Breast Augmentation

Overview

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.

Main Menu:

• Initial Surgical Consultation
• Surgery
• After Surgery
• Side Effects
• Nursing After Breast Augmentation
• Additional Resources and References

Initial Surgical Consultation

Image of breast implant courtesy of Mentor Corporation

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.

Surgery

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.

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