Breast augmentation is a procedure to change the size or shape of the breasts.

Breast augmentation; Breast implants; Implants - breast; Mammaplasty

Cosmetic breast surgery is done at an outpatient surgery clinic or in a hospital.

• Most women receive general anesthesia for this surgery. You will be asleep and pain-free.
• You may also be given medicine to relax you and local anesthesia. You will be awake and will receive medicine to numb your breast area to block pain.

There are many different ways to place breast implants:

• In the most common technique, the surgeon makes a cut (incision) on the underside of your breast, in the natural skin fold. The surgeon places the implant through this opening. Your scar may be a little more visible if you are younger, thin, and have not yet had children.
• The implant may be placed through a cut under your arm. The surgeon may perform this surgery using an endoscope. This is a tool with a camera and surgical instruments at the end. The endoscope is inserted through the cut. There will be no scar around your breast. But you may have a visible scar on the underside of your arm.
• The surgeon may make a cut around the edge of your areola. This is the darkened area around your nipple. The implant is placed through this opening. You may have more problems with breastfeeding and loss of sensation around the nipple with this method.
• A saline implant may be placed through a cut near your belly button. An endoscope is used to move the implant up to the breast area. Once in place, the implant is filled with saline.

Breast implants may be placed either directly behind the breast tissue (subglandular) or behind the outer layer of chest wall muscles (submuscular). The type of implant and implant surgery can affect:

• How much pain you have after the procedure
• The appearance of your breast
• The risk of the implant breaking or leaking in the future
• Your future mammograms

Your surgeon can help you decide which procedure is best for you.

Watch this video about: Breast lift

Breast augmentation is done to increase the size of your breasts.

A breast lift, or mastopexy, is usually done to lift sagging, loose breasts. The size of the areola can also be reduced.

Talk with a plastic surgeon if you are considering cosmetic breast surgery. Discuss how you expect to look and feel better. Keep in mind the desired result is improvement, not perfection.

Risks of any surgery are:

• Bleeding
• Infection

Risks of anesthesia are:

• Reactions to medicines
• Breathing problems, pneumonia
• Heart problems

Risks of breast surgery are:

• Difficulty breastfeeding
• Loss of feeling in the nipple area
• Small scars, usually in an area where they do not show much
• Thickened, raised scars
• Uneven position of nipples
• Different sizes or shapes of the two breasts
• Breaking or leakage of the implant
• Visible rippling of the implant
• Need for more breast surgery

It is normal for your body to create a “capsule” made up of scar tissue around your new breast implant. This helps keep the implant in place. Sometimes, this capsule becomes thickened and larger and may cause a change in the shape of your breast, hardening of breast tissue, or some pain.

Emotional risks of this surgery may include feeling that your breasts do not look perfect. Or you may be disappointed with people's reactions to your “new” breasts.

Tell your doctor or nurse:

• If you are or could be pregnant
• What medicines you are taking, including medicines, supplements, or herbs you bought without a prescription

During the days before your surgery:

• You may need mammograms or breast x-rays before surgery. The plastic surgeon will do a routine breast exam.
• Several days before surgery, you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other medicines that make it hard for your blood to clot.
• Ask your doctor which medicines you should still take on the day of surgery.
• You may need to fill prescriptions for pain medicine before surgery.
• Arrange for someone to drive you home after surgery and help you around the house for 1 or 2 a days.
• If you smoke, try to stop. Smoking can cause problems with healing. Ask your doctor or nurse for help.

On the day of the surgery:

• You will usually be asked not to drink or eat anything after the midnight before surgery.
• Take the medicines your doctor told you to take with a small sip of water.
• Wear or bring loose clothing that buttons or zips in front. And bring a soft, loose-fitting bra with no underwire.
• Arrive on time at the outpatient clinic or hospital.

You will likely go home when the anesthesia wears off and you can walk, drink water, get to the bathroom safely.

After breast augmentation surgery, a bulky gauze dressing will be wrapped around your breasts and chest. Or you might wear a surgical bra. Drainage tubes may be attached to your breasts. These will be removed within 3 days.

The surgeon may also recommend massaging the breasts starting 5 days after surgery. Massaging helps reduce hardening of the capsule that surrounds the implant. Ask your doctor first before massaging over your implants.

You are likely to have a very good outcome from breast surgery. You may feel better about your appearance and yourself. Also, any pain or skin symptoms due to the surgery will likely disappear. You may need to wear a special supportive bra for a few months to reshape your breasts.

Scars are permanent and are often more visible in the year after surgery. They may fade after this. Your surgeon will try to place the incisions so that your scars are as hidden as possible.

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McGrath MH, Pomerantz J. Plastic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 69.

Sarwer DB. The psychological aspects of cosmetic breast augmentation. Plast Reconstr Surg. 2007;120(7 Suppl 1):110S-117S. 

Strock LL. Transaxillary endoscopic silicone gel breast augmentation. Aesthet Surg J. 2010;30:745-755.