Breast augmentation, or augmentation mammoplasty, or is a surgical procedure that aims to increase the size, shape, or fullness of the breast.
The surgeon places silicone, saline, or alternative composite breast implants under the chest muscles or breast tissue. Implants last from 7 to 12 years on average.
The American Society of Plastic Surgeons (ASPS) note that in 2015, there were 279,143 breast augmentations procedures in the United States.
This was 2 percent lower than the previous year but 31 percent higher than in 2000.
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 or breasts after surgery
Plastic surgery includes reconstructive surgery and cosmetic surgery.
Reconstructive breast surgery may be done as a part of the treatment for breast cancer. Cosmetic breast surgery is done for esthetic purposes. Breast augmentation is normally cosmetic surgery.
In 2007, a study by researchers from the University of Florida found that breast enlargement through cosmetic surgery boosts women's self-esteem and their feelings about their sexuality. The results were reported in Plastic Surgery Nursing.
A breast implant is a medical prosthesis that is placed inside the breast to augment, reconstruct, or create the physical form of the breast.
There are three main types of breast implants:
Saline implants are filled with a sterile saline solution, like salt water. The solution is held within an elastomer silicone shell. These implants can be filled with different amounts of saline solution. This affects the feel, firmness, and shape of the breast.
If a saline implant leaks, the solution will be absorbed and expelled by the body naturally.
Silicone gel-filled implants consist of a silicone outer shell filled with a silicone gel. 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 may or may not collapse.
Patients choosing this type of implant should carry out more regular checks with their doctor compared with those on saline solution implants. An MRI or ultrasound scan can check the condition of the implants.
Alternative composite implants may be filled with polypropylene string, soy oil, or some other material.
Breast augmentation is a type of surgery, so patients need to think carefully before opting for the procedure.
Before surgery, the surgeon should help the patient choose the size of the implant needed. This may be done by putting different sized implants into a bra, to see how they feel.
A general anesthetic is normally used, so that the patient is asleep during surgery. Sometimes local anesthetic is used, and the patient is awake.
The surgeon and patient should discuss incision options.
The following options are possible:
- Inframmammary incision, done in the crease under the breast
- Transaxillary incision, in the armpit
- Periareolar incision, around the nipple
The choice of incision depends on several factors, including how much enlargement is involved, the patient's anatomy, the type of implant, and surgeon-patient preference.
Inserting and placing implant
The breast implant is inserted into a pocket.
There are two types of placement:
A submuscular placement goes under the pectoral muscle. Recovery may take longer, and there may be more pain after the operation.
A submammary, or subglandular, placement goes behind the breast tissue, over the pectoral muscle.
Closing the incisions
The surgeon closes the incisions with layered sutures, or stitches, in the breast tissue. Stitches, skin adhesives, and surgical tape close the skin and keep it closed.
At first, the incision lines will be visible, but these will fade with time.
Assessing the results
Surgery will leave some swelling, but this should resolve within two of weeks. The incision lines will also fade. After this, the patient will be able to decide whether the procedure met her expectations.
As the anesthetic wears off, the patient will be given painkillers to relieve the pain.
After a general anesthesia, the patient will not be able to drive. They should arrange for a friend to take them home.
Absorbable, or dissolvable, sutures usually disappear within 6 weeks.
If the patient has sutures that do not dissolve, or if drainage tubes are placed near the breasts, a follow-up appointment will be necessary to remove them.
The medical team should provide the following information:
- How to care for the breasts after the procedure
- How to use the prescribed medications
- When to attend a follow-up visit
- When to call the doctor
The patient should seek medical help immediately if they experience:
- any sign of infection, such as fever, or warmth and redness in the breast area
- chest pains, unusual heart beats, or shortness of breath
The patient should not engage in strenuous physical activities for about 6 weeks.
The doctor may advise about some post-operative exercises, such as flexing and moving the arms, to relieve pain and discomfort, and also what type of bra to wear.
Every surgical procedure has risks.
Among patients who undergo breast reconstruction, 46 percent of women with silicone gel implants and 21 percent of those with saline implants had at least one additional operation within 3 years.
Eight percent of women with saline implants and 25 percent of those with silicone implants had surgery to remove the devices.
Nearly 50 percent of those having cosmetic breast augmentation experience some kind of complication, for example, pain, hardening, infection, or the need for additional surgery.
Some of the risks and complications associated with breast augmentation are:
- Painful breasts
- Sensation in the breast, the nipples, or both, may change temporarily
- Rupturing or leaking of the implant
- Fluid accumulation
Capsular contracture refers to a hardening of the area around the implant. It can distort the shape of the implant, and it can cause pain.
The scars may become red, thick, and painful. Sometimes they require further surgery.
Implants and breast cancer
The U.S. Food and Drug Administration (FDA) have been investigating reports that women with saline and silicone gas-filled breast implants have a higher risk of developing anaplastic large cell lymphoma.
In Australia, say the FDA, there have been 46 confirmed cases of this rare type of cancer and 3 fatalities. The data suggests that the risk of developing this type of cancer ranges from 1 in 1,000 to 1 in 10,000 women with breast implants. According to the Australian government, 23 cases were reported between 2011 and 2016.
Can I still breastfeed with implants
There have been concerns that breast augmentation may affect a woman's ability to breastfeed.
The Institute of Medicine (IOM) state that women who have had breast implants are three times as likely as other women to have an inadequate milk supply for nursing.
Regarding the safety of breast milk, the Centers for Disease Control and Prevention (CDC) have not updated information published in 2009 stating that there is "insufficient evidence to justify classifying silicone implants as a contraindication to breastfeeding."
However, some infants born to and nursed by women who had implants were found to have higher levels of toxins in their blood compared with siblings born before the implants.
There is some concern that toxins may lead to neurological symptoms in women, possibly leading to problems with thinking and memory.
The skin on the breast above the implant can become rippled or wrinkled, especially in very slim women or those who suddenly lose a lot of weight.
If a woman chooses to remove the implants, her breasts may look less attractive than they did before surgery. If the implants rupture, removal surgery can mean a loss of breast tissue.
Breast augmentation surgery can be expensive. The ASPS note that in 2015, the average cost was $3,822, and the cost for implant removal was $2,380. Women whose implants wear out will also need to consider the cost of replacement.
Choosing a surgeon
It is important to choose a surgeon who is licensed and recognized by a competent professional plastic surgery association.
Surgeons in the U.S. should belong to a professional association.
Patients should check that a doctor:
- Has certification with the American Board of Cosmetic Surgery (ABCS) or the American Society of Plastic Surgeons (ASPS)
- Has experience and professional training in the type of surgery they need
- Works only in accredited medical facilities
- Complies with a strict code of ethics
- Adheres to medical education requirements, including standards and innovations in patient safety
The ASPS points out that as awareness of other options grows, fewer women may opt for breast augmentation. Between 2000 and 2015, for example, the number of breast lifts increased by 89 percent, from 52,836 to 99,614.