts may have permanent wrinkles, dimples, or other
    changes.

Insurance will not cover the cost of breast enlargement surgery. It may not cover the
costs of treatment for problems during
or after surgery or the costs of future surgeries to remove or replace the implants.
Check with your insurance company to find out what is covered. Also ask if getting breast implants
will affect how much you pay for your insurance.

Breast cancer screening after surgery

Breast implants may cause problems during mammography.

  • Having implants may make it harder to find abnormal breast tissue or breast cancer.
  • Scarring and calcium deposits around the implant may look like
    cancerous tissue. This may make the mammogram harder to interpret.

During mammography, the breast has to be
squeezed tightly to get accurate images. In rare cases, this causes a breast implant to leak or
rupture.

Be sure to tell the person who schedules your mammogram that you have implants. The technician will need to know what type of implants you have (saline or silicone)
and whether they are behind or in front of the chest muscle. The technician may need to take more
views than during a typical screening. In some cases, MRI scans
may be needed to get a clear image.

Questions about breast implant safety

The U.S. Food and Drug Administration (FDA) reports that both saline- and silicone-filled breast implants appear to be safe.

For more information on the safety of breast implants, see the FDA’s website at www.fda.gov/breastimplants.

What To Expect After Surgery

You will have gauze over the incisions. Your breasts will be wrapped in an elastic
bandage or supported by a special bra. The stitches may be removed in 7 to 10
days.

You may have some swelling, bruising, and soreness in
your breasts for several days after the surgery. Some women also
have a burning feeling in their nipples right after surgery. Swelling and bruising may last for several weeks.

  • Wearing a
    support bra 24 hours a day can help reduce swelling while your breasts heal.
  • Your doctor may give you medicine to help with
    the pain.

You will probably be able to return to most of your normal activities within a few days. You will need to avoid heavy
lifting and strenuous exercise until your doctor says it is safe.

You will have scars after breast enlargement surgery. But they are usually in areas that are not easily seen, such
as the crease under the breast or the armpit. Scars usually fade after a few months. If you also have a breast lift, you will have larger scars that are easier to see.

Why It Is Done

This surgery is done to
make the breasts bigger and to enhance their shape. You may decide to get
breast implants:

  • If you think your breasts are too small. What is “too small” (or too large) is a personal opinion. If you are happy with the size of your breasts,
    they are not too small.
  • To restore the size or shape of the breasts
    after pregnancy or losing a lot of weight.
  • To make the breasts match better. In many women, one breast may be larger or sit higher than
    the other breast.

How Well It Works

Breast enlargement surgery can
increase your breast size by one or more bra cup sizes. It can also help your breasts match better in size and shape.

Most women who get breast implants
are satisfied with the results. You are likely to be happy with the results if
you are realistic about what you expect from the surgery. The surgeon can show you pictures of other women who got implants. This can give you a good idea about what to expect.

Risks

Breast implants may make it harder for a
mammogram to
detect breast cancer.

Other risks
include:

  • Capsular contracture. This occurs when scar tissue
    around the implant hardens and begins to squeeze the implant. Surgery may be needed to remove the scar tissue or replace the implant.
  • Loss of feeling in the nipples or breast. Often this doesn’t last very long, but sometimes it is permanent.
  • An unwanted change in the size or shape of the breasts after
    surgery.
  • Changes in the implant. Over time, the implant may harden, develop ripples, or change
    shape or position. If this happens, you may need surgery to remove the implant.

Less common risks include infection, blood under the skin (hematoma), and abnormal scarring.

The risk of problems after the
surgery is higher if you have more than one surgery at the same time, such as a
breast lift and breast enlargement.

What To Think About

For more information on the safety of breast implants, see the FDA’s website at www.fda.gov/breastimplants.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

Citations

  1. Vasconez HC, Habash A (2010). Plastic and reconstructive surgery. In GM Doherty, ed., Current Diagnosis and Treatment: Surgery, 13th ed., pp. 1092-1131. New York: McGraw-Hill.
  2. U.S. Food and Drug Administration (2006). FDA approves silicone gel-filled breast implants after in-depth evaluation: Agency requiring 10 years of patient follow-up. FDA News P06-189. Available online: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108790.htm.

Credits

ByHealthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD – Internal Medicine
Adam Husney, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Specialist Medical Reviewer Keith A. Denkler, MD – Plastic Surgery

Current as ofOctober 5, 2017