Breast Augmentation

A breast implant is a prosthesis used to change the size, shape, and contour of a woman’s breast. In reconstructive plastic surgery, breast implants can be placed to restore a natural looking breast mound for post–mastectomy breast reconstruction patients or to correct congenital defects and deformities of the chest wall. They are also used cosmetically to enhance or enlarge the appearance of the breast through breast augmentation surgery.

Breast augmentation is one of the most common cosmetic surgery procedures in the country. According to the American Society of Plastic Surgeons, 307,000 women had breast implants placed in 2011. Of course, all of these surgical cases were different and the women chose the procedure for a variety of reasons.

Breast implant surgery can be performed in a hospital, surgery center or doctor’s office. Breast implant surgery patients may have to stay overnight in the hospital (inpatient surgery) or may be able to go home afterward (outpatient surgery). The surgery can be done under local anesthesia, where the patient remains awake and only the breast is numbed to block the pain, or under general anesthesia, where medicine is given to make the patient sleep. Most women receive general anesthesia for this surgery. Breast implant surgery can last from one to several hours depending on the procedure and personal circumstances.

If the surgery is done in a hospital, the length of the hospital stay will vary based on the type of surgery, the development of any complications after surgery and your general health. The length of the hospital stay may also depend on the type of coverage your insurance provides.

If you are undergoing breast implant surgery for reconstruction, you will also need to speak with your surgeon about your personal circumstances, including being treated with chemotherapy and/or radiation therapy, as these can affect your risks of complication and the appearance of the reconstructed breast. The surgeon should also speak to you about the amount of breast tissue that will remain after surgery and future screening for breast implant ruptures and breast cancer.

During the consultation be sure to ask the surgeon for a copy of the patient labeling for the breast implant s/he plans to use. You have the right to request this information, and your physician is expected to provide it. Be sure to read the patient labeling entirely prior to surgery. It will provide you with information specific to your breast implants, including how to take care of them. Make sure you read and understand the informed consent form before you sign it.

Breast implant manufacturers are currently conducting clinical studies to evaluate new types of breast implants and to understand the long term experiences of women who receive breast implants. If you are interested in participating in a clinical study, be sure to ask your surgeon what specific steps you will need to take.

Once you have been given anesthesia and it has taken effect, the surgeon will make an incision (cut) in one of the following areas:

  • along the underside of your breast (inframammary)
  • under your arm (transaxillary)
  • around the nipple (periareolar)
  • through the mastectomy scar (for reconstruction)
  • The FDA-approved labeling warns surgeons NOT to place breast implants through the belly-button (peri-umbilical approach). The location of the incision can affect how visible the scars are, as well as any complications you may experience after surgery.

Cutting the underside of the breast is the most common location used since it is where the skin naturally folds. Your scarring with this type of incision may be a bit more visible, especially if you are younger, thin and have not yet had children.

Placing the implant through an incision under the arm will likely require your surgeon to use an endoscope, a tool with a camera and other surgical instruments inserted into the incision site to help the surgeon guide the implant into place. While there will likely be no visible scar around your breast, you may have a scar on the underside of your arm.

Cutting around the edge of the nipple (areola) may cause problems with loss or change of sensation in the nipple.

The surgeon will place the implant above (subglandular) or below (submuscular) the chest wall muscles. Be sure to discuss the pros and cons of the implant placement selected for you with your surgeon prior to surgery.

If you are getting silicone-gel filled implants they will already be filled with silicone gel when inserted. If you are getting saline-filled implants and the implant is not pre-filled, the surgeon will insert the silicone shell and then fill the implant to the desired level with saline.

The incision is then closed with stitches.  .After surgery you will be taken to a recovery area to be monitored. Your breasts will be wrapped in gauze or a surgical bra. Your surgeon should describe the usual after surgery (postoperative) recovery process, the possible complications that may occur, and the recovery period. Following the operation, as with any surgery, you can expect some pain, swelling, bruising and tenderness. These effects may last for a month or longer, but should disappear with time. Scarring is a natural result of surgery. Prior to surgery, ask your surgeon to describe the location, size and appearance of any expected scars. For most women, scars will fade over time into thin lines. The darker your skin, the more prominent the scars are likely to be.

Your surgeon may prescribe medications for pain and/or nausea. If you experience bleeding, fever, warmth, redness of the breast, or other symptoms of infection, you should immediately report these symptoms to your surgeon. Your surgeon should tell you about wound healing and how to care for your wound.

You may need a postoperative bra, compression bandage or jogging bra for extra support as you heal. At your surgeon’s recommendation you will most likely be able to return to work within one to two weeks, but you should avoid any strenuous activities that could raise your pulse and blood pressure for at least two weeks.

Ask your surgeon about a schedule for follow-up visits, limits on your activities, precautions you should take, and when you can return to your normal activities, including exercising. If you received silicone gel-filled breast implants, the FDA recommends that you receive MRI screening for silent rupture 3 years after receiving your implant and every 2 years after that.

Continue to get mammograms to screen for breast cancer. Be sure to tell the person giving your mammogram that you have breast implants. Breast implants may make it difficult to see breast tissue on standard mammograms, so they may need to use different techniques.

If you are enrolled in a clinical study, be sure to ask your surgeon for a schedule of follow-up examinations set by the study plan.