Breast Augmentation

What is breast augmentation?

Breast augmentation is a common surgical procedure that increases the size and shape of your breasts. Your breasts can be augmented using breast implants or fat transfer.

What are the different kinds of breast augmentation?

There are two main types of breast augmentation: breast implants and fat transfer augmentation. Within those two categories, there are multiple different options based on how you want your breasts to look and feel. Certain breast implants are only FDA-approved for certain ages. It’s important to fully research and know the pros and cons of each option and to talk to a board-certified plastic surgeon before opting for breast augmentation.

Breast implants are the most common type of breast augmentation. Breast implant options include:

• Saline breast implants: These implants are filled with sterile saline (salt water). If the implant were to break inside your breast, your body will absorb the saline and naturally get rid of it.
• Structured saline breast implants: These implants are filled with sterile saline (salt water) and have an inner structure that helps the implant feel more natural.
• Silicone breast implants: These implants are made of silicone gel. If the implant were to break, the gel could stay within its shell or leak into your breast. If you get silicone implants, you may have to see your plastic surgeon regularly to make sure your implants are working properly.
• Form-stable breast implants: These implants are often called gummy bear breast implants because they keep their shape even if the implant shell breaks. They are made of a thicker silicone gel and are firmer than traditional implants. Form-stable breast implants require a longer surgery incision in your skin.
• Round breast implants: These implants usually make breasts look fuller. Since the implants are round all over, they don’t typically change the look of your breast if they rotate out of place.
• Smooth breast implants: These implants feel the softest of all the different kinds of implants. Smooth breast implants usually make breast movement look more natural than other implants.
• Textured breast implants: These implants create scar tissue to adhere to the implant, which makes them less likely to move around inside of your breast. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), though rare, occurs most frequently in people who have breast implants with textured surfaces.

Fat transfer breast augmentation: In a fat transfer breast augmentation, your surgeon will use liposuction to take fat from another area of your body and then inject that fat into your breasts. This type of augmentation is usually for people who want a relatively small increase in their breast size. In most cases, your surgeon will take fat tissue from one of the following areas:

• Your belly.
• Your flanks (the sides and lower back of your abdomen).
• Your back.
• Your thighs.

Why do people get breast augmentations?

There are many reasons you may want or choose to undergo breast augmentation surgery, including:

• To change the appearance of your breasts if you think they are small.
• To change the symmetry of your breasts if one is smaller than the other.
• To account for a decrease in your breast size after pregnancy or significant weight loss.
• To correct any unevenness or issues with your breasts after breast surgery for other conditions.
• To improve your confidence and self-esteem.

How common are breast augmentations?

Breast augmentation is the most popular type of cosmetic surgery. Every year, around 300,000 people have breast augmentation surgery in the United States.

What happens at a consultation for breast augmentation?

Before you undergo breast augmentation, you'll meet with your plastic surgeon. You should prepare for this consultation by thinking about what you want to change about your breasts. Remember, you're not seeking perfection, but improvement. Also, be sure that you're in good mental and physical health, overall, and that you have realistic expectations.

Your surgeon will ask you detailed questions about your medical history, including:

• What medications you are taking.
• What allergies you may have.
• Your smoking history.
• Prior surgeries.
• Any previous issues you've had with your breasts, including lumps, previous mammograms and any family history of breast issues.

It may be helpful to ask your surgeon the following questions during your breast augmentation consultation:

• Are you certified by the American Board of Plastic Surgery?
• How many years have you been a plastic surgeon?
• How often do you perform breast augmentations?
• Can I see some of the before-and-after pictures from the augmentation surgeries you’ve performed?
• Should I get breast implants or have a fat transfer?
• What are the pros and cons of the different types of breast implants?
• Will I be able to breastfeed after breast augmentation?
• What are the risks of my type of augmentation surgery?
• What will happen if I’m not satisfied with the results of my augmentation?

How do I prepare for breast augmentation surgery?

In preparation for your breast augmentation surgery, your surgeon may have you:

• Get a blood test.
• Take certain medications or adjust your current medications.
• Stop smoking.
• Avoid certain foods or beverages.
• Avoid taking aspirin and certain anti-inflammatory drugs, since they can increase bleeding.
• Stop using recreational drugs.

It’s crucial to follow any instructions that your surgeon gives you before your surgery. Following their instructions will help the surgery go more smoothly and will help you heal properly.

You should arrange for someone to drive you home after your surgery and also have someone stay with you the first night at least. You will need to take at least three days off from work, so plan accordingly. If you have a labor-intensive job, you will likely need to take off at least three weeks of work.

Establishing a home recovery area

Before you undergo breast augmentation surgery, you should set up an area in your home for recovery. Make sure you have:

• Pain medication prescribed by your surgeon and/or acetaminophen (Tylenol®).
• Ointment or cream for incision sites (if recommended by your surgeon).
• Clean gauze to cover the incision sites.
• Plenty of loose, comfortable, button-down blouses or shirts.

What happens during breast augmentation surgery?

There are many steps involved in breast augmentation surgery. Here’s an explanation of the steps.

Anesthesia

Your surgeon will perform the surgery while you are under general anesthesia (you'll go to sleep) or through IV sedation. You and your surgeon will determine this together.

The incision

Breast augmentation can be performed in one of several ways. Your surgeon can perform the procedure:

• Via the crease under your breast (known as the inframammary fold).
• Along the edge of your areola (known as the periareolar incision).
• Via your armpit (known as a transaxillary approach).

Your surgeon will discuss these possible methods with you before your surgery, and together you will determine which approach best suits your needs.

Implant insertion

There are two different ways for your surgeon to insert the implant: under your breast tissue and in front of your muscle or behind your breast muscle (pectoral muscle). The placement of the implants depends on a few factors, including the type of implant you choose and how much you’re increasing the size of your breasts. You can discuss the benefits of each method with your surgeon and make that decision together.

Closing the incision

After your surgeon places your implants, they will stitch the incision sites together to close them. Your surgeon may also use drainage tubes. You must follow your surgeon's follow-up care instructions for the incision site. Your breasts will be covered with a gauze bandage and you may be sent home wearing a surgical bra.

What happens after breast augmentation?

Right after your breast augmentation surgery, a healthcare provider will take you to a room for observation while you wake up from the surgery. You’ll be able to leave the hospital once you’re stable enough. This usually takes around an hour.

Before you leave, your surgeon will give you specific instructions for your breast augmentation surgery recovery and schedule a follow-up appointment. Your surgeon will give you a prescription for medication to control pain, if necessary. If you have drainage tubes, your surgeon will tell you when to return to have those removed, as well as instructions as to when to remove the gauze bandages.

Your surgeon will probably remove your stitches in about one week. You should not do any heavy lifting for at least four weeks. If you are physically active in sports, it may take up to six weeks before you can return to those activities.

What are the benefits of breast augmentation?

People typically undergo breast augmentation to change the appearance of their breasts. This may help increase confidence and self-esteem.

What are the possible complications and side effects of breast augmentation?

As with any surgery, there are side effects, and you do risk certain complications. Side effects of breast augmentation surgery can include:

• Soreness and increased sensitivity in the nipple region.
• Bruising.
• Bleeding.
• Swelling.

Immediate complications of breast augmentation surgery, though rare, can include:

• Infection.
• Wound healing issues.
• Hematoma (blood collection in the surgical area).

Complications from breast augmentation surgery that might happen over time can include:

• Formation of scar tissues: This is also known as capsule contracture.
• Sagging of the implants: This can cause your breasts to droop.
• Symmastia: Symmastia happens when your breast implants trend toward the middle of your chest and can give the appearance of one continuous breast.
• Fluid around the implant: This is also known as seroma.
• Implant rupture or deflation: Implants are not designed to be life-long. You might need another procedure later on.
• Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL): This immune system cancer is very rare, but has happened in patients who have received breast implants that have rough or textured surfaces. Symptoms, such as changes in the size or shape of breasts, swelling, or lumps, may show up two to eight years after the implant surgery.

Other important considerations to take into account include:

• Breast implants are not guaranteed to last your entire life. You may need surgery in the future to replace one or both implants.
• Pregnancy, weight loss and menopause may affect the appearance of your augmented breasts.
• Breast augmentation surgery could potentially affect your ability to breastfeed.
• If you have breast augmentation you will need to perform regular examinations of your breasts to assess your health. You will also have to see your plastic surgeon regularly so they can evaluate the condition of your breast implants.

It’s very important to do your research before choosing a plastic surgeon. Only get a breast augmentation from a board-certified plastic surgeon.

Can breast implants affect cancer screenings?

Although all breast tissue is in front of the implant, breast implants can affect self-examinations. You’ll need to become familiar with examining your breast(s) with the implant in place.

Implants can also make it more difficult for a mammogram to detect the presence of cancer. However, as screening technology becomes more advanced, the issue of implants preventing the detection of cancer becomes less of an issue.

Currently, if you have breast implants, the American College of Radiology, the American Cancer Society, the American Society of Breast Imaging, and the American Society of Plastic and Reconstructive Surgeons recommend that you receive your breast examinations at a facility accredited by the American College of Radiology. Because they are capable of multiple, special views of the breasts, these facilities will be more equipped to make a proper evaluation than screening clinics, which often only screen using two basic views of the breast.

What is the recovery time for breast augmentation?

Everyone heals differently, so recovery time for breast augmentation surgery can vary depending on the type of breast augmentation you had and your overall health. On average, full recovery takes about six to eight weeks.

When can I return to work or other activities after breast augmentation?

Your plastic surgeon will give you specific instructions for your recovery plan and when you can return to physical activities. Be sure to follow them. Your surgeon will likely encourage you to slowly ease back into your normal daily routine and light exercise after the first week of your surgery. You should avoid intense or jarring physical activities such as running, horseback riding or heavy lifting until you’ve fully recovered. In most cases, surgeons recommend that people who have labor-intensive jobs should wait at least three weeks before returning to work.

When should I see my healthcare provider after a breast augmentation?

Contact your healthcare provider immediately if you’re experiencing any of the following symptoms:

• Fever.
• Abnormal discharge, such as pus, from your incision site.
• Rupture of your stitches.
• Increasing enlargement, or firmness, of one or both of your breasts that’s associated with pain and pressure.

Does insurance cover breast augmentation?

In most cases, breast augmentation is considered elective cosmetic surgery and therefore insurance carriers will not cover the procedure or any necessary follow-up visits. Your premiums for future insurance coverage may increase. Additionally, insurance might not cover the procedure should you want your implants removed in the future. Therefore, it’s important to receive your doctor's charges in writing.

However, if you are having implants put in as part of reconstructive surgery, your insurance carrier may provide coverage. It's very important that you find out well in advance of your surgery what type of coverage your carrier may provide.

Is breast augmentation reversible?

Yes, a plastic surgeon can remove your implants through breast implant removal surgery. Since breast implants aren’t guaranteed to last a lifetime, many people who’ve had breast implant surgery will need another breast implant procedure in the future. These procedures include:

• Removing the original breast implants and replacing them with new implants.
• Repositioning the existing breast implants.
• Removing the breast implants without replacing them.

Can I breastfeed with breast augmentation?

Breast augmentation surgery can affect the nerves and ducts within your breast, which could affect lactation. Breast implants that are placed below your muscle usually affect milk production less than implants that are above your muscle. Surgical incisions around your areola are more likely to cause reductions in milk production. It’s important to talk to your plastic surgeon if you’re planning on breastfeeding in the future before you get a breast augmentation.

What is the difference between breast augmentation and breast implants?

Breast implants are a type of breast augmentation, which is a surgery that increases the size and shape of your breasts. The other type of breast augmentation is fat transfer breast augmentation.

A note from Cleveland Clinic

Breast augmentations are a common cosmetic surgery and usually have high satisfaction rates. However, it’s important to consider all the risks and possible side effects of having breast augmentation surgery. Be sure to consult a board-certified plastic surgeon and discuss all of your wants, needs and concerns. Together you’ll decide on the type of augmentation and surgery that works best for you.