Augmentation mammoplasty, or breast augmentation is a surgical procedure to increase the size, shape or fullness of a woman's breasts. The surgeon places silicone, saline or alternative composite breast implants under the chest muscles or breast tissue.
Breast augmentation is done to:
- Enlarge breasts that are naturally small.
- Restore breast size and shape after pregnancy, weight loss or breastfeeding.
- Restore symmetry when the breasts are asymmetrical
- Restore the breast(s) after surgery as treatment for breast cancer or some other condition or event that affected the size and shape of the breast.
Breast enlargement boosts self-esteem - women usually experience a significant boost in self-esteem and positive feelings about their sexuality after undergoing breast enlargement, researchers from the University of Florida reported in Plastic Surgery Nursing.
The authors emphasized that although plastic surgery is not a panacea for feelings of sexual attractiveness or self-worth, it is important for health-care professionals to understand the psychological benefits of these procedures.
Study leader, Prof. Cynthia Figueroa-Haas, said "Many individuals, including health-care providers, have preconceived negative ideas about those who elect to have plastic surgery, without fully understanding the benefits that may occur from these procedures."
According to an article published in Plastic and Reconstructive Surgery (May 2013 issue), 98% of women who underwent breast augmentation surgery said the results met their expectations. Dr. Eric Swanson, a plastic surgeon who conducted the prospective outcome study, added that women also reported improvements in quality of life and self-esteem after their procedure.
Dr. Swanson reported that the average patient was 34 years old, and most opted for the 390 cc saline-filled breast plant under the muscle.
The study, involving 225 women who were followed for five years, found that:
- Patients said they were "back to normal" within 25 days of their surgery
- 85% said their new breast size was "just right"
- 13% said a larger size would have been better
- Less than 2% would have preferred a smaller size
- 1% were not happy with their scars, which are usually in the crease under the breast
- 75% thought their breast firmness was "just right"
- 98% said their results met with their expectations
According to the American Society of Plastic Surgeons, there were 307,190 breast augmentations procedures in the USA in 2011, as well as 22,271 breast implant removals.
Women with breast implants can still breastfeed - no part of the implant gets into the breast milk.
What are breast implants?
A breast implant is a medical prosthesis that is placed inside the breast to augment, reconstruct or create the physical form of the breast.
The outer layer of breast implants is made of firm silicone. The inside of the implant is filled either with salt water (saline solution), silicone gel, or a composite of alternative substances. Makers of breast implants say they should last for at least ten years.
There are three main types of breast implants:
- Saline implants - filled with a sterile saline solution (biological-concentration salt water 0.90% w/v of NaCl, ca. 300 mOsm/L.) which is held within an elastomer silicone shell. These implants can be filled with different amounts of saline solution, which may affect the feel, firmness and shape of the breast.
If this type of implant leaks, the solution will be absorbed and expelled by the body naturally.
- Silicone implants - filled with a viscous silicone gel which is held within an elastomer silicone shell.
If a silicone-filled implant leaks, the gel will either stay in the shell or escape into the breast implant pocket. A leaking silicone-filled implant might not collapse. Patients choosing this type of implant should carry out more regular checks with their doctor compared to those on saline solution implants. The condition of the implants can be determined with an MRI or ultrasound scan.
Although the US FDA recommends regular follow-up MRI scans for women with silicone implants, a study published in Plastic and Reconstructive Surgery (March 2011 issue) says there are significant flaws supporting this recommendation. The authors wonder how effective MRI screening is for women with silicone implants.
There are five generations of this type of implant. The latest one is made of a semi-solid gel that has virtually completely eliminated silicone gel bleed (filler leakage) and silicone migration from the breast to other parts of the body, according to manufacturers.
- Alternative composite implants - these may be filled with polypropylene string, soy oil or some other material.
What happens during the breast augmentation procedure?
The patient may have a choice of general or local anesthesia. Under local anesthesia the patient is awake and only the surgical area is numbed. However, in most cases the procedure is done under general anesthesia.
The surgeon and patient should discuss incision options. The doctor should explain which are most suitable for the patient and her desired outcome.
The following incision options are possible:
- Inframmammary incision - in the crease under the breast.
- Transaxillary incision - in the armpit (axilla)
- Periareolar incision - around the nipple
The choice of which incision to use depends on several factors, including the degree of enlargement, the patient's anatomy, the type of implant, and surgeon-patient preference.
Inserting and placing the breast implant
The breast implant is inserted into a pocket. Today, there is a choice between two types of placements:
- A submuscular placement - under the pectoral muscle. When placed here the patient may take slightly longer to recover, compared to subglandular placement, and may also experience a little more post-operative pain.
- A submammary (subglandular) placement - behind the breast tissue, over the pectoral muscle.
Techniques used today for placing breast implants have significantly improved recovery times.
Dr. Lucian Ion talks about some basic principles behind choosing placement of the breast implants:
The incisions are closed
The surgeon closes the incisions with layered sutures (stitches) in the breast tissue, and with skin adhesives, sutures and surgical tape to close the skin and keep it closed.
Initially, there will be evident incision lines. These will fade with time.
View the results
Breast augmentation results are visibly evident straight away. There will be some swelling caused by the surgery, which will resolve within a couple of weeks. As the swelling dies down and the incision lines fade, the patient will have a better idea of whether the procedure met her expectations.
Recovering after the breast augmentation procedure
As the anesthetic wears off, the patient will be given painkillers to relieve the pain.
Nobody should drive immediately after anesthesia, because it affects coordinating and reasoning skills for at least 24 hours. Ideally, the patient should have a relative or friend stay with them for a day if they go home soon after the operation.
In most cases, the woman should not engage in strenuous physical activities for about six weeks. She will probably be encouraged to do some post-operative exercises, such as flex and move her arms to relieve pain and discomfort.
Thanks to more advanced techniques today, including submuscular and subglandular placements, recovery times have improved considerably.
It is important to follow the surgeon's advice regarding what type of bra to wear, and when to wear it.
If the surgeon used sutures that do not dissolve, or placed drainage tubes near the breasts, the patient will need a follow-up appointment to have them removed.
Absorbable (dissolvable) sutures usually disappear within six weeks.
If there is any sign of infection, such as fever, or warmth and redness in the breast area, the surgeon or his/her nurse should be contacted immediately. If the patient experiences chest pains, unusual heart beats, or shortness of breath, the surgeon needs to be told straight away.
The patient should have received the following instructions from her medical team
- How to care for her breasts after the procedure
- How to use the medications which have been prescribed
- When to come for a follow-up visit
- When to call the doctor
The patient should have asked the following questions before the surgery:
- After my surgery is complete, where will I be taken?
- What medications will I be given and which do I need to buy after the procedure?
- What dressings or bandages will I have after the surgery?
- When will the dressing/bandages be removed?
- When is my follow-up appointment?
- When can I exercise?
- When can I go back to work, or resume my normal activities?
Women whose implants were inserted beneath the chest muscles (submuscular placement) will take longer to recover, and will also experience slightly more pain, because of the healing of the incisions to the chest muscles.
What are the risks and complications linked to breast augmentation?
Every surgical procedure has risks, and breast enlargement is no exception. A good surgeon will explain all the risks to the patient.
Below are some of the risks and complications associated with breast augmentation:
- Capsular contracture - hardening of the area around the implant, this can distort the shape of the implant, and can also cause pain
- Painful breasts
- Nipple and/or breast sensation may change - this is nearly always temporary
- The implant ruptures or leaks
- Fluid Accumulation
- Anaplastic large cell lymphoma (ALCL) - the US FDA (Food and Drug Administration) carried out a review in 2011 which found that women with saline and silicone gas-filled breast implants have a higher risk of developing anaplastic large cell lymphoma.
- The FDA reported in 2011 that 20% of women who received silicone gel-filled breast implants had to have them removed within ten years.
- There is a risk that the scars become red and thick, as well as painful. Sometimes they require further surgery.
- The skin on the breast above where the implant is can become wrinkly or with ripples. Very thin women, or those who suddenly lose a lot of weight have a higher risk.
Below is an informational video from the American Society of Plastic Surgeons about breast augmentation
Questions to ask the surgeon
In order to be fully informed, and also for the surgeon to completely understand the needs of the patient, you should make a list of questions. Tick each one off as the surgeon answers them.
Below are examples of some questions you could ask regarding breast augmentation:
- Are you a certified/licensed plastic surgeon. In the USA the surgeon should be certified by the American Board of Plastic Surgery.
- Have you been specifically trained in plastic surgery?
- What is your experience in plastic surgery? How long have you been doing it for?
- How many procedures do you perform each month?
- On average, how many revisions of your work do you perform?
- Have patients sued you?
- Do you have hospital privileges to carry out this procedure? If so, where?
- Do you consider that I am a good candidate for this procedure?
- What do I have to do in order to achieve the best results?
- Where will the surgery take place?
- How will you do the surgery?
- Is the place where the surgery will take place equipped to deal with emergencies?
- What do you recommend for me, regarding placement site, incision site, surface texturing, size and shape?
- How long will it take me to recover?
- Will I need help during my recovery? If so, what kind?
- What are the risks and complications linked to breast augmentations?
- What happens when there is a complication? What do you do? What should I do?
- During my lifetime, how many additional procedures and/or implants will I probably have?
- If I am not happy with the results, what are my options?
- If I want the implants taken out one day without replacements, how will my breasts look?
- Could you show me before-and-after photos? Of these photos, show me one that might be a reasonable result for me.
- Should I go on a special diet before or after the procedure?
- How long should I be off work?
Choosing a surgeon you can trust is crucial
It is important that the surgeon you chose is licensed and recognized by a competent professional plastic surgery association of your country.
In the USA, the surgeon should be a member of the American Society of Plastic Surgeons (ASPS). Go to this web page to Find an ASPS certified plastic surgeon.
You will then be sure that he/she:
- Has done five years of surgical training, which includes at least two years in plastic surgery.
- Has experience and professional training in all plastic surgery procedures, including face, body and breast reconstruction.
- Works only in accredited medical facilities
- Complies with a strict code of ethics
- Adheres to medical education requirements, which include standards and innovations in patient safety
- Is certified by The American Board of Plastic Surgery
If you are in the UK, you should seek out a plastic surgeon certified by The British Association of Aesthetic Plastic Surgeons. Go to this web page "Aesthetic Plastic Surgeon by Region".
The Canadian Society for Aesthetic Plastic Surgery is the only recognized professional body of Canadian plastic surgeons. Click here to find a CSAPS member near your area.
The Australian Society of Plastic Surgeons Inc (ASPS) is the peak body for Specialist Plastic Surgeons (both reconstructive and cosmetic). Click here to find an accredited plastic surgeon in your area.