Breast enlargement is surgery to make the breasts bigger and improve their shape. This surgery may also be called breast augmentation or augmentation mammoplasty. During breast enlargement , the surgeon places an implant in the breast. An implant is a soft silicone shell filled with silicone gel or saline (salt water).
To position the implant, the surgeon makes a cut (incision) in the bottom crease of the breast, in the armpit, or along the lower edge of the areola. (The areola is the colored area around the nipple). The surgeon carefully adjusts the implant to the correct shape and position. Then the incision is closed with stitches.
The implant may be placed under the breast tissue or under the chest muscle beneath the breast. Some doctors think that putting the implant under the chest muscle lowers the risk for a problem called capsular contracture (hardening of tissue around the implant). This placement may also interfere less with mammography.
A breast lift may be done at the same time as a breast enlargement. This surgery can raise sagging breasts as well as the nipple and areola. For a breast lift, the surgeon removes excess skin from the bottom of the breast and around the areola. The remaining skin is then brought together. This tightens and raises the breast.
A breast lift requires a larger incision than a breast enlargement alone. The incision may go from the areola to the crease below the breast.
Breast enlargements and lifts are usually done in a hospital or surgery center. You will not need to stay overnight in the hospital unless problems occur during surgery. You will probably get medicine to make you sleep during the surgery (general anesthesia). Or you might be awake and get medicine that makes the area numb (local anesthesia or epidural).
What To Expect After Surgery
You will have gauze over the incisions. Your breasts will be wrapped in an elastic bandage or supported by a special bra. The stitches may be removed in 7 to 10 days.
You may have some swelling, bruising, and soreness in your breasts for several days after the surgery. Some women also have a burning feeling in their nipples right after surgery. Swelling and bruising may last for several weeks.
- Wearing a support bra 24 hours a day can help reduce swelling while your breasts heal.
- Your doctor may give you medicine to help with the pain.
You will probably be able to return to most of your normal activities within a few days. You will need to avoid heavy lifting and strenuous exercise until your doctor says it is safe.
You will have scars after breast enlargement surgery. But they are usually in areas that are not easily seen, such as the crease under the breast or the armpit. Scars usually fade after a few months. If you also have a breast lift, you will have larger scars that are easier to see.
Why It Is Done
This surgery is done to make the breasts bigger and to enhance their shape. You may decide to get breast implants:
- If you think your breasts are too small. What is "too small" (or too large) is a personal opinion. If you are happy with the size of your breasts, they are not too small.
- To restore the size or shape of the breasts after pregnancy or losing a lot of weight.
- To make the breasts match better. In many women, one breast may be larger or sit higher than the other breast.
How Well It Works
Breast enlargement surgery can increase your breast size by one or more bra cup sizes. It can also help your breasts match better in size and shape.
Most women who get breast implants are satisfied with the results. You are likely to be happy with the results if you are realistic about what you expect from the surgery. The surgeon can show you pictures of other women who got implants. This can give you a good idea about what to expect.
Other risks include:
- Capsular contracture. This occurs when scar tissue around the implant hardens and begins to squeeze the implant. Surgery may be needed to remove the scar tissue or replace the implant.
- Loss of feeling in the nipples or breast. Often this doesn't last very long, but sometimes it is permanent.
- An unwanted change in the size or shape of the breasts after surgery.
- Changes in the implant. Over time, the implant may harden, develop ripples, or change shape or position. If this happens, you may need surgery to remove the implant.
The risk of problems after the surgery is higher if you have more than one surgery at the same time, such as a breast lift and breast enlargement.
What To Think About
Most women who get breast implants will need at least one more implant surgery in their lives. Implants don't last forever. They may need to be removed or replaced if they leak, rupture, change shape, or develop other problems.
Newer silicone implants have gel in them instead of liquid. These types of implants don't leak if they are punctured or cut. About 1 out of 100 saline implants ruptures each year.1
The U.S. Food and Drug Administration (FDA) recommends having a breast MRI 3 years after getting implants and then every 2 years after that.2 The MRI is done to check if the implants are intact and the breast tissue looks healthy. This testing can cost more than getting the implants, and it may not be covered by insurance.
Also keep in mind that:
- Breast implants will not keep the breasts from sagging as a result of future pregnancy, weight gain or loss, or aging.
- Implants cause lasting changes in the breast tissue and skin. If you later have the implants removed, your breasts may have permanent wrinkles, dimples, or other changes.
Insurance will not cover the cost of breast enlargement surgery. It may not cover the costs of treatment for problems during or after surgery or the costs of future surgeries to remove or replace the implants. Check with your insurance company to find out what is covered. Also ask if getting breast implants will affect how much you pay for your insurance.
Breast cancer screening after surgery
Breast implants may cause problems during mammography.
- Having implants may make it harder to find abnormal breast tissue or breast cancer.
- Scarring and calcium deposits around the implant may look like cancerous tissue. This may make the mammogram harder to interpret.
During mammography, the breast has to be squeezed tightly to get accurate images. In rare cases, this causes a breast implant to leak or rupture.
Be sure to tell the person who schedules your mammogram that you have implants. The technician will need to know what type of implants you have (saline or silicone) and whether they are behind or in front of the chest muscle. The technician may need to take more views than during a typical screening. In some cases, MRI scans may be needed to get a clear image.
Questions about breast implant safety
A few women have had anaplastic large cell lymphoma (ALCL) that started in breast tissue near the implant. These cases are very rare, but the U.S. Food and Drug Administration (FDA) is checking for a possible link between implants and ALCL.
For more information on the safety of breast implants, see the FDA's website at www.fda.gov/breastimplants.
U.S. Food and Drug Administration (2006). FDA approves silicone gel-filled breast implants after in-depth evaluation: Agency requiring 10 years of patient follow-up. FDA News P06-189. Available online: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108790.htm.
U.S. Food and Drug Administration (2011). FDA update on the safety of silicone gel-filled breast implants. Available online: http://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/UCM260090.pdf.
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Specialist Medical ReviewerKeith A. Denkler, MD - Plastic Surgery
Current as ofJuly 10, 2015